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This retrospective matched-cohort study compared TKA outcomes in 45 patients with prior ACL reconstruction to 175 primary TKA patients. TKA after ACL reconstruction was associated with longer operative times, but resulted in similar PROMs and pain scores at 12 weeks and 1 year, with no difference in 90-day complications. The study suggests TKA is safe and effective in patients with a history of ACL reconstruction.
TKA following prior ACL reconstruction results in comparable short-term outcomes to primary TKA, despite longer operative times.
BACKGROUND Prior anterior cruciate ligament (ACL) reconstruction may introduce technical challenges during total knee arthroplasty (TKA), including altered anatomy and retained hardware. Evidence regarding how prior ACL reconstruction might change TKA outcomes remains limited. The primary objective of this study was to compare perioperative characteristics, patient-reported outcome measures (PROMs), and short-term complications in patients undergoing TKA with and without a history of ACL reconstruction. MATERIALS AND METHODS This was a retrospective matched-cohort study of patients who underwent TKA between January 2020 and December 2023 at a high-volume orthopedic hospital. Forty-five patients with prior ACL reconstruction were matched 1:4 to 175 patients undergoing primary TKA for osteoarthritis. Demographics, operative parameters, inpatient outcomes, and PROMs were compared. RESULTS Prior to surgery, the ACL group had higher preoperative Knee injury and Osteoarthritis Outcomes Score for Joint Replacement scores (P = .006). The operative time was longer in the ACL group (mean 103.9 vs 88.3 minutes, P < .001). The ACL group reported lower inpatient pain (P = .049) and required fewer opioids (P = .028), but had similar physical therapy outcomes. By 12 weeks, PROMs and pain scores were equivalent between groups and remained similar at 1 year. No differences were observed in 90-day complications. CONCLUSION TKA after ACL reconstruction is associated with increased operative time but yields comparable short-term outcomes to primary TKA. These findings support the safety and effectiveness of TKA in this distinct patient population. Larger, comparative studies are needed to confirm these findings and to better understand the long-term ramifications of prior ACL reconstruction on TKA outcomes.
