Objective Compare the effectiveness of primarily surgical versus primarily rehabilitative management for anterior cruciate ligament (ACL) rupture. Design Living systematic review and meta-analysis. Data sources Six databases, six trial registries and prior systematic reviews. Forward and backward citation tracking was employed. Eligibility criteria Randomised controlled trials that compared primary reconstructive surgery and primary rehabilitative treatment with or without optional reconstructive surgery. Data synthesis Bayesian random effects meta-analysis with empirical priors for the OR and standardised mean difference and 95% credible intervals (CrI), Cochrane RoB2, and the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence. Results Of 9514 records, 9 reports of three studies (320 participants in total) were included. No clinically important differences were observed at any follow-up for self-reported knee function (low to very low certainty of evidence). For radiological knee osteoarthritis, we found no effect at very low certainty of evidence in the long term (OR (95% CrI): 1.45 (0.30 to 5.17), two studies). Meniscal damage showed no effect at low certainty of evidence (OR: 0.85 (95% CI 0.45 to 1.62); one study) in the long term. No differences were observed between treatments for any other secondary outcome. Three ongoing randomised controlled trials were identified. Conclusions There is low to very low certainty of evidence that primary rehabilitation with optional surgical reconstruction results in similar outcome measures as early surgical reconstruction for ACL rupture. The findings challenge a historical paradigm that anatomic instability should be addressed with primary surgical stabilisation to provide optimal outcomes. PROSPERO registration number CRD42021256537.

中文翻译：

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初次手术与初次康复治疗前十字韧带损伤：实时系统评价和荟萃分析


目的 比较主要手术治疗与主要康复治疗治疗前交叉韧带 (ACL) 断裂的效果。设计生活系统回顾和荟萃分析。数据来源 六个数据库、六个试验登记处和之前的系统评价。采用了前向和后向引文跟踪。资格标准 比较初次重建手术和初次康复治疗（有或没有可选重建手术）的随机对照试验。数据合成贝叶斯随机效应荟萃分析，使用 OR 和标准化均值差和 95% 可信区间 (CrI) 的经验先验、Cochrane RoB2 以及建议评估、制定和评估方法的分级来判断证据的确定性。结果 9514 条记录中，包含三项研究的 9 份报告（总共 320 名参与者）。在自我报告的膝关节功能的任何随访中均未观察到临床上重要的差异（证据质量低至极低）。对于放射性膝骨关节炎，我们发现长期证据质量非常低（OR（95% CrI）：1.45（0.30 至 5.17），两项研究）没有影响。从长远来看，半月板损伤在证据质量较低的情况下没有显示任何影响（OR：0.85（95% CI 0.45 至 1.62）；一项研究）。治疗之间没有观察到任何其他次要结果的差异。确定了三项正在进行的随机对照试验。结论 低至极低质量的证据表明，初级康复结合可选的手术重建会产生与 ACL 断裂早期手术重建相似的结果。 这些发现挑战了一个历史范式，即解剖结构不稳定应通过初次手术稳定来解决，以提供最佳结果。 PROSPERO 注册号 CRD42021256537。