Total Knee Arthroplasty Using Robotic-Assisted Technology in Patients Who Have Prior Anterior Cruciate Ligament Reconstruction.

Abstract

Total knee arthroplasty (TKA) in patients who have prior anterior cruciate ligament reconstruction (ACLR) has demonstrated decreased survivorship, with instability as the primary etiology of failure. Robotic-assisted TKA (RA-TKA) provides intraoperative gap data to help achieve a balanced soft-tissue sleeve. The purpose of this study was to evaluate outcomes, patient-reported outcome measures (PROMs), complications, and revisions in patients undergoing primary RA-TKA who had a history of prior ACLR. A review of 1,932 consecutive RA-TKAs was performed with preoperative computed tomography (CT) scan data and functional alignment techniques. There were 62 patients identified who had prior ACLRs and were matched 1:3 to a control group who did not have prior ACLR by sex, implant type, body mass index (BMI), and age. In the ACLR group, seven patients (11.3%) were lost to follow-up, and two underwent revision surgery, leaving 53 patients who had a minimum two-year follow-up. The mean age was 55 years (range, 28 to 69), the mean BMI was 32.8 (range, 21.6 to 49.1), and 43.5% were women. Clinical outcomes, PROMS, complications, and revisions were reported. There were no significant postoperative differences between the study group and the control group in length of follow-up, range of motion, or PROMs. There were no significant differences between either group regarding complications or all-cause survivorship at two years of follow-up (P = 0.604). The use of RA-TKA provided real-time adjustments in implant positioning to achieve a balanced soft-tissue sleeve, resulting in 96% survivorship at two years for all-cause failure in patients who had a prior ACLR compared to 94% survivorship for the control group (P = 0.604). Additional work is needed to determine if results of RA-TKA in patients who had prior ACLR demonstrate improved results compared to a group who had prior ACLR undergoing TKA using manual instruments.