Combined treatment with medial unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction is effective on long-term follow-up

Abstract

Purpose The purpose of the present study was to evaluate the long-term outcome of combined medial unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament reconstruction (ACLR). The authors hypothesized that the combined procedure leads to good long-term outcome in patients with isolated medial knee osteoarthritis (OA) and anterior cruciate ligament (ACL) deficiency. Methods Twenty-three patients with ACL deficiency and concomitant medial knee OA were treated from 2008 to 2016 with a combined UKA (Oxford Partial Knee) and ACLR using a hamstring tendon autograft. The follow-up assessment included VAS pain score, Lysholm score, Oxford Knee Score (OKS), American Knee Society scores (AKSS), International Knee Documentation Committee (IKDC 2000), Tegner and UCLA activity scores. Instrumented laxity test was done using the KT-1000 arthrometer. Survivorship analysis was performed using the Kaplan–Meier method. Implant loosening and disease progression was assessed by conventional radiography. Results Average follow-up duration was 10 years (6–14.5). VAS, Lysholm, Tegner and UCLA scores improved significantly. OKS, AKSS and IKDC 2000 showed excellent results on follow-up. Implant survivorship was 91.4% at 14.5 years. There were 2 revisions with conversion to total knee arthroplasty at 6 and 12 years postoperatively due to trauma and disease progression, respectively. There were no radiological or clinical signs of instability or disease progression in any of the remaining knees. The side-to-side difference using the KT-1000 arthrometer was insignificant. Conclusions UKA combined with ACLR is an effective therapeutic option with good outcome and return to sport rate on the long-term. Level of evidence IV.

Unicompartmental knee arthroplasty combined with posterior cruciate ligament reconstruction: a case report

“…Jaber et al studied 23 patients who underwent ACLR combined with UKA, all of whom underwent Oxford UKA with autologous hamstring tendons. The functional scores of the patients significantly improved after surgery, and the survival rate was 91.4% at the 14.5year follow-up [16]. In another study, Foissey et al performed ACLR combined with robot-guided FB UKA on 10 patients using autologous tendons, and 9 patients returned to sports, but 2 patients underwent arthroscopic release surgery for joint stiffness [17].…”

“…For patients with significant varus and large osteophytes on the medial side of the knee joint, TKA is the primary surgical option. However, the combination of ACLR and UKA has been shown to be nearly as effective as TKA [16,18]. Some studies suggest that complete removal of medial osteophytes during UKA may result in MCL relaxation and the potential risk of bearing dislocation.…”

Unicompartmental knee replacement combined with anterior cruciate ligament reconstruction provides comparable results to total knee replacement with no increased risk of complications

“…Jaber et al followed up for 10 years 23 patients who had undergone mobile-bearing UKR combined with ACL reconstruction [ 12 ]. The average Lysholm score was 85.5, while the mean OKS was 40.…”

“…Eventually, concerning patients’ selection, only patients with OA secondary to ACL deficiency should be eligible for this combined procedure. In fact, for patients whose main problem is cartilage deterioration and secondary ACL instability, TKR should be preferred due to the presence of contracture to the medial collateral ligament and wear on the other compartments [ 12 , 20 ].…”

“…For these reasons, more recently, ACL-deficient patients with isolated medial OA demonstrated to benefit from fixedbearing UKR implanted with a lower grade of tibial slope in order to compensate for anterior tibial translation [6]. However, to overcome the potential risks of posterior femoral shift brought by ACL insufficiency and increased incidence of aseptic loosening, a surgical strategy allowing concomitant UKR and ACL reconstruction has been successfully proposed (Table 1) [7][8][9][10][11][12][13][14][15][16][17][18][19].…”