This systematic review analyzed studies published between 2020 and 2025 comparing early anterior cruciate ligament (ACL) reconstruction with structured, rehabilitation-first management in adults. Across eight high-quality trials including over 1,600 participants, no clinically meaningful differences were found in functional outcomes, return-to-sport rates, or patient satisfaction after two to five years.
Early reconstruction showed slightly fewer re-ruptures and secondary meniscal injuries but did not improve long-term joint health or reduce osteoarthritis risk. The decisive factor for recovery was adherence to a well-structured rehabilitation program emphasizing neuromuscular control and psychological readiness.
Overall, early surgery should be reserved for patients with complex injuries or elite athletic demands. For most individuals, a rehabilitation-first approach achieves equivalent results with lower risks and costs. ACL management should therefore prioritize function, not fixation.
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- Tobias Giesen (Author), 2025, Anterior Cruciate Ligament (ACL) Reconstruction or Rehabilitation First. A Systematic Review of Recent Evidence and Clinical Implications, Munich, GRIN Verlag, https://www.grin.com/document/1669869
