A Cochrane review [withdrawn from publication] included 2 poor quality studies with a total of 324 subjects. In a quasi-randomised trial (n=167), there was no difference in the return to sports activities between surgical or conservative treatment of people with a complete anterior cruciate ligament (ACL) rupture. Measures of knee stability and functional (Lysholm) knee scores were higher in surgically-treated participants. By the end of the follow-up period (average 55 months), three people treated with repair only and 16 treated conservatively had had ACL reconstruction. In another trial (n=157) conservatively-treated participants recovered from their injury more rapidly but the functional outcome was similar in both treatment groups at the last follow up (minimum 13 months). A large proportion of participants experienced some temporary discomfort after surgery and there were some more serious postoperative complications. There was less knee instability in surgically-treated participants and a tendency to fewer subsequent operations in the longer term.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison), by limitations in study quality and by indirectness (the procedures used in the trials reflect outdated practices).