313 / 324
Intra-operatively, we noted two cases of techni-
cal difficulties due to the exposure of the tibia
among the study group. When there was poste-
rior and medial tibial wear the bony deficit was
managed by drilling and filling with cement as
described by previous authors [16]. Once the
tibial bone deficit required a metallic wedge.
The treating surgeon should be aware of the
potential difficulties to expose the tibia. We
routinely insert a pin in the patellar tendon in
these situations to avoid patellar tendon avul-
sion. However, this was not recorded in the sur-
gical report and we were unable to identify the
cases where it was needed. This may explain
the reason why we had only one case of patel-
lar tendon partial rupture when no tibial
tubercle osteotomies were performed. We did
not find any postoperative laxity as suggested
by previous study that the effect of a chronic
ACL rupture was to strain the MCL [12].
Only one study has reported the results of TKA
after ACL reconstruction. Hoxie
et al.
[8]
found that ACL reconstruction does not mar-
kedly affect the results of TKA. The postope-
rative range of motion, knee society scores and
rate of revision were similar. They found there
was patellar tendon baja (shortening) after
ACL reconstruction. The overall rate of patel-
la baja pre TKA was 11%, but post TKA none
showed radiographic patella baja. The age of
their patient group was significantly younger
(53yo) at the time of their TKA.
The strength of this study is that it is a conse-
cutive series with strict inclusion criteria and
matched case control patients. The weaknesses
are that it is a retrospective review; it is neither
randomized nor blinded. The data obtained in
this review indicates that prior ACL injury
does not have a negative effect on subsequent
TKA with respect to motion, outcome scores,
rate of revision, or incidence of intraoperative
or postoperative complications.
CONCLUSION
Total knee arthroplasty performed for advan-
ced osteoarthritis in a chronic isolated anterior
cruciate ligament deficient knee is a safe and
efficient procedure. At the time of the surgery
the surgeon should be aware of the potential
difficulty due to the medial tibial wear for ade-
quate exposure of the tibia and resulting patel-
la tendon avulsion and the need to address
medial tibial bone deficit. In this situation a
TKA has clinical and radiological outcomes
comparable to a primary TKA performed for
degenerative osteoarthritis.
14
es
JOURNÉES LYONNAISES DE CHIRURGIE DU GENOU
312
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