Department of Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain; Traumatology and Orthopaedia, Miguel Hernandez University, San Juan, Alicante, Spain.
Department of Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain.
J Arthroplasty. 2018 Jul;33(7):2141-2145. doi: 10.1016/j.arth.2018.02.054. Epub 2018 Feb 21.
Few studies have analyzed the outcomes of total knee arthroplasty (TKA) in patients with prior anterior cruciate ligament (ACL) reconstruction, and the reported outcomes are controversial. The purpose of this study is to assess if prior ACL reconstruction had any impact on the outcome of subsequent TKA.
A matched case-control study was conducted in patients who underwent TKA, including 37 with prior ACL reconstruction and 37 patients without ACL reconstruction. Preoperative and postoperative clinical and radiological data were collected from a prospective arthroplasty database with a minimum follow-up of 5 years. The mean age was 69.6 years, and 59.4% were men. The Knee Society scores, Short Form-12, and Western Ontario and McMaster Universities questionnaires were used for functional evaluations. Visual analogue scale 0-10 was used for patient satisfaction.
The mean follow-up after TKA was 6.1 (range 5-7.3) years. Two patients in the ACL group developed knee stiffness requiring manipulation under anesthesia, while 1 patient in the control group suffered superficial wound infection. At last follow-up, no significant differences in functional or radiologic outcomes were found between both groups. The performance of TKA in ACL patients had increased technical difficulty and significantly longer time of surgery, but this had no influence on the outcomes. In the ACL group, 24 knees had technical difficulty in surgery. The main difficulty in most ACL patients was due to varus deformity and increased retraction of the medial soft structures which required progressive medial release. Other 2 knees had difficult knee exposure. One was an unexpected partial patellar tendon avulsion and the other required planned quadriceps snip.
TKA was an effective procedure for patients with prior ACL reconstruction. The surgeon should be warned of the possible difficulties in the knee exposure and possible need of medial release to obtain an appropriate ligament balance. However, these additional procedures had no negative effect on the outcomes of TKA.
很少有研究分析过既往前交叉韧带（ACL）重建患者行全膝关节置换术（TKA）的结果，且报道的结果存在争议。本研究旨在评估既往 ACL 重建对后续 TKA 结果的影响。
对行 TKA 的患者进行了一项匹配的病例对照研究，其中包括 37 例既往行 ACL 重建患者和 37 例未行 ACL 重建患者。从前瞻性关节置换数据库中收集了术前和术后的临床和影像学数据，随访时间至少为 5 年。平均年龄为 69.6 岁，59.4%为男性。使用膝关节学会评分、SF-12 量表和 Western Ontario and McMaster Universities 膝关节评分评估功能。采用视觉模拟评分 0-10 评估患者满意度。
TKA 后平均随访 6.1 年（范围 5-7.3 年）。ACL 组有 2 例患者出现膝关节僵硬，需在全身麻醉下进行手法松解，对照组有 1 例患者发生浅表伤口感染。末次随访时，两组在功能和影像学结果方面无显著差异。ACL 患者行 TKA 手术的技术难度增加，手术时间明显延长，但对结果无影响。在 ACL 组中，24 例手术存在技术困难。大多数 ACL 患者的主要困难是由于存在内翻畸形和内侧软组织的过度牵张，需要进行渐进性内侧松解。另外 2 例膝关节暴露困难。其中 1 例是意外的部分髌腱撕脱，另 1 例需要计划行股四头肌切断术。
TKA 是既往 ACL 重建患者的有效治疗方法。术者应注意膝关节暴露可能存在的困难以及可能需要内侧松解以获得适当的韧带平衡。然而，这些额外的操作对 TKA 的结果没有负面影响。
