Surgical vs Conservative Management of Anterior Cruciate Ligament (Acl) Injury: A Systematic Review of Clinical Outcomes

Background: ACL injuries are among the most commonly studied knee injuries in orthopaedic and sports medicine. Despite decades of research, no clear consensus exists regarding the optimal treatment pathway-surgical reconstruction or conservative rehabilitation. To systematically review and compare the clinical outcomes of surgi Objective: cal versus conservative management of ACL injuries across diverse patient populations. A systematic search was conducted ac Methods: ross Ovid Emcare, Ovid MEDLINE, Embase, and Cochrane Library for studies published between 2015 and 2025. Inclusion criteria were RCTs, systematic reviews, and comparative cohort studies assessing outcomes of surgical versus conservative treatment for ACL injuries. Risk of bias and methodological quality were evaluated using the ROB 2.0 and Newcastle-Ottawa scales. Seventeen eligible studies we Results: re included. While surgical management demonstrated improved mechanical stability and higher return-to-sport (RTS) rates in athletic populations, conservative approaches yielded comparable long-term functional outcomes in non-athletes and those with partial tears. Surgery was associated with higher re-injury risk and longer recovery. Evidence quality was generally moderate, with significant heterogeneity across study designs and outcome measures. No one-size-fits-all approach exists for ACL injury management. Surgical intervention may Conclusion: be appropriate for highdemand individuals, whereas conservative rehabilitation can suffice for others. Shared decision-making, considering patient-specific factors and expectations, remains key. Further high-quality RCTs are warranted.