For years, many patients and clinicians have believed that Anterior Cruciate Ligament Reconstruction (ACLR) is required to get back to sport after an ACL injury. In fact, some consensus statements even recommend ACLR as the preferred treatment to maintain sports participation, often based on expert opinion rather than solid evidence.
But a new systematic review and meta-analysis of 15 studies and over 1600 participants challenges this long-held belief!
Here’s the surprising results:
There appears to be no difference in Return-to-Sport Rates! The analysis found no meaningful difference in return-to-sport rates between people who had ACLR (48% returned) and those who chose exercise-based rehabilitation alone (45% returned). This means your likelihood of getting back to sport might be similar regardless of surgery!
Activity Levels Are Comparable! When assessing activity levels (using tools like the Tegner Activity Scale), while a small difference favoring ACLR was initially noted (0.7 points), this difference was not clinically significant and disappeared when accounting for study biases.
Interestingly, most of the studies included in this review had biases that would favor the ACLR group for return to sport outcomes. This often meant non-surgical groups were advised not to return to sport, or less active patients were directed to rehab alone. Despite this inherent bias, the results still showed no significant difference!
Time to Return to Sport? The limited data available suggests no difference in the time it takes to return to sport between groups.
What does this mean for YOU?
If you or someone you know has an ACL injury, know that a desire to return to cutting and pivoting sports should not be the sole factor in recommending ACLR. Patients can return to sport with either management option. It’s important for clinicians to provide evidence-based information to help you make an informed treatment decision that aligns with your values and preferences. Including ‘Coper none Coper’ assessment in prehab programs may be a viable and important determinant when choosing to follow through with surgery. Implementing a strong pre-hab program can optimize recovery, success with conservative management, and for ‘non-copers’, post-operative outcomes.
While the evidence is still in its infancy and of low certainty due to heterogeneity and risk of bias in the studies included, these findings shed some light on ACLR is not necessarily a prerequisite for returning to sport.
References
Delgado D, Nyland J, Fong S, Martin T, Cabarkapa D, Kremplewski M, et al. (2022). Return to sport after anterior cruciate ligament injury: a systematic review and meta-analysis of operative versus nonoperative treatment. The American Journal of Sports Medicine (AJSM).