Lin Rongjie, Huang Yiqing, Zheng Qingcong, Weng Jiansong, Liu Quan, Luo Xiangjun, Lin Xingyu, Wang Yao, Weng Shaohuang, Chen Min
Fujian Medical University Union Hospital, Fuzhou, China.
the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Int Orthop. 2025 May 10. doi: 10.1007/s00264-025-06553-w.
Total knee arthroplasty (TKA) is the gold-standard treatment for end-stage osteoarthritis (OA), offering substantial pain relief and functional improvement. With the rising incidence of sports-related injuries and advancements in anterior cruciate ligament reconstruction (ACLR) techniques, an increasing number of patients undergoing TKA have a history of ACLR. However, the impact of prior ACLR on postoperative complications and functional recovery after TKA remains controversial.
This study performed a systematic search across four databases, including case-control and cohort studies reporting on the outcomes of TKA following ACLR. Primary endpoints included infection, reoperation, prosthesis revision, thrombosis, and postoperative stiffness following manual release under general anaesthesia, with results compared to those of a control group of patients receiving TKA for primary OA. Secondary endpoints were operative time and postoperative range of motion in both flexion and extension. This study was registered in PROSPERO under the registration number CRD420250635375.
A total of nine studies were included in this study, involving 4381 participants, with 1112 undergoing TKA with ACLR history and 3269 undergoing TKA for primary OA. This study showed that the operative time of TKA after ACLR was significantly extended (P < 0.01), but there was no significant difference in postoperative infection, reoperation, prosthesis re-revision, thrombus, postoperative stiffness following manual release under general anaesthesia, and range of motion in both flexion and extension.
Although the operation time of TKA after ACLR was extended, the complication rate and postoperative functional recovery of TKA were not significantly different from those of primary OA patients. This study provided an evidence-based basis for preoperative assessment and patient management.
全膝关节置换术（TKA）是终末期骨关节炎（OA）的金标准治疗方法，能显著缓解疼痛并改善功能。随着运动相关损伤发生率的上升以及前交叉韧带重建（ACLR）技术的进步，越来越多接受TKA的患者有ACLR病史。然而，既往ACLR对TKA术后并发症和功能恢复的影响仍存在争议。
本研究在四个数据库中进行了系统检索，纳入了报告ACLR后TKA结果的病例对照研究和队列研究。主要终点包括感染、再次手术、假体翻修、血栓形成以及全身麻醉下手法松解后的术后僵硬，结果与接受原发性OA的TKA对照组患者进行比较。次要终点是手术时间以及屈伸的术后活动范围。本研究在PROSPERO注册，注册号为CRD420250635375。
本研究共纳入9项研究，涉及4381名参与者，其中1112名有ACLR病史接受TKA，3269名因原发性OA接受TKA。本研究表明，ACLR后TKA的手术时间显著延长（P < 0.01），但术后感染、再次手术、假体再次翻修、血栓形成、全身麻醉下手法松解后的术后僵硬以及屈伸活动范围方面无显著差异。
虽然ACLR后TKA的手术时间延长，但TKA的并发症发生率和术后功能恢复与原发性OA患者无显著差异。本研究为术前评估和患者管理提供了循证依据。
