SRS291 - The recovery trajectory of anterior cruciate ligamentruptures in randomised controlled trials: a systematic review of operative and nonoperative treatments

Abstract Purpose This study aimed to compare recovery trajectories following anterior cruciate ligament (ACL) reconstruction versus nonoperative treatment. Methods A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted across Medline, Embase, Web of Science, and Cochrane Central up to 18 May 2023. Included studies involved patients with partial or complete ACL tears undergoing either reconstruction or nonoperative care. The primary outcome was change in the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) over time. Secondary outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, ACL-quality-of-life questionnaire, Lysholm, Tegner, and CKRS scores. Results Eighty-four RCTs were included. Pooled standardised mean changes in IKDC scores from baseline were: 2.0 (95% c.i.: 0.3–3.6) at 3 months, 2.2 (0.9–3.6) at 6 months, 2.2 (0.8–3.6) at 12 months, and 2.3 (1.3–3.4) at 24 months. IKDC improvements plateaued after 12 months. Similar trends were observed in secondary patient-reported outcome measures (PROMs), with most recovery occurring within the first 6–12 months. Conclusions PROMs, including the IKDC, effectively track recovery up to 12 months post-injury, with minimal improvement beyond this period. Pain and functional recovery plateau around 6 months, while quality of life improves up to 12 months. The lack of further PROM improvement despite extended return-to-sport timelines suggests these tools may lack sensitivity to detect later-stage recovery, particularly return-to-sport readiness.