Open versus arthroscopic anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials

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Abstract

Background:

The purpose of this paper was to determine if significant differences exist between open and arthroscopic anterior cruciate ligament reconstruction (ACLR). We have hypothesized that patients would experience less pain, fewer complications, and fewer reoperations after arthroscopic ACLR.

Methods:

A systematic review of multiple medical databases was performed. Randomized controlled trials with a minimum of 6 mo follow-up were included. Study quality was analyzed using the Modified Coleman Methodology Score (MCMS) and Jadad Scale.

Results:

Three studies met the inclusion criteria (212 subjects; 212 knees). The MCMS rating was fair at 60.7±1.5, and the mean Jadad score was fair at 2.7±1.5. One study reported long-term outcomes (mean 12 yr) of 53 patients (25 open, 28 arthroscopic) and noted no differences in pain, strength, functional testing, or prevalence of osteoarthritis between groups. Two studies reported short-term outcomes of a combined 125 patients (58 open, 67 arthroscopic) with an average follow-up of 6 mo. In these studies, there were no differences in operative time, Lysholm scores, knee range of motion, laxity, complications, or reoperations between groups. Immediate postoperative analgesic use was higher in the open group. Average thigh atrophy ranged from 1.5 to 2.8 cm in the open group and 1.4 to 1.5 cm in the arthroscopic group.

Conclusions:

Based on the examined studies, there are no differences in operative time, knee range of motion, laxity, Lysholm scores, complications, or reoperations between open and arthroscopic ACLR techniques. Immediate postoperative pain appears decreased in patients undergoing arthroscopic ACLR.

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