A Torn or Reconstructed Anterior Cruciate Ligament Does Not Adversely Affect Clinical Outcome Scores and the Incidence of Reoperation After Unrestricted Kinematically Aligned Total Knee Arthroplasty

Elliot T Sappey-Marinier; Stephen M Howell; Alexander J Nedopil; Maury L Hull

doi:10.1016/j.arth.2023.06.018

A Torn or Reconstructed Anterior Cruciate Ligament Does Not Adversely Affect Clinical Outcome Scores and the Incidence of Reoperation After Unrestricted Kinematically Aligned Total Knee Arthroplasty

J Arthroplasty. 2023 Dec;38(12):2612-2617. doi: 10.1016/j.arth.2023.06.018. Epub 2023 Jun 13.

Authors

Elliot T Sappey-Marinier¹, Stephen M Howell², Alexander J Nedopil³, Maury L Hull⁴

Affiliations

¹ Department of Orthopaedic Surgery, University of California, San Francisco, California; Department of Orthopaedic Surgery, Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.
² Department of Biomedical Engineering, University of California, Davis, California.
³ Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, Würzburg, Germany.
⁴ Department of Biomedical Engineering, University of California, Davis, California; Department of Orthopedic Surgery, Davis Medical Center, University of California, Sacramento, California; Department of Mechanical Engineering, University of California, Davis, California.

PMID: 37321516
DOI: 10.1016/j.arth.2023.06.018

Abstract

Background: There are no reports as to whether the condition of the anterior cruciate ligament (ACL) adversely affects the 2 to 3 year function and reoperation risk of a kinematically aligned (KA) total knee arthroplasty (TKA) performed with posterior cruciate ligament (PCL) retention and an intermediate medial conforming (MC) insert.

Methods: A single surgeon's prospective database query identified 418 consecutive primary TKAs performed between January 2019 and December 2019. The surgeon recorded the ACL condition in the operative note. Patients filled out the Forgotten Joint Score (FJS), Oxford knee score (OKS), and Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement at the final follow-up. There were 299 patients with an intact ACL, 99 with a torn ACL, and 20 with a reconstructed ACL. The mean follow-up was 31 months (range, 20 to 45).

Results: The median FJS, OKS, and Knee Injury and Osteoarthritis Outcome Score (KOOS) of the reconstructed/torn/intact KA TKAs were 90/79/67, 47/44/43, and 92/88/80 points, respectively. The median OKS and KOOS of the reconstructed ACL cohort were 4 and 11 points higher than in the intact ACL cohort (P = .003, .04). One patient who had a reconstructed ACL underwent manipulation under anesthesia (MUA) for stiffness. The 5 reoperations in the intact ACL cohort were for instability (n = 2), revision after failed MUA for stiffness (n = 2), and infection (n = 1).

Conclusion: These results suggest that patients who have a torn and reconstructed ACL can expect high function and a low risk of reoperation comparable to patients who have an intact ACL when treated with unrestricted, caliper-verified KA, PCL retention, and an intermediate MC insert.

Keywords: KOOS score; Oxford knee score; forgotten joint score; medial conforming; revision surgery; total knee arthroplasty.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anterior Cruciate Ligament / surgery
Anterior Cruciate Ligament Injuries* / complications
Anterior Cruciate Ligament Reconstruction* / adverse effects
Arthroplasty, Replacement, Knee* / adverse effects
Humans
Incidence
Knee Injuries* / surgery
Knee Joint / surgery
Osteoarthritis* / surgery
Osteoarthritis, Knee* / etiology
Osteoarthritis, Knee* / surgery
Reoperation / adverse effects
Treatment Outcome