title: Tibiofemoral Osteoarthritis After Surgical or Nonsurgical Treatment of Anterior Cruciate Ligament Rupture: A Systematic Review.
abstract: OBJECTIVE
  To determine if surgical or nonsurgical treatment of anterior cruciate ligament rupture affects the prevalence of posttraumatic tibiofemoral osteoarthritis (OA).
  
  
  METHODS
  Studies published between 1983 and April 2012 were identified via EBSCOhost and OVID. Reference lists were then screened in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
  
  
  METHODS
  Studies were included if (a) treatment outcomes focused on a direct comparison of surgical versus nonsurgical treatment of anterior cruciate ligament rupture, (b) the prevalence of tibiofemoral OA was reported, and (c) they were written in English. Studies were excluded if (a) the included patients were treated with cast immobilization after surgery, (b) the mean follow-up was less than 10 years, or (c) the patients underwent anterior cruciate ligament revision surgery.
  
  
  METHODS
  Two independent investigators reviewed the included articles using the Newcastle-Ottawa Scale. Frequency of OA, surgical procedure, nonsurgical treatments, and participant characteristics were extracted and summarized. We calculated prevalence (%) and 95% confidence intervals for treatment groups for each individual study and overall. We developed 2 × 2 contingency tables to assess the association between treatment groups (exposed had surgery, referent was nonsurgical treatment) and the prevalence of OA.
  
  
  RESULTS
  Four retrospective studies were identified (140 surgical patients, 240 nonsurgical patients). The mean Newcastle-Ottawa Scale score was 5 (range = 4-6 [of 10] points). Average length of follow-up was 11.8 years (range = 10-14 years). The prevalence of OA for surgically treated patients ranged from 32.6% to 51.2% (overall = 41.4%, 95% confidence interval = 35.0%, 48.1%) and for nonsurgical patients ranged from 24.5% to 42.3% (overall = 30.9%, 95% confidence interval = 24.4%, 38.3%).
  
  
  CONCLUSIONS
  Although OA prevalence was higher in the surgical treatment group at a mean follow-up of 11.8 years, no definitive evidence supports surgical or nonsurgical treatment after anterior cruciate ligament injury to prevent posttraumatic OA. Current studies have been limited by small sample sizes, low methodologic quality, and a lack of data regarding confounding factors.
authors.affiliation: Department of Health, Physical Education and Nursing, Bucks County Community College, Newtown, PA.
authors.forename: Kyle P
authors.initials: KP
authors.lastname: Harris
authors.affiliation: Division of Rheumatology, Tufts Medical Center, Boston, MA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Driban
authors.affiliation: Department of Health, Physical Education and Nursing, Bucks County Community College, Newtown, PA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Sitler
authors.affiliation: Department of Sports Medicine, West Chester University of Pennsylvania.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Cattano
authors.affiliation: Department of Clinical Orthopedic Surgery, Temple University, Philadelphia, PA.
authors.forename: Easwaran
authors.initials: E
authors.lastname: Balasubramanian
authors.affiliation: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hootman
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods; D006801:Humans; D020370:Osteoarthritis, Knee / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D016896:Treatment Outcome
keywords: knee injuries; lower extremity; prevalence