(English) Episode 161-ACL Surgery vs rehab - the stunning new evidence that shatters the myth of return-to-sport necessity

The document is a systematic review and meta-analysis titled "No Difference in Return-to-Sport Rate or Activity Level in People with Anterior Cruciate Ligament (ACL) Injury Managed with ACL Reconstruction or Rehabilitation Alone." This research compares outcomes for patients who receive ACL reconstruction (ACLR) surgery versus those managed with exercise-based rehabilitation alone following an ACL rupture. The authors conclude that there was no significant difference in return-to-sport rates or activity levels between the two treatment groups, even though most of the included studies had a high risk of confounding bias that typically favored the surgical group. The review cautions that the evidence certainty is very low due to this bias and the heterogeneity of results, but suggests that the belief that ACLR is necessary for returning to high-level sport is not supported by current evidence. Ultimately, the findings aim to help patients with ACL injuries make a more informed treatment decision.(Filbay SR, Bullock G, Russell S, Brown F, Hui W, Egerton T. No difference in return-to-sport rate or activity level in people with anterior cruciate ligament (ACL) injury managed with ACL reconstruction or rehabilitation alone: A systematic review and meta-analysis. Sports Med [Internet]. 2025;55(9):2191–205. Available from: http://dx.doi.org/10.1007/s40279-025-02268-5)