Young and more active patients with medial compartmental osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency are challenging for orthopaedic surgeons. The aim of the present study was to examine the early–mid clinical and radiological outcomes of combined Oxford unicondylar knee arthroplasty (UKA) and ACL reconstruction for the patients presenting ACL deficiency and concomitant medial compartment symptomatic OA. Twelve patients were included in the study. All patients were treated by combination of ACL reconstruction with medial UKA. The varus–valgus angles of the tibial and femoral components, and pathological radiolucent lines were measured on anteroposterior and lateral knee radiographs. Clinical evaluations include knee osteoarthritis outcome score (KOOS pain, symptom, daily life, sports, and quality of life), Oxford knee score (OKS), EQ-5D-3L, and EQ-visual analog scale (VAS). All the patients were followed up for an average of 45.6 months. The leg alignment showed 3.6 degrees ± 1 of varus deformity before surgery and 2.6 degrees ± 1 of valgus after surgery. With the exception of KOOS sports (p > 0.001), the KOOS pain, symptom, daily life, and quality of life, OKS, EQ-5D-3L, and EQ-VAS improved significantly after surgery (p < 0.001). Preoperative knee instability showed anterior translation of 5 to 10 mm in eight patients and >10 mm in four patients. There were no complications at follow-up. The early–mid clinical data have shown that UKA in conjunction with ACL reconstruction has revealed promising results. However, long-term follow-up studies are required to confirm the combined procedure in these patients.

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