Complications of total knee arthroplasty in patients with prior anterior cruciate ligament reconstruction compared to a matched cohort

Background: Current literature reports a 500 % increase in reoperation in total knee arthroplasty (TKA) after anterior cruciate ligament reconstruction (ACLR). The purpose of this study is to determine the effect of ACLR on subsequent TKA. Methods: This retrospective case control study included 30 patients that underwent TKA following an ACLR who were matched 3:1 to a control cohort at a single tertiary academic center between January 1, 2011 and January 1, 2021. The electronic medical records were queried for demographics, complications, history of ACLR, and range of motion (ROM) preoperatively and postoperatively at 3 months and 1 year. Student's t-tests and Fisher's exact tests were used for analysis (alpha = 0.05). Results: The mean ROM between the ACLR and control groups preoperatively, at 3 months and at 1 year postoperatively were 108.2 degrees v 104.8 degrees (p = 0.42), 114.0 degrees v 111.8 degrees (p = 0.51), and 115.3 degrees v 115.8 degrees (p = 0.88). At 1 year, 9 of 30 (30 %) ACLR patients decreased ROM versus 14 of 90 (15.6 %) control patients (mean loss of 21.4 degrees v 11.9 degrees, p = 0.076). No difference in complication rate was found (10 % v 11.1 %, p = 1). Complications in the ACLR group included open debridement and capsular release for stiffness after 2 failed manipulations under anesthesia (MUA), lysis of adhesions for patellar clunk, and revision surgery for flexion instability. No control patients required MUA. Conclusion: This study demonstrated that TKA following ACLR is without an increased risk of complications. However, ACLR patients should be followed closely since loss of ROM can be large.