Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction: A Matched-cohort Analysis

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.

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.

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.

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.