Abstract Purpose We hypothesized that patients undergoing anterior cruciate ligament reconstruction (ACL‐R) are more likely to develop patellofemoral osteoarthritis (PFOA) than those with an ACL injury managed non‐surgically. Study design Systematic review and Meta‐analysis. Methods A systematic literature review and meta‐analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Studies reporting PFOA assessment by radiographic or magnetic resonance imaging after ACL‐R compared to non‐surgical treatment of ACL injury were included. Studies involving individuals with concurrent other ligamentous or chondral injuries treated surgically were excluded to minimize bias. Results A total of six studies were included in the systematic review. The meta‐analysis demonstrated that patients undergoing ACL‐R had a significantly higher likelihood of developing PFOA compared to those who received non‐surgical treatment after ACL injury (odds ratio OR = 2.21; 95% confidence interval CI: 1.13−4.35; p = 0.02). Patients who underwent ACL‐R with bone–patellar tendon–bone (BPTB) autograft exhibited a significantly higher prevalence of PFOA than those with HT autograft ( p < 0.01). Moreover, male patients exhibited a higher association with PFOA than females in both the ACL‐R (34.38% vs. 7.77%, p < 0.001) and non‐surgical ACL injury groups (28.13% vs. 0.97%, p < 0.001). Conclusions ACL‐R significantly increases the likelihood of PFOA compared to non‐surgical ACL treatment, especially when using BPTB autografts. Male patients demonstrated a higher association with PFOA in both groups. Targeted preventive strategies, including optimized graft selection and enhanced rehabilitation protocols, are crucial for reducing the risk of PFOA following ACL‐R. Level of Evidence Level III.
Franco et al. (Wed,) studied this question.