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Surgery vs. Rehab for ACL Tear. Who Wins?

If someone suffers an ACL tear, should they get surgery? For many people, this is a resounding yes, boarding on 'duh.' However, the current state of research should give you pause. This living systematic review (meaning it will continually be updated as new evidence is published) examines the current state of research assessing ACL-R vs. non-op care. The review excluded patients with enf-stage OA (grade 4) and unstable longitudinal meniscus tears. The outcomes included function, future OA and menuscal injuries, sports participation, quality of life, strength, activity level, and knee stability. The search yielded three studies and nine study reports, totaling 320 participants.

Across the board, the outcomes for surgery and non-op care were comparable with no significant differences. Over 90% of participants achieved MCID on the KOOS after 2 years, regardless of the intervention type. Does this mean ACL reconstructions should be abandoned? Not so fast my friend (college football is back, I had to). This review yields low to very low certainty evidence. ACL-R largely has good and predictable outcomes for athletes. When contracts, scholarships, and years of college eligibility are on the line, don't expect patients to risk non-op care. For the patients who aren't competetive atheltes, it is worth discussing and potentially exploring non-op rehabilitation first.

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