Comparison of patellofemoral osteoarthritis between patients treated surgically or non-surgically following anterior cruciate ligament injuries: A systematic review and meta-analysis.

Abstract

We hypothesized that patients undergoing anterior cruciate ligament reconstruction (ACL-R) are more likely to develop patellofemoral osteoarthritis (PFOA) than those with an ACL injury managed non-surgically. Systematic review and Meta-analysis. A systematic literature review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies reporting PFOA assessment by radiographic or magnetic resonance imaging after ACL-R compared to non-surgical treatment of ACL injury were included. Studies involving individuals with concurrent other ligamentous or chondral injuries treated surgically were excluded to minimize bias. A total of six studies were included in the systematic review. The meta-analysis demonstrated that patients undergoing ACL-R had a significantly higher likelihood of developing PFOA compared to those who received non-surgical treatment after ACL injury (odds ratio [OR] = 2.21; 95% confidence interval [CI]: 1.13-4.35; <i>p</i> = 0.02). Patients who underwent ACL-R with bone-patellar tendon-bone (BPTB) autograft exhibited a significantly higher prevalence of PFOA than those with HT autograft (<i>p</i> < 0.01). Moreover, male patients exhibited a higher association with PFOA than females in both the ACL-R (34.38% vs. 7.77%, <i>p</i> < 0.001) and non-surgical ACL injury groups (28.13% vs. 0.97%, <i>p</i> < 0.001). ACL-R significantly increases the likelihood of PFOA compared to non-surgical ACL treatment, especially when using BPTB autografts. Male patients demonstrated a higher association with PFOA in both groups. Targeted preventive strategies, including optimized graft selection and enhanced rehabilitation protocols, are crucial for reducing the risk of PFOA following ACL-R. Level III.