Background <p>Total knee arthroplasty (TKA) is the gold-standard treatment for end-stage osteoarthritis (OA), offering substantial pain relief and functional improvement. With the rising incidence of sports-related injuries and advancements in anterior cruciate ligament reconstruction (ACLR) techniques, an increasing number of patients undergoing TKA have a history of ACLR. However, the impact of prior ACLR on postoperative complications and functional recovery after TKA remains controversial.</p> Methods <p>This study performed a systematic search across four databases, including case–control and cohort studies reporting on the outcomes of TKA following ACLR. Primary endpoints included infection, reoperation, prosthesis revision, thrombosis, and postoperative stiffness following manual release under general anaesthesia, with results compared to those of a control group of patients receiving TKA for primary OA. Secondary endpoints were operative time and postoperative range of motion in both flexion and extension. This study was registered in PROSPERO under the registration number CRD420250635375.</p> Results <p>A total of nine studies were included in this study, involving 4381 participants, with 1112 undergoing TKA with ACLR history and 3269 undergoing TKA for primary OA. This study showed that the operative time of TKA after ACLR was significantly extended (P &lt; 0.01), but there was no significant difference in postoperative infection, reoperation, prosthesis re-revision, thrombus, postoperative stiffness following manual release under general anaesthesia, and range of motion in both flexion and extension.</p> Conclusions <p>Although the operation time of TKA after ACLR was extended, the complication rate and postoperative functional recovery of TKA were not significantly different from those of primary OA patients. This study provided an evidence-based basis for preoperative assessment and patient management.</p>