Total knee arthroplasty for secondary osteoarthritis following ACL reconstruction: a matched-pair comparative study of intra-operative and early post-operative complications.

Injury to the anterior cruciate ligament (ACL) is associated with increased risk of osteoarthritis and subsequent need for total knee arthroplasty (TKA). The impact of prior ACL reconstruction on TKA has been rarely studied. Twenty-two patients undergoing TKA, with a mean of 26 years following ACL reconstruction, were compared to a matched control group. Tibial exposure was more difficult in the study group, requiring tibial tubercle osteotomy in three cases (14%). Manipulation under anesthesia was required in five patients in the study group (23%) and none in the control group (p=0.048). No differences in final range of motion, outcomes scores, or alignment were noted 2 to 3 year post-operative. Total knee arthroplasty following ACL reconstruction is effective. Difficulties in obtaining tibial exposure and post-operative stiffness requiring manipulation under anesthesia are common.