top of page
Person with a backpack standing in front of a fork in a path within a beautiful forest

How do outcomes compare between treatments?

What outcomes are similar between treatment options?

Studies have shown that there is very little difference in outcomes between ACL reconstruction surgery and rehab without surgery. Both treatment options result in similar levels of:¹ ⁻ ³

Knee function (like using stairs, running)

Knee strength

Activity levels

Quality of life

Knee pain

Knee symptoms (like stiffness, swelling)

Additional meniscus surgeries 

Additional injury to the meniscus

Icon of two dumbbells
Icon of person walking up stairs
Icon of person stretching to the side
Icon of tick of approval
Icon of fire
Icon of knee
Icon of surgical instruments
Icon of leg bones with pain radiating from knee joint

What outcomes differ based on treatment choice?

ACL surgery may cause worse knee proprioception. It can also lead to more swelling in the knee joint and more changes in the cartilage within two years of injury compared to rehab without surgery.

 

Studies have found that after ACL surgery, there are more signs of knee osteoarthritis (OA) seen on x-ray than with rehab without surgery.⁶ ⁻ ⁸ However, not everyone with OA seen on x-ray experiences knee pain and symptoms. There are not yet enough studies to say if rates of painful knee OA differ between ACL surgery and rehab without surgery.

An X-ray of left and right knees

Click on the headings below to compare outcomes between treatment options.​

A person kicking a soccer ball on a green pitch

Can my ACL heal without surgery?

People used to think that the ACL could not heal without surgery, but new research suggests that healing is possible. This new research shows that after rehab without surgery, at least one in three people experience some healing of their ruptured ACL.¹⁰ It is possible that this healing can lead to better function and better quality of life compared with ACL surgery, but this needs further research.¹⁰ ¹¹

Scientists are also currently testing new treatments to help more people heal their ACL naturally without needing surgery.¹²

Can the surgical graft rupture?

Graft rupture is when the graft that has been used to surgically rejoin the thigh bone to the shin bone tears. This is also known as graft failure.

 

About one in five people have a second ACL injury in either knee after ACL surgery,¹³ ⁻ ¹⁵ and this risk increases to one in four who return to sport.¹

  • People who rupture their ACL graft and people who have another ACL surgery are more likely to experience poor outcomes, including:¹ ⁻ ¹⁹ 

    • Poor function

    • Long-term pain

    • More damage to the meniscus and the cartilage in the knee

    • Reduced chance of returning to sport

    • High rates of another graft rupture after a second ACL surgery

    • A higher risk of knee osteoarthritis (OA)

  • The risk of graft rupture after ACL surgery can vary. People with a high risk of rupturing their ACL graft may include those who:² ⁻ ²⁵

    • Return to sports that involve quick changes in direction or sudden turns

    • Are less psychologically ready to return to sport

    • Have an early ACL surgery, within one year of injury

    • Have a family history of ACL injury

    • Are young at the time of ACL injury

    • Are male

    • Report knee issues (like swelling, pain, reduced movement) before ACL surgery

    • Have a medial collateral ligament (MCL) injury

    • Have weak thigh muscles and still find it hard to hop when they return to sport

    • Return to sport earlier than 9 months after ACL surgery

    Many surgical factors also impact the likelihood of graft rupture. These include the placement and technique used to drill the bone tunnels, the choice of graft, the size and tension of the graft, surgical errors and complications including infection.

Icon of one person highlighted out of five people
The legs and tennis racquet of a person about to serve in a tennis game

Returning to sport

    • On average, only 55% of people return to competitive sport after ACL surgery²⁶

    • The average time that it takes people to return to sport after surgery is 17 months²⁷

    • 37% of people who do return to sport after ACL surgery are unable to perform at their previous level²⁷

  • On average, people are just as likely to return to sport if they choose surgery or rehab without surgery.² ⁻ ³⁰

  • The most common reason people don't return to sport after ACL surgery is a fear of injuring their knee again.²⁷ ³¹ ⁻ ³²

    People with low confidence in their knee, ongoing pain and swelling, poor knee function, a loose ACL graft, and weak thigh muscles may also be less likely to return to sport after ACL surgery.³³ ⁻ ³⁴

    We know less about barriers to returning to sport after rehab without surgery. 

About half of all people with an ACL injury will return to sport, and this is the same whether they choose ACL surgery or rehab without surgery. 

Risk of further knee surgery or injury

    • At least 10% of people  (1 in 10) are likely to have additional knee surgery, such as meniscus surgery, after an ACL tear.³⁵ 

  • Further knee injury (i.e. the knee giving way and injuring other structures like the meniscus, ACL graft or cartilage) can occur after ACL reconstruction surgery and after rehab without surgery. 

     

    There are not many studies that compare the rates of further knee injuries between treatments. One study of 275 people with ACL injury who tried rehab for around 3 months before considering ACL surgery, found that 4% of people (4 out of 100) managed without surgery had a new knee injury within 2 years. In comparison, 11% of people (11 out of 100) who decided to have ACL surgery had a new knee injury after surgery.

There is a risk of going on to have further knee surgery or other knee injuries after an ACL injury.

A patient with a knee brace on using crutches to walk towards a physiotherapist
A person preparing to deadlift a barbell with weights added

 

 

Strength and function

  • ACL surgery can cause weakness in the thigh muscles (quadriceps) and can change muscle control of these muscles. These changes can affect how much force goes through the knee during activities such as walking, running, jumping, or going up stairs and can last several years.³⁶ ⁻ ⁵⁰

    Studies have found that only a small number of people (less than 25%) have the same muscle strength in their injured knee as in their other knee one year after surgery, and it can take around five years for the strength to recover.³⁷

  • Knee proprioception (the brain's ability to know where the knee is in space) is reduced after surgery, compared to the other knee and compared to management with rehab without surgery.⁴ ⁵¹

There is less strength in the muscles around the knee after ACL surgery, and this can take years to recover. There is less known about muscle recovery after rehab without surgery.

Psychological impacts

There can be long-term psychological impacts of ACL injury, and these tend to be similar for people treated with ACL surgery or rehab without surgery. 
  • ACL injury can have long lasting psychological impacts, such as: ²⁰ ⁵² ⁻ ⁵⁶

    • a fear of injuring the knee again

    • symptoms of depression (which are common within 6 weeks of surgery)

    • Low confidence in the knee

    • Poor long-term quality of life

    People who don’t go back to sports or who exercise less after an ACL injury tend to have a higher fear of re-injuring their ACL and worse long-term quality of life.²⁰ ⁵⁷

  • Whether you have ACL surgery or rehab without surgery, it is likely that your quality of life in the long run will be similar.⁵⁴

Close-up of a persons arms clasped together in a mustard jumper
A person sitting, clasping their right knee with both hands

Knee osteoarthritis

Osteoarthritis (OA) is a disorder that can affect any moveable joint of the body. It can cause breakdown of tissues and changes to the knee joint. OA can cause pain, stiffness and loss of movement. People with ACL injury have an increased risk of developing OA in their injured knee.

    • Someone with an ACL injury is 7 times more likely to get OA compared to people with no ACL injury.⁵⁸

    • The chances of developing OA increase even more for people who have ACL surgery who are around 8 times more likely than someone without an ACL injury.⁵⁸

    • The knee that has had surgery is 3 to 4 times more likely to get OA than the knee that hasn’t.⁵⁹ ⁻ ⁶⁰

    • OA is common 10 years after an ACL injury and the risk goes up over time.⁶¹

    • More than 20 years after ACL surgery, 73% of people have signs of OA in their knee on X-ray. Of these, 26% have moderate to severe OA and 13% will have severe OA. ⁵⁹ ⁶² 

    • It is important to remember that not everyone who has signs of OA on X-ray will have symptoms of OA - some people experience no pain or swelling at all.

  • If you have had an ACL injury, certain things may increase your risk of going on to have knee OA. These include:⁵⁹ ⁶² ⁻ ⁶⁴

    • Damaged cartilage at the time of ACL surgery

    • Removal of all or part of the meniscus at the time of ACL surgery

    • Non-ideal drill tunnel placement during surgery

    • Use of a specific surgical drilling technique (transtibial drilling)

    • Returning to certain sports after ACL surgery

    • Inability to fully straighten or fully bend the knee after ACL surgery

To download a pdf of the information on this page, click the button below.

  • 1. Ekås GR, Ardern CL, Grindem H, et al. Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: A systematic review of the risk of new meniscal tears after anterior cruciate ligament injury. British Journal of Sports Medicine 2020;54(9):520-27. doi: 10.1136/bjsports-2019-100956

    2. Filbay SR, Culvenor AG, Ackerman IN, et al. Quality of life in anterior cruciate ligament-deficient individuals: A systematic review and meta-analysis. British Journal of Sports Medicine 2015;49(16):1033-41. doi: 10.1136/bjsports-2015-094864

    3. Saueressig T, Braun T, Steglich N, et al. Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries: a living systematic review and meta-analysis. British Journal of Sports Medicine 2022;56(21):1241-51. doi: 10.1136/bjsports-2021-105359

    4. Fleming JD, Ritzmann R, Centner C. Effect of an Anterior Cruciate Ligament Rupture on Knee Proprioception Within 2 Years After Conservative and Operative Treatment: A Systematic Review with Meta-Analysis. Sports Medicine 2021 doi: 10.1007/s40279-021-01600-z

    5. Van Ginckel A, Verdonk P, Witvrouw E. Cartilage adaptation after anterior cruciate ligament injury and reconstruction: Implications for clinical management and research? Asystematic review of longitudinal MRI studies. Osteoarthritis and Cartilage 2013;21(8):1009-24. doi: 10.1016/j.joca.2013.04.015

    6. Lien-Iversen T, Morgan DB, Jensen C, et al. Does surgery reduce knee osteoarthritis, meniscal injury and subsequent complications compared with non-surgery after ACL rupture with at least 10 years follow-up? A systematic review and meta-analysis. British journal of sports medicine 2020;54(10):592-98. doi: http://dx.doi.org/10.1136/bjsports-2019-100765

    7. Webster KE, Hewett TE. Anterior Cruciate Ligament Injury and Knee Osteoarthritis: An Umbrella Systematic Review and Meta-analysis. Clin J Sport Med 2021 doi: 10.1097/jsm.0000000000000894

    8. Harris KP, Driban JB, Sitler MR, et al. Tibiofemoral osteoarthritis after surgical or nonsurgical treatment of anterior cruciate ligament rupture: A Systematic Review. Journal of Athletic Training 2017;52(6):507-17. doi: 10.4085/1062-6050-49.3.89

    9. Smith TO, Postle K, Penny F, et al. Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment. Knee 2014;21(2):462-70. doi: 10.1016/j.knee.2013.10.009

    10. Filbay SR, Roemer FW, Lohmander LS, et al. Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial. British Journal of Sports Medicine 2022:bjsports-2022-105473. doi: 10.1136/bjsports-2022-105473

    11. Pitsillides A, Stasinopoulos D, Giannakou K. Healing potential of the anterior cruciate ligament in terms of fiber continuity after a complete rupture: A systematic review. J Bodyw Mov Ther 2021;28:246-54. doi: 10.1016/j.jbmt.2021.06.003

    12. Filbay SR, Dowsett M, Jomaa MC, et al. Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. British Journal of Sports Medicine 2023:bjsports-2023-106931. doi: 10.1136/bjsports-2023-106931

    13. Barber-Westin S, Noyes FR. One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years. Sports Health 2020;12(6):587-97. doi: 10.1177/1941738120912846

    14. Patel AD, Bullock GS, Wrigley J, et al. Does sex affect second ACL injury risk? A systematic review with meta-analysis. British Journal of Sports Medicine 2021;55(15):873-82. doi: 10.1136/bjsports-2020-103408

    15. Wiggins AJ, Grandhi RK, Schneider DK, et al. Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. The American journal of sports medicine 2016;44(7):1861-76. doi: http://dx.doi.org/10.1177/0363546515621554

    16. Yan X, Yang XG, Feng JT, et al. Does Revision Anterior Cruciate Ligament (ACL) Reconstruction Provide Similar Clinical Outcomes to Primary ACL Reconstruction? A Systematic Review and Meta-Analysis. Orthopaedic Surgery 2020;12(6):1534-46. doi: 10.1111/os.12638

    17. Wright RW, Johnson L, Brophy RH, et al. Revision Anterior Cruciate Ligament Reconstruction Outcomes at a Minimum of 5-Year Follow-Up: A Systematic Review. Journal of Knee Surgery 2019;32(3):218-21. doi: 10.1055/s-0038-1641137

    18. Glogovac G, Schumaier AP, Grawe BM. Return to Sport Following Revision Anterior Cruciate Ligament Reconstruction in Athletes: A Systematic Review. Arthroscopy - Journal of Arthroscopic and Related Surgery 2019;35(7):2222-30. doi: 10.1016/j.arthro.2019.01.045

    19. Grassi A, Ardern CL, Muccioli GMM, et al. Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results. British Journal of Sports Medicine 2016;50(12):716-24. doi: 10.1136/bjsports-2015-094948

    20. Cronström A, Tengman E, Häger CK. Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction. Sports Medicine 2022 doi: 10.1007/s40279-022-01747-3

    21. Zhao D, Pan JK, Lin FZ, et al. Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. American Journal of Sports Medicine 2022 doi: 10.1177/03635465221119787

    22. Rahardja R, Zhu M, Love H, et al. Factors associated with revision following anterior cruciate ligament reconstruction: A systematic review of registry data. Knee 2020;27(2):287-99. doi: 10.1016/j.knee.2019.12.003

    23. Hurley ET, Mojica ES, Haskel JD, et al. Return to play testing following anterior cruciate reconstruction - A systematic review & meta-analysis. Knee 2022;34:134-40. doi: https://dx.doi.org/10.1016/j.knee.2021.11.010

    24. Alomar AZ, Nasser ASB, Kumar A, et al. Hamstring graft diameter above 7 mm has a lower risk of failure following anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2022;30(1):288-97. doi: 10.1007/s00167-021-06503-0

    25. Yayra Kwaku Ashigbi E, Banzer W, Niederer D. Return to Sport Tests' Prognostic Value for Reinjury Risk after Anterior Cruciate Ligament Reconstruction: A Systematic Review. Med Sci Sports Exerc 2020;52(6):1263-71. doi: 10.1249/MSS.0000000000002246

    26. Ardern CL, Taylor NF, Feller JA, et al. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: An updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. British Journal of Sports Medicine 2014;48(21):1543-52. doi: 10.1136/bjsports-2013-093398

    27. Nwachukwu BU, Adjei J, Rauck RC, et al. How Much Do Psychological Factors Affect Lack of Return to Play After Anterior Cruciate Ligament Reconstruction? A Systematic Review. Orthopaedic Journal of Sports Medicine 2019;7(5) doi: 10.1177/2325967119845313

    28. Frobell RB, Roos HP, Roos EM, et al. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ: British Medical Journal 2013;346(jan24 1):f232-f32. doi: 10.1136/bmj.f232

    29. Moksnes H, Snyder-Mackler L, Risberg MA. Individuals with an anterior cruciate ligament-deficient knee classified as noncopers may be candidates for nonsurgical rehabilitation. Journal of Orthopaedic and Sports Physical Therapy 2008;38(10):586-95. doi: 10.2519/jospt.2008.2750

    30. Grindem H, Eitzen I, Moksnes H, et al. A Pair-matched comparison of return to pivoting sports at 1 year in anterior cruciate ligament-injured patients after a nonoperative versus an operative treatment course. American Journal of Sports Medicine 2012;40(11):2509-16. doi: 10.1177/0363546512458424

    31. Xiao M, van Niekerk M, Trivedi NN, et al. Patients Who Return to Sport After Primary Anterior Cruciate Ligament Reconstruction Have Significantly Higher Psychological Readiness: A Systematic Review and Meta-analysis of 3744 Patients. American Journal of Sports Medicine 2022 doi: 10.1177/03635465221102420

    32. Ross CA, Clifford A, Louw QA. Intrinsic factors associated with return to sport after anterior cruciate ligament reconstruction: A systematic review. S 2015;71(1):230. doi: https://dx.doi.org/10.4102/sajp.v71i1.230

    33. Czuppon S, Racette BA, Klein SE, et al. Variables associated with return to sport following anterior cruciate ligament reconstruction: A systematic review. British Journal of Sports Medicine 2014;48(5):356-64. doi: 10.1136/bjsports-2012-091786

    34. Andrade ALLD, Sardeli AV, Livani B, et al. Determinants of Return to Play After Anterior Cruciate Ligament Reconstruction. Acta Ortopedica Brasileira 2020;28(6):303-10. doi: 10.1590/1413-785220202806236114

    35. Ding DY, Tucker LY, Rugg CM. Comparison of Anterior Cruciate Ligament Tears Treated Nonoperatively Versus With Reconstruction: Risk of Subsequent Surgery. The American journal of sports medicine 2022:3635465211066940. doi: https://dx.doi.org/10.1177/03635465211066940

    36. Tayfur B, Charuphongsa C, Morrissey D, et al. Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta-Analyses. Sports Medicine 2021;51(2):321-38. doi: 10.1007/s40279-020-01386-6

    37. Tsai LC, Jeanfreau CM, Hamblin KA, et al. Time, graft, sex, geographic location, and isokinetic speed influence the degree of quadriceps weakness after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2022;30(10):3367-76. doi: 10.1007/s00167-022-06906-7

    38. Rush JL, Glaviano NR, Norte GE. Assessment of Quadriceps Corticomotor and Spinal-Reflexive Excitability in Individuals with a History of Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Sports Medicine 2021;51(5):961-90. doi: 10.1007/s40279-020-01403-8

    39. Rodriguez KM, Palmieri-Smith RM, Krishnan C. How does anterior cruciate ligament reconstruction affect the functioning of the brain and spinal cord? A systematic review with meta-analysis. Journal of Sport and Health Science 2021;10(2):172-81. doi: 10.1016/j.jshs.2020.07.005

    40. Johnston PT, McClelland JA, Feller JA, et al. Knee muscle strength after quadriceps tendon autograft anterior cruciate ligament reconstruction: systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2021;29(9):2918-33. doi: 10.1007/s00167-020-06311-y

    41. Brown C, Marinko L, LaValley MP, et al. Quadriceps Strength After Anterior Cruciate Ligament Reconstruction Compared With Uninjured Matched Controls: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine 2021;9(4) doi: 10.1177/2325967121991534

    42. Petersen W, Taheri P, Forkel P, et al. Return to play following ACL reconstruction: a systematic review about strength deficits. Archives of Orthopaedic and Trauma Surgery 2014;134(10):1417-28. doi: 10.1007/s00402-014-1992-x

    43. Bakal D, Morgan J, Lyons S, et al. Analysis of limb kinetic asymmetry during a drop vertical jump in adolescents post-ACL reconstruction. Clinical Journal of Sport Medicine 2021;31(2):177-78. doi: http://dx.doi.org/10.1097/JSM.0000000000000913

    44. Hughes G, Musco P, Caine S, et al. Lower limb asymmetry after anterior cruciate ligament reconstruction in adolescent athletes: A systematic review and meta-analysis. Journal of Athletic Training 2020;55(8):811-25. doi: 10.4085/1062-6050-0244-19

    45. Abdullah Y, Alokozai A, O'Connell S, et al. Online Patient Education Materials for Common Sports Injuries Are Written at Too-High of a Reading Level: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation 2022 doi: 10.1016/j.asmr.2021.12.017

    46. Pairot-de-Fontenay B, Willy RW, Elias ARC, et al. Running Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Medicine 2019;49(9):1411-24. doi: 10.1007/s40279-019-01120-x

    47. Lepley AS, Kuenze CM. Hip and knee kinematics and kinetics during landing tasks after anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Journal of Athletic Training 2018;53(2):144-59. doi: 10.4085/1062-6050-334-16

    48. Johnston PT, McClelland JA, Webster KE. Lower Limb Biomechanics During Single-Leg Landings Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Sports Medicine 2018;48(9):2103-26. doi: 10.1007/s40279-018-0942-0

    49. Kaur M, Ribeiro DC, Theis JC, et al. Movement Patterns of the Knee During Gait Following ACL Reconstruction: A Systematic Review and Meta-Analysis. Sports Medicine 2016;46(12):1869-95. doi: 10.1007/s40279-016-0510-4

    50. Gokeler A, Benjaminse A, van Eck CF, et al. Return of Normal Gait as an Outcome Measurement in ACL Reconstructed Patients: A Systematic Review. International Journal of Sports Physical Therapy 2013;8(4):441-51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812834/

    51. Relph N, Herrington L, Tyson S. The effects of ACL injury on knee proprioception: A meta-analysis. Physiotherapy (United Kingdom) 2014;100(3):187-95. doi: 10.1016/j.physio.2013.11.002

    52. Bullock GS, Sell TC, Zarega R, et al. Kinesiophobia, Knee Self-Efficacy, and Fear Avoidance Beliefs in People with ACL Injury: A Systematic Review and Meta-Analysis. Sports Medicine 2022 doi: 10.1007/s40279-022-01739-3

    53. Piussi R, Berghdal T, Sundemo D, et al. Self-Reported Symptoms of Depression and Anxiety After ACL Injury: A Systematic Review. Orthopaedic Journal of Sports Medicine 2022;10(1) doi: 10.1177/23259671211066493

    54. Filbay S, Culvenor, AG, Ackerman, IN, Russell, TG and Crossley KM. Quality of life in anterior cruciate ligament-deficient individuals: A systematic review and meta-analysis. British Journal of Sports Medicine 2015;49(16):1033-41. doi: 10.1136/bjsports-2015-094864

    55. Filbay SR, Skou ST, Bullock GS, et al. Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: A systematic review and meta-analysis for the OPTIKNEE consensus. British Journal of Sports Medicine 2022 doi: 10.1136/bjsports-2022-105626

    56. Filbay SR, Ackerman IN, Russell TG, et al. Health-related quality of life after anterior cruciate ligament reconstruction: A systematic review. American Journal of Sports Medicine 2014;42(5):1247-55. doi: 10.1177/0363546513512774

    57. Marok E, Soundy A. The effect of kinesiophobia on functional outcomes following anterior cruciate ligament reconstruction surgery: an integrated literature review. Disability and Rehabilitation 2021 doi: 10.1080/09638288.2021.1998665

    58. Webster KE, Hewett TE. Anterior Cruciate Ligament Injury and Knee Osteoarthritis: An Umbrella Systematic Review and Meta-analysis. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 2021;01 doi: http://dx.doi.org/10.1097/JSM.0000000000000894

    59. Grassi A, Pizza N, Al-zu’bi BBH, et al. Clinical Outcomes and Osteoarthritis at Very Long-term Follow-up After ACL Reconstruction: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine 2022;10(1) doi: 10.1177/23259671211062238

    60. Poulsen E, Goncalves GH, Bricca A, et al. Knee osteoarthritis risk is increased 4-6 fold after knee injury-a systematic review and meta-analysis. British Journal of Sports Medicine 2019;53(23):1454-63. doi: 10.1136/bjsports-2018-100022

    61. Spahn G, Schiltenwolf M, Hartmann B, et al. The time-related risk for knee osteoarthritis after ACL injury: Results from a systematic review. Orthopade 2016;45(1):81-90. doi: 10.1007/s00132-015-3170-4

    62. Everhart JS, Yalcin S, Spindler KP. Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data. American Journal of Sports Medicine 2021 doi: 10.1177/03635465211027302

    63. Whittaker JL, Losciale JM, Juhl CB, et al. Risk factors for knee osteoarthritis after traumatic knee injury: A systematic review and meta-analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus. British Journal of Sports Medicine 2022 doi: 10.1136/bjsports-2022-105496

    64. Cinque ME, Kunze KN, Williams BT, et al. Higher Incidence of Radiographic Posttraumatic Osteoarthritis With Transtibial Femoral Tunnel Positioning Compared With Anteromedial Femoral Tunnel Positioning During Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. American Journal of Sports Medicine 2022;50(1):255-63. doi: 10.1177/0363546521993818

    65. Manuscript under review (https://www.isakos.com/Assets/Meetings/2023Congress/ePosters/ABS_22170_Samuelsson%20Selin%20.pdf)

bottom of page