Evidence map›Paper›PMID 30765021›Full record

SynthesisDeutsches Arzteblatt international2018

Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture.

Matthias Krause, Fabian Freudenthaler, Karl-Heinz Frosch, Andrea Achtnich, Wolf Petersen, Ralph Akoto

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Deutsches Arzteblatt international, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
54citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

54 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Trial
  6. Trial
  7. Trial
  8. The impact of a physician's recommendation and gender on informed decision making: A randomized controlled study in a simulated decision situation.Health expectations : an international journal of public participation in health care and health policy · 2021
    Trial
  9. Step-by-step insight into gait analysis: A narrative review unlocking knee biomechanics.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026
    Review
  10. Review
  11. Article
  12. Review
  13. Article
  14. Article
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  16. Sport-specific differences in ACL injury, treatment and return to sports: Football.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025
    Review
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  18. Article
  19. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Matthias KrauseDepartment of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf; Department of General Orthopedics and Center for Endoprosthetics, Schön Klinik Hamburg Eilbek; Department of Sports Orthopedics, University Hospital rechts der Isar, Technical University of Munich (TUM); Department of Orthopedics and Trauma Surgery, Martin-Luther-Hospital, Berlin; Department of Trauma and Reconstructive Surgery With Division of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Klinik St. Georg, Hamburg.
Fabian Freudenthaler
Karl-Heinz Frosch
Andrea Achtnich
Wolf Petersen
Ralph Akoto

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnterior cruciate ligament (ACL) rupture is a serious injury in patients who are typically young and athletically active, with potential long-term complica- tions including functional limitation, posttraumatic osteoarthritis of the knee, and impaired quality of life. ACL reconstruction is now considered the gold standard of treatment for regaining stability and improving knee function. Conservative treatment is an alternative.

methodsTo compare operative and conservative treatment, we reviewed pertinent publications retrieved by a systematic search in Ovid MEDLINE, the Cochrane Database of Systematic Reviews, and other databases. PROSPERO registration of the study protocol: CRD42017060462 on 31 March 2017.

results13 publications concerning a total of 1246 patients were included in the analysis; only two were reports of randomized controlled trials (RCTs). In one of the RCTs, ACL reconstruction was found to yield better functional outcomes than con- servative management. The other RCT did not reveal any harm from initial conser- vative management, although the conservative-to-operative crossover rate in this trial was 51%. The functional outcomes were heterogeneous. In six observational studies, knee function was significantly better after surgery; in seven others, it was not. Five out of nine analyses in which knee-joint stability was restored after surgery showed superior functional outcomes after ACL reconstruction compared to conser- vative management. Three studies in which no satisfactory postoperative knee-joint stability was found did not show any functional difference between surgery and conservative management.

conclusionOn the basis of RCTs published to date, it cannot be definitively con- cluded whether surgery or conservative (expectant) management of ACL rupture yields a better functional outcome. There is a trend in observational studies toward better functional outcomes after ACL reconstruction. As an average across studies, conservative treatment fails in 17.5% (± 15.5%) of patients.

Indexed as

AdolescentAdultAnterior Cruciate LigamentAnterior Cruciate Ligament InjuriesChildConservative TreatmentFemaleHumansMaleQuality of LifeRupture

Identifiers

PMID30765021
PMCPMC6381773

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.