2026 COA Annual Meeting: Anterior Cruciate Ligament Reconstruction Does Not Reduce Osteoarthritis Risk but Lowers Total Knee Arthroplasty Rates Compared With Conservative Treatment

18 studies with 33 540 patients were included in this systematic review and meta-analysis comparing anterior cruciate ligament reconstruction (ACLR) with non-operative management following anterior cruciate ligament (ACL) injury. Pooled outcomes of interest included radiographic knee osteoarthritis, secondary meniscal surgery, and total knee arthroplasty (TKA). The meta-analysis demonstrated no significant difference in the long-term prevalence of radiographic osteoarthritis between ACLR and non-operative treatment, and rates of secondary meniscal surgery were also similar. However, ACLR was associated with a significantly lower risk of subsequent TKA. These findings suggest that while ACLR does not appear to prevent degenerative joint changes, it may improve long-term knee function and stability sufficiently to reduce the need for knee replacement.