title: ACL Damage and Deficiency is Associated with More Severe Preoperative Deformity, Lower Range of Motion at the Time of TKA.
abstract: BACKGROUND
  ACL status varies in the arthritic knee during TKA.
  
  
  OBJECTIVE
  The purpose of this study was to examine clinical features and intraoperative findings associated with stages of ACL degeneration.
  
  
  METHODS
  Coronal deformity, ROM, intra-articular degenerative patterns, and ligament releases were assessed for 1656 knees during TKA. Common patterns of deformity and severity of degenerative change were assessed as a function of the severity of ACL deficiency.
  
  
  RESULTS
  Of the 1656 knees assessed, 27% had a normal ACL, 55% exhibited damage, and 18% exhibited complete absence of the ACL. Increased coronal deformity and lower preoperative ROM was associated with ACL deficiency. Increased chondral and meniscal damage and more extensive osteophyte formation were also found. More extensive ligament releases were required in ACL-deficient knees.
  
  
  CONCLUSIONS
  The status of the ACL is predictive of the need for increased surgical deformity correction. A better understanding of ACL status is an important consideration during in choosing TKA as opposed to unicompartmental arthroplasty. The status of the ACL should be considered in planning for implant choice in TKA.
authors.affiliation: Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Berend
authors.affiliation: Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Meding
authors.affiliation: Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Malinzak
authors.affiliation: Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Faris
authors.affiliation: Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Jackson
authors.affiliation: Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Davis
authors.affiliation: Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA ; Joint Replacement Surgeons of Indiana Research Foundation, Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA.
authors.forename: Merrill A
authors.initials: MA
authors.lastname: Ritter
keywords: TKA; anterior cruciate ligament (ACL); kinematic alignment; ligament balancing; range of motion