Patients who underwent anterior cruciate ligament reconstruction were six times more likely to undergo total knee replacement with older age.
Anterior cruciate ligament reconstruction (ACL-R) is one of the most commonly performed Orthopedic procedures. ACL deficient knees are at an increased risk of developing of osteoarthritis (OA). Total knee replacement (TKR) treats end stage OA, and therefore, can be used as an surrogate measure to gauge the clinical severity of knee degeneration after ACL-R.
(1) Determine the rate of total knee replacement after anterior cruciate ligament reconstruction compared to the general population.
(2) Determine from our database whether there are other risk factors that increase risk of TKR after ACL-R.
This is a retrospective review of data stored in the Manitoba Center for Health Policy Database. Surgical and physician billing codes were used to identify ACL-R surgeries performed on Manitoba residents between 16-60 from 1980 to 2015. Patient factors gathered at time of surgery included: age, gender, urban or rural residence, neighbourhood income quintile, and resource utilization band. Each person was matched with up to five people from the general population who had never had ACL-R and had not had a TKR at the time of the case ACL-R.
Overall from 1980-2015, 8,500 ACL-R were identified within the 16-60 age group and time frame with a resultant 42,497 population matches. Gender was predominantly male. The mean age at the time of ACL-R that went on to have a TKR was 36.9 (SD 10.2), while the population that also had ACL-R, but not TKR was 29.2 (SD 9.9), P<0.0001. The mean age of Case group at the time of TKR was 53.7, while the mean age for matched cohort was 58.2, p<0.001. Those with ACL-R were 6.23 times more likely to go on to have TKR and this difference remained statistically significant after adjusting for age, sex, year of case surgery, region of residence and income quintile, adjusted hazard ratio: 4.85, 95% CI: 3.71-6.34, p<0.0001. Apart from age, no other risk factors examined (location, year of surgery, place of inhabitance, income quintile, RUB) appeared to increase risk of TKR after ACL-R.
Cruciate ligament reconstruction is one of the most commonly performed Orthopaedic procedures. It results in considerable patient morbidity, in both the short and long term. We found that patients who underwent anterior cruciate ligament reconstruction were six times more likely to undergo total knee replacement with older age. No other identifiable factors in our database were risk factors for future total knee replacements.