Survivorship of TKA in post-ACL reconstruction knees lower than expected

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-05-01T20:00:28+05:30 | Updated On 2 May 2023 11:57 AM IST

Following anterior cruciate ligament (ACL) injury, 20% of patients will develop osteoarthritis. Despite this, there remains a paucity of data describing outcomes of total knee arthroplasty (TKA) after prior ACL reconstruction.

J.M. Wilson et al aimed to describe survivorships, complications, radiographic results, and clinical outcomes of TKA after ACL reconstruction in one of the largest series to date. The study was conducted at Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. It has been published in “The Journal of Arthroplasty.”

The authors identified 160 patients (165 knees) who underwent primary TKA following prior ACL reconstruction using the total joint registry. The mean age at TKA was 56 years (range, 29-81), 42% were women, and their mean body mass index was 32. Ninety percent of knees were posterior-stabilized designs. Survivorship was assessed using the Kaplan-Meier method. The mean follow-up was 8 years.

Key findings of the study were:

• The 10-year survivorships free of any revision and any reoperation were 92 and 88%, respectively.

• Seven patients were revised for instability (6 global and 1 flexion), 4 for infection, and 2 for other reasons.

• There were 5 additional reoperations: 3 manipulations under anesthesia, 1 wound debridement, and 1 arthroscopic synovectomy for patellar clunk.

• Non operative complications occurred in 16 patients, 4 of which were flexion instability.

• Radiographically, all non revised knees were well-fixed.

• Knee Society Function Scores significantly improved from preoperative to 5 years postoperative (P < .0001).

The authors concluded that – “Survivorship of TKA in post-ACL reconstruction knees was lower than expected with instability being the most common reason for revision. In addition, the most common non revision complications were flexion instability and stiffness requiring manipulations under anesthesia, indicating that achieving soft tissue balance in these knees may be difficult.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751