Surgical Versus Rehabilitation-First Management Strategies After ACL Injury: Persisting Uncertainty over Long-Term Outcomes—A Systematic Search and Narrative Synthesis of Randomized Trial Cohorts

Background/Objectives: The optimal management of anterior cruciate ligament (ACL) rupture remains debated, especially regarding long-term outcomes after early ACL reconstruction (ACLR) versus rehabilitation-first with optional delayed ACLR. The interpretation of randomized evidence is complicated by frequent treatment crossover. This review synthesized evidence from randomized controlled trial (RCT) cohorts comparing surgical versus rehabilitation-first management strategies across available fol