Dataset Information

Total knee arthroplasty after anterior cruciate ligament reconstruction: a narrative review.

ABSTRACT:

Background and objective

Knee replacement following anterior cruciate ligament (ACL) reconstruction can be demanding due to altered anatomy, soft tissue scars, bone loss, extensor mechanism complications, and knee instability. This narrative review summarizes the strategies and approaches to managing operative challenges in total knee arthroplasty (TKA) following ACL reconstruction.

Methods

Studies reporting outcomes of patients who underwent TKA after ACL reconstruction were retrieved and assessed to be included in this review that synthesizes the available evidence highlighting the pitfalls encountered during surgery, the intraoperative challenges posed by ligament balancing and exposure, and the leading role of modular and retained implants.

Key content and findings

TKA following ACL reconstruction has a high rate of intra-operative complications such as instability, bone loss, difficult exposure and demanding soft tissue balancing, representing a revision surgery rather than routine primary knee arthroplasty and a revision-oriented skill set and modular components are recommended to significantly optimize both surgical strategy and patient outcomes. With a rising incidence of ACL injuries and growing reconstructions, anticipating an increase in TKA procedures, this review aims to provide a call for rethinking clinical approaches to ensure effective and patient-centric care.

Conclusions

This narrative review seems to indicate that TKA after ACL reconstruction should be considered as revision surgery and modular components should be used. However, future prospective and high-quality studies are required to better clarify risk factors and give strong recommendations for this complex surgery.

SUBMITTER: Alessio-Mazzola M

PROVIDER: S-EPMC11304087 | biostudies-literature | 2024

REPOSITORIES: biostudies-literature

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Publications

Total knee arthroplasty after anterior cruciate ligament reconstruction: a narrative review.

Alessio-Mazzola Mattia M Biavardi Nicolo' N Solarino Giuseppe G Marongiu Giuseppe G Salini Vincenzo V Placella Giacomo G

Annals of joint 20240520

<h4>Background and objective</h4>Knee replacement following anterior cruciate ligament (ACL) reconstruction can be demanding due to altered anatomy, soft tissue scars, bone loss, extensor mechanism complications, and knee instability. This narrative review summarizes the strategies and approaches to managing operative challenges in total knee arthroplasty (TKA) following ACL reconstruction.<h4>Methods</h4>Studies reporting outcomes of patients who underwent TKA after ACL reconstruction were retr ...[more]

PMID: 39114421

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Project description:BackgroundWe aimed to evaluate clinical and radiological results after simultaneous open-wedge high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction in patients with ACL deficiency combined with medial uni-compartmental osteoarthritis (OA) and varus deformity.MethodsThis retrospective study was performed using data collected from 2005 to 2011 on a total of 24 patients who were diagnosed with ACL injury and medial unicompartmental OA with varus deformity, and who subsequently underwent simultaneous open-wedge HTO and arthroscopic ACL reconstruction. The mean follow-up duration was 5.2 years. For clinical outcomes, we evaluated Lysholm score, Tegner activity score, range of motion, Lachmann test, and pivot-shift test, and for radiological outcomes, we evaluated the degree of varus deformity, progression of medial OA, tibial posterior slope, anterior instability, and postoperative complication.ResultsThere were no limitations in range of motion found in any cases. Three patients showed progressive osteoarthritis on the medial compartment. The mechanical femorotibial angle was significantly corrected from varus 7.0 degrees to valgus 1.2 degrees, and the tibial posterior slope was not significantly changed. The Lysholm and Tegner activity scores were significantly improved after surgery (from 58 to 94 points on the Lysholm scale and from 4.0 to 5.3 points on the Tegner activity scale). Although the Lachman test and the pivot-shift test showed significant improvements after surgery, instability greater than Gr II was observed in three patients on the Lachman test and in four patients on the pivot-shift test. The side-to-side difference improved from 9.6 mm to 4.2 mm postoperatively as assessed using a Telos® arthrometer. There were no cases of nonunion or fixation loss.ConclusionsSimultaneous open-wedge HTO and ACL reconstruction in patients with ACL injury with medial compartmental OA showed satisfactory functional outcomes and postoperative activity level scores. However, some patients showed residual instability and progression of OA.

Dataset Information

Total knee arthroplasty after anterior cruciate ligament reconstruction: a narrative review.

Background and objective

Methods

Key content and findings

Conclusions

Publications

Total knee arthroplasty after anterior cruciate ligament reconstruction: a narrative review.

Similar Datasets

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