Long-term risk of knee replacement after ACL reconstruction using the contralateral knee as an internal control: a National Hospital Episode Statistics database study of 135 881 patients

Key Points

1. There was a three times increased risk of arthroplasty in the ACLR knee compared to the uninjured knee, however the absolute risk was small over 25 years (< 2.5% of those had arthroplasty in the ACLR knee).

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BACKGROUND & OBJECTIVE

Traumatic knee injuries are well-established risk factors for future post-traumatic osteoarthritis, and ~50% of those with anterior cruciate ligament (ACL) tears have been reported to develop radiographic osteoarthritis within 10 years after injury (1). Despite increased awareness of the early risk for knee osteoarthritis, little is known of the risk of having knee joint arthroplasty in those with ACL tears.

The goal of this study was to investigate osteoarthritis risk after unilateral ACL reconstruction (ACLR) compared to the contralateral (uninjured) knee by determining the subsequent risk of knee arthroplasty.

Approximately 50% of those with anterior cruciate ligament tears have been reported to develop radiographic osteoarthritis within 10 years after injury.

While we have focused on ‘ACL reinjury prevention’ once we’ve returned patients to their desired sport/activity after ACLR, equal efforts should be made so that patients can have healthy knees long-term.

METHODS

• This was a retrospective study that looked at health medical records from England UK, National Health Service (NHS) database. Patients who had initial ACLR surgery between April 1997 and March 2023 with no previous or subsequent ACL surgery were identified

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