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Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Deficiency

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Abstract

The management of the arthritic anterior cruciate ligament (ACL)-deficient knee remains a significant challenge to surgeons, as these patients are often young with high functional demands. While unicompartmental knee arthroplasty (UKA) would appear to have significant advantages, it has historically been considered contraindicated due to an increased incidence of aseptic loosening.

Around one-third of knees undergoing arthroplasty have been reported as being ACL deficient, with half of these being contraindicated for UKA, based on the pathoanatomy of disease, most commonly due to involvement of both tibiofemoral compartments.

Ten case series, 308 knees, have reported the outcomes of UKA implanted in the setting of ACL deficiency (four series without, six series with ACL reconstruction) at a mean follow-up of 5 years. Overall, the results of UKA alone are inferior to UKA with ACL reconstruction, with the results of UKA with ACL reconstruction being comparable to published outcomes of UKA in the ACL-intact knee.

In arthritic ACL-deficient knees who meet indications for UKA, good outcomes following UKA with ACL reconstruction are seen, with this choice of management having significant advantages in this challenging patient group.

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References

  1. McLean SG, Mallett KF, Arruda EM. Deconstructing the anterior cruciate ligament: what we know and do not know about function, material properties, and injury mechanics. J Biomech Eng. 2015;137(2):020906.

    Article  PubMed  Google Scholar 

  2. Chalmers PN, et al. Does ACL reconstruction alter natural history?: a systematic literature review of long-term outcomes. J Bone Joint Surg Am. 2014;96(4):292–300.

    Article  PubMed  Google Scholar 

  3. Smith TO, et al. Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment. Knee. 2014;21(2):462–70.

    Article  CAS  PubMed  Google Scholar 

  4. Relph N, Herrington L, Tyson S. The effects of ACL injury on knee proprioception: a meta-analysis. Physiotherapy. 2014;100(3):187–95.

    Article  CAS  PubMed  Google Scholar 

  5. Fowler PJ, Regan WD. The patient with symptomatic chronic anterior cruciate ligament insufficiency. Results of minimal arthroscopic surgery and rehabilitation. Am J Sports Med. 1987;15(4):321–5.

    Article  CAS  PubMed  Google Scholar 

  6. Giove TP, et al. Non-operative treatment of the torn anterior cruciate ligament. J Bone Joint Surg Am. 1983;65(2):184–92.

    Article  CAS  PubMed  Google Scholar 

  7. Hawkins RJ, Misamore GW, Merritt TR. Followup of the acute nonoperated isolated anterior cruciate ligament tear. Am J Sports Med. 1986;14(3):205–10.

    Article  CAS  PubMed  Google Scholar 

  8. Kannus P, Jarvinen M. Conservatively treated tears of the anterior cruciate ligament. Long-term results. J Bone Joint Surg Am. 1987;69(7):1007–12.

    Article  CAS  PubMed  Google Scholar 

  9. Kessler MA, et al. Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc. 2008;16(5):442–8.

    Article  CAS  PubMed  Google Scholar 

  10. Lohmander LS, et al. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. 2004;50(10):3145–52.

    Article  CAS  PubMed  Google Scholar 

  11. McDaniel WJ Jr, Dameron TB Jr. The untreated anterior cruciate ligament rupture. Clin Orthop Relat Res. 1983;172:158–63.

    Google Scholar 

  12. Meuffels DE, et al. Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes. Br J Sports Med. 2009;43(5):347–51.

    Article  CAS  PubMed  Google Scholar 

  13. Meunier A, Odensten M, Good L. Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: a randomized study with a 15-year follow-up. Scand J Med Sci Sports. 2007;17(3):230–7.

    CAS  PubMed  Google Scholar 

  14. Myklebust G, et al. Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury: a follow-up study. Am J Sports Med. 2003;31(6):981–9.

    Article  PubMed  Google Scholar 

  15. Neuman P, et al. Prevalence of tibiofemoral osteoarthritis 15 years after nonoperative treatment of anterior cruciate ligament injury: a prospective cohort study. Am J Sports Med. 2008;36(9):1717–25.

    Article  PubMed  Google Scholar 

  16. Noyes FR, et al. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am. 1983;65(2):154–62.

    Article  CAS  PubMed  Google Scholar 

  17. Pattee GA, et al. Four to ten year followup of unreconstructed anterior cruciate ligament tears. Am J Sports Med. 1989;17(3):430–5.

    Article  CAS  PubMed  Google Scholar 

  18. von Porat A, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. 2004;63(3):269–73.

    Article  Google Scholar 

  19. Harman MK, et al. Wear patterns on tibial plateaus from varus and valgus osteoarthritic knees. Clin Orthop Relat Res. 1998;352:149–58.

    Google Scholar 

  20. Rout R, et al. The pattern of cartilage damage in antero-medial osteoarthritis of the knee and its relationship to the anterior cruciate ligament. J Orthop Res. 2013;31(6):908–13.

    Article  CAS  PubMed  Google Scholar 

  21. White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br. 1991;73(4):582–6.

    Article  CAS  PubMed  Google Scholar 

  22. Pandit H, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg Br. 2006;88(7):887–92.

    Article  CAS  PubMed  Google Scholar 

  23. Shelbourne KD, Benner RW. Isolated anterior cruciate ligament reconstruction in the chronic ACL-deficient knee with degenerative medial arthrosis. J Knee Surg. 2007;20(3):216–22.

    Article  PubMed  Google Scholar 

  24. Weston-Simons JS, et al. Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction: a study of 52 cases with mean follow-up of five years. J Bone Joint Surg Br. 2012;94(9):1216–20.

    Article  CAS  PubMed  Google Scholar 

  25. Hasegawa A, et al. Anterior cruciate ligament changes in the human knee joint in aging and osteoarthritis. Arthritis Rheum. 2012;64(3):696–704.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mullaji AB, et al. Cruciate ligaments in arthritic knees: a histologic study with radiologic correlation. J Arthroplasty. 2008;23(4):567–72.

    Article  PubMed  Google Scholar 

  27. Deschamps G, Lapeyre B. Rupture of the anterior cruciate ligament: a frequently unrecognized cause of failure of unicompartmental knee prostheses. Apropos of a series of 79 Lotus prostheses with a follow-up of more than 5 years. Rev Chir Orthop Reparatrice Appar Mot. 1987;73(7):544–51.

    CAS  PubMed  Google Scholar 

  28. Cloutier JM. Results of total knee arthroplasty with a non-constrained prosthesis. J Bone Joint Surg Am. 1983;65(7):906–19.

    Article  CAS  PubMed  Google Scholar 

  29. Cloutier JM, Sabouret P, Deghrar A. Total knee arthroplasty with retention of both cruciate ligaments. A nine to eleven-year follow-up study. J Bone Joint Surg Am. 1999;81(5):697–702.

    Article  CAS  PubMed  Google Scholar 

  30. Dodd M, et al. The pivot shift test is of limited clinical relevance in the arthritic anterior cruciate ligament-deficient knee. J Knee Surg. 2010;23(3):131–5.

    Article  PubMed  Google Scholar 

  31. Hill CL, et al. Cruciate ligament integrity in osteoarthritis of the knee. Arthritis Rheum. 2005;52(3):794–9.

    Article  PubMed  Google Scholar 

  32. Jenny JY, Jenny G. Preservation of anterior cruciate ligament in total knee arthroplasty. Arch Orthop Trauma Surg. 1998;118(3):145–8.

    Article  CAS  PubMed  Google Scholar 

  33. Lee GC, et al. Evaluation of the anterior cruciate ligament integrity and degenerative arthritic patterns in patients undergoing total knee arthroplasty. J Arthroplasty. 2005;20(1):59–65.

    Article  PubMed  Google Scholar 

  34. Johnson AJ, et al. The ACL in the arthritic knee: how often is it present and can preoperative tests predict its presence? Clin Orthop Relat Res. 2013;471(1):181–8.

    Article  PubMed  Google Scholar 

  35. Berend KR, et al. Consensus statement on indications and contraindications for medial unicompartmental knee arthroplasty. J Surg Orthop Adv. 2015;24(4):252–6.

    Article  PubMed  Google Scholar 

  36. Boissonneault A, et al. No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2013;21(11):2480–6.

    Article  PubMed  Google Scholar 

  37. Hamilton TW, et al. Radiological Decision Aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation. Bone Joint J. 2016;98-B(10 Supple B):3–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Keyes GW, et al. The radiographic classification of medial gonarthrosis. Correlation with operation methods in 200 knees. Acta Orthop Scand. 1992;63(5):497–501.

    Article  CAS  PubMed  Google Scholar 

  39. Mullaji AB, Marawar SV, Luthra M. Tibial articular cartilage wear in varus osteoarthritic knees: correlation with anterior cruciate ligament integrity and severity of deformity. J Arthroplasty. 2008;23(1):128–35.

    Article  PubMed  Google Scholar 

  40. Phelan N, et al. A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1525–39.

    Article  PubMed  Google Scholar 

  41. Hamilton TW, et al. Unicompartmental knee replacement: does the macroscopic status of the anterior cruciate ligament affect outcome? Knee. 2016;23(3):506–10.

    Article  CAS  PubMed  Google Scholar 

  42. Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am. 2004;86-A(3):506–11.

    Article  Google Scholar 

  43. Engh GA, Ammeen DJ. Unicondylar arthroplasty in knees with deficient anterior cruciate ligaments. Clin Orthop Relat Res. 2014;472(1):73–7.

    Article  PubMed  Google Scholar 

  44. Goodfellow JW, et al. The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br. 1988;70(5):692–701.

    Article  CAS  PubMed  Google Scholar 

  45. Krishnan SR, Randle R. ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res. 2009;4:43.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Tinius M, Hepp P, Becker R. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):81–7.

    Article  PubMed  Google Scholar 

  47. Ventura A, et al. Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):675–80.

    Article  PubMed  Google Scholar 

  48. Dervin GF, Conway AF, Thurston P. Combined anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty: surgical technique. Orthopedics. 2007;30(5 Suppl):39–41.

    PubMed  Google Scholar 

  49. Tian S, et al. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in knees with osteoarthritis and deficient anterior cruciate ligament. BMC Musculoskelet Disord. 2016;17:327.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hamilton TW, et al. The interaction of caseload and usage in determining outcomes of unicompartmental knee arthroplasty: a meta-analysis. J Arthroplasty. 2017;32(10):3228–3237.e2.

    Article  PubMed  Google Scholar 

  51. Pegg EC, et al. Behaviour of Anterior Cruciate Ligament (ACL) deficient knees after Unicompartmental Knee Arthroplasty (UKA), in American Academy of Orthopaedic Surgeons. 2015: Las Vegas.

    Google Scholar 

  52. Pandit H, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee. 2008;15(2):101–6.

    Article  CAS  PubMed  Google Scholar 

  53. Pegg EC, et al. Sagittal kinematics of mobile unicompartmental knee replacement in anterior cruciate ligament deficient knees. Clin Biomech. 2016;31:33–9.

    Article  Google Scholar 

  54. Suero EM, et al. Effects of tibial slope changes in the stability of fixed bearing medial unicompartmental arthroplasty in anterior cruciate ligament deficient knees. Knee. 2012;19(4):365–9.

    Article  PubMed  Google Scholar 

  55. Brown TD, Bartel DL, G. Implant Wear Symposium Engineering Work. What design factors influence wear behavior at the bearing surfaces in total joint replacements? J Am Acad Orthop Surg. 2008;16(Suppl 1):S101–6.

    Article  PubMed  Google Scholar 

  56. Simpson DJ, et al. The effect of bearing congruency, thickness and alignment on the stresses in unicompartmental knee replacements. Clin Biomech (Bristol, Avon). 2008;23(9):1148–57.

    Article  CAS  Google Scholar 

  57. Blunn GW, et al. Wear in retrieved condylar knee arthroplasties. A comparison of wear in different designs of 280 retrieved condylar knee prostheses. J Arthroplasty. 1997;12(3):281–90.

    Article  CAS  PubMed  Google Scholar 

  58. Mancuso F, et al. Medial unicompartmental knee arthroplasty in the ACL-deficient knee. J Orthop Traumatol. 2016;17(3):267–75.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Hemant Pandit .

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Hamilton, T.W., Pandit, H. (2020). Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Deficiency. In: Gerlinger, T. (eds) Unicompartmental Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-27411-5_12

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  • DOI: https://doi.org/10.1007/978-3-030-27411-5_12

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