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REVIEW ARTICLE
Year : 2019  |  Volume : 13  |  Issue : 2  |  Page : 58-65

Systematic review of recovery protocols for athletes following ACL injuries: Surgical vs. conservative treatment


1 Department of Exercise Physiology, Lakshmibai National Institute of Physical Education, Gwalior, Madhya Pradesh, India
2 Department of Health Education, Lakshmibai National Institute of Physical Education, Gwalior, Madhya Pradesh, India

Correspondence Address:
Mr. Manish Shukla
Department of Exercise Physiology, Lakshmibai National Institute of Physical Education, Gwalior, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/PJIAP.PJIAP_5_19

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Injuries to anterior cruciate ligament (ACL) are common in sports. The treatments prescribed for torn ACL are surgical reconstruction (ACLr) and conservative management. While both treatments do not offer relief from long-term osteoarthritis (OA), the choice of the best treatment for athletes remains unclear. To assess the effectiveness of surgical versus conservative treatment for treating torn ACL in sports, a literature search in PubMed, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Library Central Register of Controlled Trials was done for randomized controlled trials/quality randomized controlled trials (RCTs/QRCTs) that compared surgical reconstruction with conservative treatment of ACL rupture in active participants. Studies were assessed for quality using PEDro clinical appraisal tool. Since the studies were heterogeneous, meta-analysis was not performed, and a “best evidence synthesis” was reported. There were four studies (RCTs/QRCTs), which met the inclusion criteria. The mean age of participants in ACLr group ranged 25.3–45.8 years, while in CON group, it was 25.5–49.3 years. Tibiofemoral OA ranged from 23% to 80% in surgery group and 28%–68% in conservative group. Three studies reported no difference between surgical and conservative group in terms of long-term OA at 10–20 years' follow-up. When assessed in terms of functional knee outcomes (Lysholm score, IKDC score, and Tegner score) and knee laxity, ACLr group showed significantly better outcomes. Thus, it may be suggested, based on functional knee outcome scores, that ACLr may help athletes resume their sporting career postinjury. Further good quality RCTs involving a large number of participants are required to strengthen the claim.


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