Alessio-Mazzola Mattia, Placella Giacomo, Zagra Luigi, Leone Orlando, Di Fabio Natasha, Moharamzadeh Desiree, Salini Vincenzo
IRCCS Ospedale San Raffaele, Unità Clinica di Ortopedia e Traumatologia, Via Olgettina, Milan, Italy.
Università Vita-Salute San Raffaele, Via Olgettina, Milan, Italy.
EFORT Open Rev. 2023 Nov 1;8(11):854-864. doi: 10.1530/EOR-23-0069.
The results of total knee arthroplasty (TKA) following anterior cruciate ligament (ACL) reconstruction are still under-investigated. The purpose of this research is to investigate the differences between TKA after ACL reconstruction and TKA for primary osteoarthritis through a review and meta-analysis of the literature.
Case-control and cohort studies reporting outcomes of TKA following ACL reconstruction were considered eligible for inclusion. The primary endpoint was to systematically review and meta-analyze the reported complications of TKA following ACL reconstruction. The outcomes have been compared with a group of patients who underwent TKA for primary knee osteoarthritis (OA) with any previous ACL surgery. Secondary endpoints were to assess and compare technical difficulties and results including the operative time, the use of revision components, the request for intraoperative release or additional procedures, the revision rate, and the clinical outcomes.
Seven studies were included involving 1645 participants, 619 of whom underwent TKA in previous ACL reconstruction and 1026 TKA for primary OA with no previous ACL reconstruction. Meta-analysis showed that TKA in previous ACL reconstruction had a significantly higher complication rate (OR = 2.15, P < 0.001), longer operative times (mean differences (MD): 11.19 min; P < 0.001) and increased use of revision components (OR = 2.16; P < 0.001) when compared to the control group without differences of infection, and revision rate.
TKA in a previous ACL reconstruction has a significantly higher complication rate, longer operative times, and a higher need for revision components and intraoperative soft tissue releases in comparison to TKA for primary OA without previous ACL reconstruction.
前交叉韧带（ACL）重建术后全膝关节置换术（TKA）的结果仍研究不足。本研究的目的是通过对文献的回顾和荟萃分析，探讨ACL重建术后TKA与原发性骨关节炎TKA之间的差异。
纳入报告ACL重建术后TKA结果的病例对照研究和队列研究。主要终点是系统回顾和荟萃分析ACL重建术后TKA报告的并发症。将结果与一组因原发性膝关节骨关节炎（OA）接受TKA且既往有任何ACL手术史的患者进行比较。次要终点是评估和比较技术难度及结果，包括手术时间、翻修部件的使用、术中松解或额外手术的需求、翻修率和临床结果。
纳入7项研究，共1645名参与者，其中619名在既往ACL重建中接受了TKA，1026名因原发性OA接受TKA且既往无ACL重建。荟萃分析表明，与对照组相比，既往ACL重建后的TKA并发症发生率显著更高（OR = 2.15，P < 0.001），手术时间更长（平均差异（MD）：11.19分钟；P < 0.001），翻修部件的使用增加（OR = 2.16；P < 0.001），感染和翻修率无差异。
与既往无ACL重建的原发性OA的TKA相比，既往ACL重建后的TKA并发症发生率显著更高，手术时间更长，对翻修部件和术中软组织松解的需求更高。
