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INTRODUCTION
Anterior cruciate ligament (ACL) rupture is a
common injury with over 100 000 ACL ski
related injuries ocurring in the U.S. per year
[6]. Isolated ACL rupture often leads to knee
instability [10, 17]. Instability and associated
articular cartilage and meniscal damage from
an ACL rupture that is not treated may be a
contributing cause to the later development of
osteoarthritis [2].
Nebelung and Wuschech [13] found that the
return to high-level activity with an unstable
knee related to isolated ACL rupture lead to
95% of patients developing meniscal and carti-
lage damage and associated progressive
osteoarthritis. Of note they found that there was
greater than 50% risk of requiring a total joint
knee arthroplasty (TKA) after 35 years.
Therefore, the common outcome for an uns-
table ACL-deficient knee is the need for a TKA.
Hoxie
et al.
[8] performed a retrospective
study of patients who had TKA following pre-
vious ACL reconstruction. They found that
previous ACL reconstruction does not have a
negative impact on a future TKA with respect
to range of motion, outcome scores, infection,
or patella baja.
To our knowledge, no previous study has
reported the results of TKA in patients who
had clinically documented unstable ACL rup-
ture which was not surgically managed with
reconstruction. The purpose of this study was
to investigate what impact, if any, prior ACL
deficiency has on the outcome of primary
TKA. We hypothesize that ACL deficiency has
a negative impact on the intra-operative mana-
gement and the postoperative outcome of TKA
with respect to ligament balancing, postopera-
tive motion, outcome scores, survivorship or
need for revision arthroplasty. We also hypo-
thesize that patients with ACL-deficient knees
have an increased risk of anterior tibial trans-
lation or laxity after TKA.
MATERIALAND METHODS
After approval by the institutional review
board, patients were identified from a surgical
database (n=2258). All patients who underwent
a TKA performed for osteoarthritis and had a
history of ACL injury at our institution were
selected (n=255). Patients who had previous
surgery as ACL reconstruction or high tibial
osteotomy (HTO) were excluded from the
study group (n=158). Patients with multi-liga-
ment injury such as an ACL rupture associated
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TOTAL KNEE ARTHROPLASTY:
ASAFE AND EFFECTIVE PROCEDURE
FOR ADVANCED OSTEOARTHRITIS
IN CHRONIC ISOLATEDANTERIOR
CRUCIATE LIGAMENT DEFICIENT KNEE
G. DEMEY, S. LUSTIG, E. SERVIEN, C. FARY, PH. NEYRET