Surgical Reconstruction After Anterior Cruciate Ligament Injury Is Associated With Reduced Odds of Future Total Knee Arthroplasty at Mid- to Long-Term Follow-Up

Purpose: To determine whether anterior cruciate ligament (ACL) reconstruction is associated with reduced odds of future total knee arthroplasty (TKA) among patients who sustain ACL injuries and to determine whether operative intervention is associated with reduced odds of future TKA among patients who sustain concomitant ACL and meniscus injuries. Methods: Data were obtained from the TriNetX database to identify patients who were aged at least 30 years with ACL injuries between 2009 and 2019. Patients were divided into 2 groups: those who were treated with surgical ipsilateral ACL reconstruction and those who were treated nonoperatively. After propensity score matching for comorbidities, the 2 groups were followed up for ipsilateral TKA. The follow-up time was 5 to 15 years. Analyses were performed comparing odds of TKA after differing treatment options for concomitant ACL and meniscus injury. χ² Analysis and Kaplan-Meier survival analysis were performed to determine the association between treatment of ACL injury and future TKA. Odds ratios (ORs) were reported, with P < .05 considered statistically significant. Results: Our analysis included 11,683 patients. Of these patients, 5,829 were managed nonoperatively and 5,854 underwent ACL reconstruction. In the nonoperative group, 247 patients (4.2%) underwent TKA compared with 128 patients (2.2%) in the ACL reconstruction group (OR, 1.98; 95% confidence interval, 1.59-2.46; P < .0001). In our concomitant ACL and meniscus injury analysis, 2,407 patients were managed nonoperatively and 2,411 patients underwent ACL reconstruction and meniscectomy. In the nonoperative group, 105 patients (4.4%) underwent TKA compared with 49 patients (2.0%) in the ACL reconstruction and meniscectomy group (OR, 2.20; 95% confidence interval, 1.56-3.10, P < .0001). Conclusions: Patients with ACL injuries treated with ACL reconstruction and patients with ACL and meniscus injuries treated with ACL reconstruction and meniscectomy are less likely to undergo TKA at mid- to long-term follow-up compared with patients treated nonoperatively. Level of Evidence: Level III, retrospective prognostic case series.