Impact of anterior cruciate ligament surgery on the development of knee osteoarthritis: A systematic literature review and meta-analysis comparing non-surgical and surgical treatments

Stephanie Ferrero; Marion Louvois; Thomas Barnetche; Veronique Breuil; Christian Roux

doi:10.1016/j.ocarto.2023.100366

Impact of anterior cruciate ligament surgery on the development of knee osteoarthritis: A systematic literature review and meta-analysis comparing non-surgical and surgical treatments

Osteoarthr Cartil Open. 2023 Apr 28;5(3):100366. doi: 10.1016/j.ocarto.2023.100366. eCollection 2023 Sep.

Authors

Stephanie Ferrero¹, Marion Louvois¹, Thomas Barnetche², Veronique Breuil¹, Christian Roux³

Affiliations

¹ Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France.
² Department of Rheumatology, University Hospital of Bordeaux Pellegrin, France.
³ Department Rheumatology, University of Cote D'Azur, Nice Hospital, Laboratory LAMHESS, EA6312, IBV CNRS IMR 7277 INSERM U1091 UNS, France.

Abstract

Introduction: Context: The development of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is now widely recognized. The impact of surgical or non-surgical management on the development of post-traumatic osteoarthritis is still debated in the medical community.Here, we present a meta-analysis comparing the impact of surgical or non-surgical management of ACL injuries on the development of knee OA.

Method: A systematic literature review was conducted using data from the PubMed, EMBASE, Medline, and Cochrane libraries from February to May 2019. Only randomized clinical trials published between 2005 and 2019 with a non-surgical group and a surgical group were included to explore the onset or progression of knee OA after ACL injury. Trials had to have at least one radiographic endpoint (Kellgren-Lawrence scoring system). Heterogeneity was assessed using the Cochrane's Q and I² statistical methods.

Results: Only three randomized controlled trials met the inclusion criteria and were selected for meta-analysis. Of the 343 injured knees included in the studies, 180 underwent ACL reconstruction and 163 underwent non-surgical treatment. The relative risk of knee osteoarthritis was higher after surgery than after non-surgical treatment (RR 1.72, CI 95% [1.18-2.53], I² = 0%).

Conclusion: The results of this meta-analysis suggest a predisposition to knee osteoarthritis after ACL reconstruction surgery compared with non-surgical management. Due to the small number of good quality studies available, further well-conducted randomised studies are needed to confirm these findings.

Keywords: Anterior cruciate ligament; Injury; Knee; Osteoarthritis; Radiographic.

Publication types

Review