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Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the present study was to retrospectively evaluate the outcomes of patients who underwent combined medial unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament (ACL) reconstruction. The hypothesis was that this procedure would lead to a high success rate in patients affected by isolated medial unicompartmental osteoarthritis and concomitant ACL deficiency.

Methods

Fourteen patients with primary ACL lesion and concomitant medial compartment symptomatic osteoarthritis treated from 2006 to 2010 were followed up for an average time of 26.7 months (SD 4.2). Assessment included KOOS score, Oxford Knee score, American Knee Society scores, WOMAC index of osteoarthritis, Tegner activity level and objective examination including instrumented laxity test with KT-1000 arthrometer. Radiological assessment was done with standard simple radiographs in order to get information about any presence of loosening of the components.

Results

KOOS score, OKS, WOMAC index and the AKSS improved significantly after surgery (p < 0.001). Regarding AKSS, improvement was noted both in the objective score and in the functional one (p < 0.001). There was no clinical evidence of instability in any of the knees as evaluated with clinical laxity testing. No pathologic radiolucent lines were observed around the components. In one patient signs of osteoarthritis in the lateral compartment were observed 28 months after surgery.

Conclusions

UKA combined with ACL reconstruction is a valid therapeutic option for the treatment of combined medial unicompartmental knee osteoarthritis and ACL deficiency in young and active patients and confirms subjective and objective clinical improvement 2 years after surgery. The use of a fixed-bearing prosthesis represents a reliable feature as it allows to overcome problems of improper ligament tensioning during the implantation of the components.

Level of evidence

IV.

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References

  1. Bellamy N, Buchanan WW, Goldsmith CH, Campdell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833

    CAS  PubMed  Google Scholar 

  2. Biswal S, Brighton RW (2010) Results of unicompartmental knee arthroplasty with cemented, fixed-bearing prosthesis using minimally invasive surgery. J Arthroplasty 25:721–727

    Article  PubMed  Google Scholar 

  3. Boissonneault A, Pandit H, Pegg E, Jenkins C, Gill HS, Dodd CA et al (2013) No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 21:2480–2486

    Article  PubMed  Google Scholar 

  4. Brown NM, Sheth NP, Davis K, Berend ME, Lombardi AV, Berend KR, Della Valle CJ (2012) Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty 27:86–90

    Article  PubMed  Google Scholar 

  5. Dawson J, Fitzpatrick R, Murray D, Carr A (1988) Questionnaire on the perception of patients about total knee replacement. J Bone Joint Surg Br 80:63–69

    Article  Google Scholar 

  6. Dervin GF, Conway AF, Thurston P (2007) Combined anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty: surgical technique. Orthopedics 30:39–42

    PubMed  Google Scholar 

  7. Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D (1997) Total knee replacement in young, active patients: long-term follow-up and functional outcome. J Bone Joint Surg Am 79:575–582

    Article  CAS  PubMed  Google Scholar 

  8. Engh GA, Ammeen D (2004) Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement? Clin Orthop Relat Res 428:170–173

    Article  Google Scholar 

  9. Fergusson CM (2000) Management of the young patient with an osteoarthritic knee. In: Allum RL, Fergusson CM, Thomas NP (eds) Clinical challenges in orthopaedics: the knee. Martin Dunitz Ltd, London, pp 1–12

    Google Scholar 

  10. Goodfellow JW, Kershaw CJ, Benson MK, O’Connor JJ (1988) The Oxford knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br 70:672–701

    Google Scholar 

  11. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rational of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  12. Kretzer JP, Jakubowitz E, Reinders J, Lietz E, Moradi B, Hofmann K, Sonntag R (2011) Wear analysis of unicondylar mobile bearing and fixed bearing knee systems: a knee simulator study. Acta Biomater 7:710–715

    Article  PubMed  Google Scholar 

  13. Krishnan SRSR, Randle R (2009) ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res 4:43

    Article  PubMed  PubMed Central  Google Scholar 

  14. Laurencin CT, Zelicof SB, Scott RD, Ewald FC (1991) Unicompartmental versus total knee arthroplasty in the same patient: a comparative study. Clin Orthop Relat Res 273:157–164

    Google Scholar 

  15. Lee YS, Jeong YM, Sim JA, Kwak JH, Kim KH, Nam SW et al (2013) Specific compartmental analysis of cartilage status in double-bundle ACL reconstruction patients: a comparative study using pre- and postoperative MR images. Knee Surg Sports Traumatol Arthrosc 21:702–707

    Article  PubMed  Google Scholar 

  16. Li Y, Zhang H, Zhang J, Li X, Song G, Feng H (2015) Clinical outcome of simultaneous high tibial osteotomy and anterior cruciate ligament reconstruction for medial compartment osteoarthritis in young patients with anterior cruciate ligament-deficient knees: a systematic review. Arthroscopy 31:507–519

    Article  PubMed  Google Scholar 

  17. Liddle AD, Judge A, Pandit H, Murray DW (2014) Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 384:1437–1445

    Article  PubMed  Google Scholar 

  18. Mancuso F, Hamilton TW, Kumar V, Murray DW, Pandit H (2014) Clinical outcome after UKA and HTO in ACL deficiency: a systematic review. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3346-1

    PubMed  Google Scholar 

  19. Murray DW, Pandit H, Weston-Simons JS, Jenkins C, Gill HS, Lombardi AV et al (2013) Does body mass index affect the outcome of unicompartmental knee replacement? Knee 20:461–465

    Article  CAS  PubMed  Google Scholar 

  20. Pandit H, Beard DJ, Jenkins C, Kimstra Y, Thomas NP, Dodd CAF et al (2006) Combined anterior cruciate ligament reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg Br 88:887–892

    Article  CAS  PubMed  Google Scholar 

  21. Plancher KD, Dunn ASM, Petterson SC (2014) The anterior cruciate ligament. Deficient knee and unicompartmental arthritis. Clin Sports Med 33:43–55

    Article  PubMed  Google Scholar 

  22. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS) development of a self-administered outcome measure. J Orhtop Sports Phys Ther 28:88–96

    Article  CAS  Google Scholar 

  23. Schwab PE, Lavand’homme P, Yombi JC, Thienpont E (2014) Lower blood loss after unicompartmental than total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3188-x

    Google Scholar 

  24. Sofu H, Yildirim T, Gursu S, Issin A, Şahin V (2015) Short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23:184–187

    Article  PubMed  Google Scholar 

  25. Suggs JF, Li G, Park SE, Steffensmeier S, Rubash HE, Freiberg AA (2004) Function of the anterior cruciate ligament after unicompartmental knee arthroplasty: an in vivo robotic study. J Arthroplasty 19:224–229

    Article  PubMed  Google Scholar 

  26. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  27. Tinius M, Hepp P, Becker R (2012) Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:81–87

    Article  PubMed  Google Scholar 

  28. Weston-Simons JS, Pandit H, Jenkins C, Jackson WF, Price AJ, Gill HS et al (2012) 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 94:1216–1220

    Article  CAS  PubMed  Google Scholar 

  29. Whittaker JP, Naudie DD, McAuley JP, McCalden RW, Mac-Donald SJ, Bourne RB (2010) Does bearing design influence midterm survivorship of unicompartmental arthroplasty? Clin Orthop Relat Res 468:73–81

    Article  PubMed  Google Scholar 

  30. Williams RJ III, Wickiewicz TL, Warren RF (2000) Management of unicompartmental arthritis in the anterior cruciate ligament-deficient knee. Am J Sports Med 28:749–760

    Article  PubMed  Google Scholar 

  31. Zhang Q, Zhang Q, Guo W, Liu Z, Cheng L, Zhu G (2015) No need for use of drainage after minimally invasive unicompartmental knee arthroplasty: a prospective randomized, controlled trial. Arch Orthop Trauma Surg 135:709–713

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank Dr. Valentina Ferrari, MD, for her contribution to data acquisition for this study.

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Authors and Affiliations

  1. Minimally Invasive Articular Surgery Unit, Istituto Ortopedico G. Pini, Milan, Italy

    Alberto Ventura, Claudio Legnani, Clara Terzaghi & Enrico Borgo

  2. Rheumatoid Arthritis Surgery Center, Istituto Ortopedico G. Pini, Milan, Italy

    Stefano Iori

Authors
  1. Alberto Ventura
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  2. Claudio Legnani
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  3. Clara Terzaghi
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  4. Stefano Iori
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  5. Enrico Borgo
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Correspondence to Alberto Ventura.

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Ventura, A., Legnani, C., Terzaghi, C. et al. Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 25, 675–680 (2017). https://doi.org/10.1007/s00167-015-3808-0

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  • DOI: https://doi.org/10.1007/s00167-015-3808-0

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