Our Summary

This research paper discusses how reconstructive surgery for the anterior cruciate ligament (ACL), a common knee injury particularly in older athletes, is increasing in the United States. The study notes that patients who have this surgery are more likely to need total knee replacement (TKA) later in life. However, this type of knee replacement surgery can be more complex and take longer in patients who have had ACL reconstruction, often due to difficulties with the surgical procedure and the presence of remaining surgical hardware.

The paper also mentions that the outcomes for patients who have had both ACL reconstruction and total knee replacement aren’t well known. Some reports suggest these patients may experience more complications and a higher likelihood of needing additional surgery compared to those who have only had a knee replacement. However, these findings are based on small, non-randomized groups of patients, so more research is needed.

Additionally, the study raises the question of whether the type of graft used or the way it’s attached during ACL reconstruction may affect the results of later knee replacement surgery. It also questions whether the design of the knee replacement implant might impact outcomes for patients who previously had ACL reconstruction. The paper reviews the frequency, surgical considerations, and outcomes of total knee replacement following ACL reconstruction.

FAQs

  1. Are patients who undergo ACL reconstruction more likely to require total knee arthroplasty later in life?
  2. Does a prior ACL reconstruction influence the outcomes of a subsequent total knee arthroplasty?
  3. Does the choice of graft or fixation technique for ACL reconstruction or the choice of TKA implant design affect outcomes for patients with prior ACL reconstruction?

Doctor’s Tip

One helpful tip a doctor might tell a patient about knee replacement is to follow a comprehensive rehabilitation program after surgery. This program may include physical therapy, strengthening exercises, and pain management techniques to help improve range of motion, strength, and function in the affected knee. Consistent participation in rehabilitation can lead to better outcomes and a faster recovery following knee replacement surgery.

Suitable For

Patients who are typically recommended for knee replacement surgery are those who have severe knee pain and disability that is not being adequately managed with conservative treatments such as medication, physical therapy, or injections. Common conditions that may warrant knee replacement surgery include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, and avascular necrosis.

Specifically, patients who have undergone anterior cruciate ligament (ACL) reconstruction and later develop significant arthritis in the knee joint may be recommended for knee replacement surgery. These patients may experience persistent pain, stiffness, swelling, and limited range of motion in the knee despite previous surgical interventions. Additionally, patients with prior ACL reconstruction who have failed conservative treatments and have significant functional limitations may be candidates for knee replacement surgery.

It is important for patients considering knee replacement surgery to undergo a thorough evaluation by a healthcare provider to determine if they are appropriate candidates for the procedure. Factors such as age, overall health, activity level, and severity of arthritis will be taken into consideration when determining if knee replacement surgery is the best treatment option for a patient.

Timeline

Before knee replacement:

  1. Patient experiences chronic knee pain, stiffness, and decreased mobility due to conditions such as osteoarthritis or previous ACL injury.
  2. Patient undergoes various non-surgical treatments such as physical therapy, medications, and injections to manage symptoms.
  3. Patient and surgeon decide that knee replacement surgery is the best option to improve quality of life and function.

After knee replacement:

  1. Patient undergoes pre-operative evaluation and preparation, which may include medical clearance, imaging tests, and education on the surgery and recovery process.
  2. Patient undergoes knee replacement surgery, which involves removing damaged cartilage and bone and replacing it with artificial components.
  3. Patient stays in the hospital for a few days for post-operative care and rehabilitation.
  4. Patient begins physical therapy and rehabilitation to regain strength, range of motion, and function in the knee.
  5. Patient follows a prescribed rehabilitation program at home and continues to attend outpatient therapy sessions.
  6. Patient gradually resumes daily activities and gradually increases activity level as the knee heals.
  7. Patient follows up with the surgeon for post-operative appointments to monitor progress and address any concerns.
  8. Patient experiences improved mobility, reduced pain, and enhanced quality of life as the knee replacement surgery successfully restores function in the affected knee.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with knee replacement surgery in patients who have previously undergone ACL reconstruction?

  2. How will my prior ACL reconstruction surgery affect the surgical approach and technique used during knee replacement surgery?

  3. Will the presence of retained hardware from my ACL reconstruction surgery impact the success of the knee replacement procedure?

  4. Are there any specific rehabilitation protocols or post-operative precautions that I should follow given my history of ACL reconstruction?

  5. How will my prior ACL reconstruction surgery affect my long-term outcomes and prognosis following knee replacement surgery?

  6. Are there any specific considerations or modifications that need to be made during knee replacement surgery in patients with prior ACL reconstruction?

  7. How will my prior ACL reconstruction surgery impact the durability and longevity of the knee replacement implant?

  8. Are there any alternative treatment options or approaches that should be considered given my history of ACL reconstruction?

  9. What is the likelihood of needing revision surgery or additional procedures in the future due to my prior ACL reconstruction surgery?

  10. Are there any specific factors or characteristics of my ACL reconstruction surgery that may influence the success or outcomes of knee replacement surgery?

Reference

Authors: Best MJ, Amin RM, Raad M, Kreulen RT, Musharbash F, Valaik D, Wilckens JH. Journal: J Knee Surg. 2022 Jul;35(8):844-848. doi: 10.1055/s-0040-1721423. Epub 2020 Nov 26. PMID: 33242906