ロボット支援下総膝関節形成術：過去の膝前十字靭帯再建術を受けた患者における検討

Total knee arthroplasty (TKA) in patients who have prior anterior cruciate ligament reconstruction (ACLR) has demonstrated decreased survivorship, with instability as the primary etiology of failure. Robotic-assisted TKA (RA-TKA) provides intraoperative gap data to help achieve a balanced soft-tissue sleeve. The purpose of this study was to evaluate outcomes, patient-reported outcome measures (PROMs), complications, and revisions in patients undergoing primary RA-TKA who had a history of prior ACLR.

A review of 1,932 consecutive RA-TKAs was performed with preoperative computed tomography (CT) scan data and functional alignment techniques. There were 62 patients identified who had prior ACLRs and were matched 1:3 to a control group who did not have prior ACLR by sex, implant type, body mass index (BMI), and age. In the ACLR group, seven patients (11.3%) were lost to follow-up, and two underwent revision surgery, leaving 53 patients who had a minimum two-year follow-up. The mean age was 55 years (range, 28 to 69), the mean BMI was 32.8 (range, 21.6 to 49.1), and 43.5% were women. Clinical outcomes, PROMS, complications, and revisions were reported.

There were no significant postoperative differences between the study group and the control group in length of follow-up, range of motion, or PROMs. There were no significant differences between either group regarding complications or all-cause survivorship at two years of follow-up (P = 0.604).

The use of RA-TKA provided real-time adjustments in implant positioning to achieve a balanced soft-tissue sleeve, resulting in 96% survivorship at two years for all-cause failure in patients who had a prior ACLR compared to 94% survivorship for the control group (P = 0.604). Additional work is needed to determine if results of RA-TKA in patients who had prior ACLR demonstrate improved results compared to a group who had prior ACLR undergoing TKA using manual instruments.