SynthesisBritish journal of sports medicine2022
Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries: a living systematic review and meta-analysis.
Synthesis in British journal of sports medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled 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.
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.
Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 47 citations in OpenAlex.
- No Difference in Return-to-Sport Rate or Activity Level in People with Anterior Cruciate Ligament (ACL) Injury Managed with ACL Reconstruction or Rehabilitation Alone: A Systematic Review and Meta-Analysis.Sports medicine (Auckland, N.Z.) · 2025Pooled it
- Suture techniques in the surgical management of flexor tendon, Achilles tendon and cruciate ligament injuries: a systematic review.BMC musculoskeletal disorders · 2024Pooled it
- The applied study to improve the treatment of knee sports injuries in ultimate frisbee players based on personalized exercise prescription: a randomized controlled trial.Frontiers in public health · 2024Trial
- Factors Influencing Consultant Knee Surgeons' Decision Making in Anterior Cruciate Ligament (ACL) Injury Management in Athletes: An International Delphi Study.Sports medicine (Auckland, N.Z.) · 2026Article
- Extracellular Vesicle-Mediated Communication Between Anterior Cruciate Ligament and Bone Marrow Cells Modulates Hamstring Tenocyte Behavior and Apoptosis.The Kaohsiung journal of medical sciences · 2026Article
- Advances in Gait Alterations and Rehabilitation After Anterior Cruciate Ligament Reconstruction: Biomechanics and Emerging Technologies.Orthopaedic surgery · 2026Review
- Impact of therapeutic exercises on pain-related outcomes in patients with knee osteoarthritis: an umbrella review of 116 systematic reviews.Frontiers in pain research (Lausanne, Switzerland) · 2026Review
- Management and analysis of complications associated with all-inside technique anterior cruciate ligament reconstruction: A propensity score-matched study.Journal of experimental orthopaedics · 2026Article
- Evaluating the efficacy of extracorporeal shockwave therapy in postoperative rehabilitation after anterior cruciate ligament reconstruction: A meta-analysis.World journal of orthopedics · 2025Article
- The feasibility of conducting a randomized controlled trial that compares immediate versus optional delayed surgical repair for treatment of acute Anterior cruciate ligament injury-results of the IODA pilot trial.Pilot and feasibility studies · 2025Article
- Treatment Decision-Making for Anterior Cruciate Ligament Rupture From the Perspective of Physical Therapists in Australia: A Mixed Methods Study.Physical therapy · 2025Article
- Which patients need anterior cruciate ligament reconstruction after initial treatment with rehabilitation? A scoping review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Mechanisms and Management of Knee Anterior Cruciate Ligament Injury; A Review.The archives of bone and joint surgery · 2025Review
- Review
- Article
- Nonoperative Treatment as an Option for Isolated Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis.Orthopaedic journal of sports medicine · 2024Review
- Knee-Related Quality of Life Compared Between 20 and 35 Years After an Anterior Cruciate Ligament Injury Treated Surgically With Primary Repair or Reconstruction, or Nonsurgically.The American journal of sports medicine · 2024Article
- [Treatment of acute injury of the anterior cruciate ligament : Always only reconstruction?]Unfallchirurgie (Heidelberg, Germany) · 2024Review
- Refixation of the anterior cruciate ligament: A biomechanical analysis of suture techniques in a porcine model.Journal of experimental orthopaedics · 2024Article
- Impact of COVID-19 Era on the Anterior Cruciate Ligament Injury Rehabilitation: A Scoping Review.Journal of clinical medicine · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveCompare the effectiveness of primarily surgical versus primarily rehabilitative management for anterior cruciate ligament (ACL) rupture.
designLiving systematic review and meta-analysis. DATA SOURCES: Six databases, six trial registries and prior systematic reviews. Forward and backward citation tracking was employed. ELIGIBILITY CRITERIA: Randomised controlled trials that compared primary reconstructive surgery and primary rehabilitative treatment with or without optional reconstructive surgery. DATA SYNTHESIS: Bayesian random effects meta-analysis with empirical priors for the OR and standardised mean difference and 95% credible intervals (CrI), Cochrane RoB2, and the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence.
resultsOf 9514 records, 9 reports of three studies (320 participants in total) were included. No clinically important differences were observed at any follow-up for self-reported knee function (low to very low certainty of evidence). For radiological knee osteoarthritis, we found no effect at very low certainty of evidence in the long term (OR (95% CrI): 1.45 (0.30 to 5.17), two studies). Meniscal damage showed no effect at low certainty of evidence (OR: 0.85 (95% CI 0.45 to 1.62); one study) in the long term. No differences were observed between treatments for any other secondary outcome. Three ongoing randomised controlled trials were identified.
conclusionsThere is low to very low certainty of evidence that primary rehabilitation with optional surgical reconstruction results in similar outcome measures as early surgical reconstruction for ACL rupture. The findings challenge a historical paradigm that anatomic instability should be addressed with primary surgical stabilisation to provide optimal outcomes. PROSPERO REGISTRATION NUMBER: CRD42021256537.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.