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Review
. 2019 Jul 12;7(7):2325967119857551.
doi: 10.1177/2325967119857551. eCollection 2019 Jul.

Does Prior Anterior Cruciate Ligament Reconstruction Affect Outcomes of Subsequent Total Knee Arthroplasty? A Systematic Review

Zaira S Chaudhry  1 , Hytham S Salem  2 , James J Purtill  1 , Sommer Hammoud  1
Affiliations
Review

Does Prior Anterior Cruciate Ligament Reconstruction Affect Outcomes of Subsequent Total Knee Arthroplasty? A Systematic Review

Zaira S Chaudhry et al. Orthop J Sports Med. .

Abstract

Background: Anterior cruciate ligament injury may accelerate knee osteoarthritis, and patients with a history of anterior cruciate ligament reconstruction (ACLR) tend to undergo total knee arthroplasty (TKA) at a greater rate than patients without a history of ACLR.

Purpose: To compare clinical outcomes of TKA in patients with and without a history of ACLR through a systematic review.

Study design: Systematic review; Level of evidence, 3.

Methods: A comprehensive search of the PubMed (MEDLINE), Cochrane Central, and SPORTDiscus databases from inception through November 2018 was performed to identify studies directly comparing outcomes of TKA between patients with and without a history of ipsilateral ACLR. Eligible studies were included in this review if they reported at least 1 outcome measure.

Results: Included for review were 5 retrospective case-control studies collectively evaluating TKA outcomes in 318 patients (176 males, 142 females) with a history of ACLR and 455 matched controls. The mean age in the ACLR and control groups was 58.5 years and 60.9 years, respectively. The mean follow-up period after arthroplasty was 3.4 years in the ACLR group and 3.3 years in the control group. The mean time between ACLR and arthroplasty was 21.8 years. Three studies noted greater operative time in the ACLR group than in the control group. No differences in intraoperative blood loss were reported. Greater preoperative extension deficits were noted in the ACLR group in 2 studies. Two studies reported increased preoperative Knee Society Score function scores in the ACLR group, but no differences in postoperative subjective outcome scores were noted in any of the studies. One study reported increased incidence of periprosthetic joint infection and a higher total reoperation rate in the ACLR group, and another study reported an increased incidence of manipulation under anesthesia in the ACLR group.

Conclusion: Short- and midterm subjective scores and functional outcomes of TKA appear to be comparable in patients with and without a history of ACLR, although the risk for reoperation after TKA may be greater in patients with prior ACLR. Surgeons should anticipate increased operative time in patients with a history of ACLR. However, the findings of this review must be interpreted within the context of its limitations.

Keywords: anterior cruciate ligament reconstruction; outcomes; total knee arthroplasty.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: S.H. has received research support from Arthrex, educational support from Arthrex and Liberty Surgical, and hospitality payments from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) diagram. ACLR, anterior cruciate ligament reconstruction; TKA, total knee arthroplasty.
See this image and copyright information in PMC

References

    1. Barton SB, McLauchlan GJ, Canty SJ. The incidence and impact of arthroscopy in the year prior to total knee arthroplasty. Knee. 2017;24:396–401. - PubMed
    1. Bilko TE, Paulos LE, Feagin JA, Jr, Lambert KL, Cunningham HR. Current trends in repair and rehabilitation of complete (acute) anterior cruciate ligament injuries: analysis of 1984 questionnaire completed by ACL Study Group. Am J Sports Med. 1986;14:143–147. - PubMed
    1. Brophy RH, Gray BL, Nunley RM, Barrack RL, Clohisy JC. Total knee arthroplasty after previous knee surgery: expected interval and the effect on patient age. J Bone Joint Surg Am. 2014;96(10):801–805. - PubMed
    1. Buller LT, Best MJ, Baraga MG, Kaplan LD. Trends in anterior cruciate ligament reconstruction in the United States. Orthop J Sports Med. 2014;3(1):2325967114563664. - PMC - PubMed
    1. Chong ACM, Fisher BT, MacFadden LN, Piatt BE. Prior anterior cruciate ligament reconstruction effects on future total knee arthroplasty. J Arthroplasty. 2018;33(9):2821–2826. - PubMed