{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:57:25Z","timestamp":1790632645841,"version":"4.1.0"},"reference-count":69,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>An anterior cruciate ligament (ACL) rupture is a common and debilitating knee injury. Although surgical management restores knee stability, its effectiveness in preventing long-term joint degeneration compared with nonoperative management remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose\/Hypothesis:<\/jats:title>\n                    <jats:p>The purpose of this study was to compare the long-term incidence of radiographic knee osteoarthritis (OA) after the operative versus nonoperative management of ACL injuries. It was hypothesized that operative management would lead to lower rates of OA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis were conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Embase, and Scopus were searched through June 2025 for comparative studies evaluating the development of OA after an ACL injury that was treated with operative or nonoperative management. Radiographic OA was defined as Kellgren-Lawrence grade \u22652 or equivalent. Random-effects meta-analyses were performed to compare radiographic OA, secondary meniscal surgery, and total knee arthroplasty (TKA) rates between treatment groups. Study quality was assessed using the MINORS (Methodological Index for Non-Randomized Studies) instrument and the Cochrane RoB 2 (risk of bias tool). The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 18 studies comprising 33,540 patients (mean follow-up, 12.3 years) were included. A meta-analysis of 15 studies found no significant difference in radiographic OA between the ACL reconstruction (ACLR) and nonoperative groups (risk ratio [RR], 1.01 [95% CI, 0.79-1.27];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 92%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .96). A sensitivity analysis of level 1 to 2 studies with low heterogeneity yielded similar findings (RR, 1.14 [95% CI, 0.87-1.48];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 34%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .33). A meta-analysis of 2 studies assessing OA prevalence in the ACL repair versus nonoperative group also found no statistically significant difference, with moderate heterogeneity (RR, 0.78 [95% CI, 0.54-1.12];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 55%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .18). Rates of secondary meniscal surgery did not differ significantly (RR, 0.79 [95% CI, 0.52-1.21];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 56%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .29). However, ACLR significantly reduced the risk of TKA (RR, 0.17 [95% CI, 0.07-0.43];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 59%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The operative management of ACL injuries did not decrease the long-term risk of developing radiographic OA compared with nonoperative management. ACLR was associated with a lower rate of TKA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671261451241","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:37:50Z","timestamp":1785433070000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Reconstruction After an Anterior Cruciate Ligament Injury Does Not Reduce the Osteoarthritis Risk But Lowers the Total Knee Arthroplasty Rate: A Systematic Review and Meta-analysis"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8113-3705","authenticated-orcid":false,"given":"Benjamin","family":"Blackman","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1650-542X","authenticated-orcid":false,"given":"Matey","family":"Juric","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7659-5147","authenticated-orcid":false,"given":"Seth","family":"Ybema","sequence":"additional","affiliation":[{"name":"Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6883-9486","authenticated-orcid":false,"given":"Marc Daniel","family":"Bouchard","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Macciacchera","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan A.","family":"Matache","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihad","family":"Abouali","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513508376"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.oto.2004.10.009"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24479"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354658601400405"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659702500605"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-019-09596-w"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/19476035211046041"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-014-0448-1"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518774315"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v7.i2.82"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2021.103039"},{"key":"e_1_3_3_13_2","unstructured":"Evans J Mabrouk A Nielson JI. 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