Chronic inflammation may lead to poor outcomes after ACL surgery, progression to TKA
Key takeaways:
- Patients with inflammatory disease had increased rates of arthrofibrosis, arthritis and progression to TKA after ACL surgery.
- Results were compared with a matched cohort of patients without inflammatory disease.
Published results showed patients with chronic inflammatory diseases, such as rheumatoid arthritis and lupus, may have increased risks for arthrofibrosis and arthritis and faster progression to total knee arthroplasty after ACL surgery.
However, other postoperative patient-reported outcomes, such as functional and patient satisfaction scores, and retear rates were similar between patients with a chronic inflammatory disease (CID) vs. patients without CID.
“CIDs significantly impact the long-term outcomes of ACL reconstruction. Patients with CIDs demonstrated higher rates of complications, such as arthrofibrosis, osteoarthritis and progression to TKA, compared to non-CID controls,” Aaron J. Krych, MD, of the Mayo Clinic Rochester, told Healio. “Moreover, individuals with CIDs underwent TKA significantly earlier than those without CIDs. Despite these findings, most patient-reported outcomes, including satisfaction and functional scores, were not markedly worse, suggesting that while ACL reconstruction constructs remain effective in CID patients, the systemic inflammatory environment contributes to accelerated joint degeneration and associated challenges.”
Krych and colleagues performed a retrospective study of propensity-matched cohorts of 30 patients with CID and 120 patients without CID who underwent ACL reconstruction between 1990 and 2021. Mean follow-up was 14.3 years.
At follow-up, Krych and colleagues found patients with CID had increased rates of arthrofibrosis (16.7% vs. 4.3%), osteoarthritis (33.3% vs. 16.7%) and conversion to TKA (16.7% vs. 3.3%), as well as faster progression to TKA (14.7 years vs. 23.5 years) compared with patients without CID. Patients with CID also had higher VAS pain scores (2 vs. 1.2) and satisfaction scores (3.92 vs. 3.39) compared with patients without CID.
Krych and colleagues found patients with CID had similar outcomes for range of motion, Tegner score, IKDC score, infection rates and retear rates compared with patients without CID.
After Kaplan-Meir survival analysis, Krych and colleagues found patients with CID had no significant differences in rates of survival free from retear at 25 years compared with patients without CID (85.7% vs 87.3%). However, they found patients with CID had significantly decreased rates of survival free from TKA at 25 years compared with patients without CID (64.9% vs. 91.2%).
“These findings underscore the importance of tailoring postoperative management and counseling for orthopedic patients with systemic inflammatory conditions. As CIDs become more prevalent in diverse patient populations, this study highlights the need for proactive strategies, such as targeted inflammatory control and early intervention, to mitigate the progression of joint deterioration,” Krych said. “These insights have the potential to guide future orthopedic research and clinical practices, particularly in optimizing care for patient subsets, thereby enhancing both surgical outcomes and long-term joint health in orthopedics.”
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