No Difference Unicompartmental Knee Arthroplasty for Medial Knee Osteoarthritis With or Without Anterior Cruciate Ligament Deficiency: A Systematic Review and Meta-analysis

Du, Genfa; Qiu, Hongtao; Zhu, Jianzong; Wang, Hongbo; Xiao, Qingnong; Zhang, Zhen; Lin, Xiaotong; Zheng, Guangming

doi:10.1016/j.arth.2022.10.018

Cited by 10 publications

(5 citation statements)

References 37 publications

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“…Ideally, suitable candidates for medial UKA are MOA patients who have intact ACL. Due to its minimally invasive nature and preservation of proprioception, along with excellent surgical outcomes, the indications for medial UKA are expanding to include patients with anterior cruciate ligament deficiency (ACLD) [4][5][6][7]. In a normal knee joint, the ACL plays a crucial role in knee joint movement and maintaining stability.…”

Section: Introductionmentioning

confidence: 99%

“…However, recent research has challenged previous conclusions and showed that UKA can successfully treat ACLD knee joints. Studies by Boissonneault et al and Kikuchi et al have indicated that the component survival rates in recipients of UKA with intact and absent ACL were similar during an average follow-up of 5 years [ 4 , 11 ]. Another research report that there is no difference in revision rates and functional outcomes between the ACLD group and the ACL-intact group [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Anterior cruciate ligament injury should not be considered a contraindication for medial unicompartmental knee arthroplasty: Finite element analysis

Ou,

Ye,

Pan

et al. 2024

PLoS ONE

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Purpose The research objective of this study is to use finite element analysis to investigate the impact of anterior cruciate ligament (ACL) injury on medial unicompartmental knee arthroplasty (UKA) and explore whether patients with ACL injuries can undergo UKA. Methods Based on the morphology of the ACL, models of ACL with diameters ranging from 1 to 10mm are created. Finite element models of UKA include ACL absence and ACLs with different diameters. After creating a complete finite element model and validating it, four different types of loads are applied to the knee joint. Statistical analysis is conducted to assess the stress variations in the knee joint structure. Results A total of 11 finite element models of UKA were established. Regarding the stress on the ACL, as the diameter of the ACL increased, when a vertical load of 750N was applied to the femur, combined with an anterior tibial load of 105N, the stress on the ACL increased from 2.61 MPa to 4.62 MPa, representing a 77.05% increase. Regarding the equivalent stress on the polyethylene gasket, a notable high stress change was observed. The stress on the gasket remained between 12.68 MPa and 14.33 MPa in all models. the stress on the gasket demonstrated a decreasing trend. The equivalent stress in the lateral meniscus and lateral femoral cartilage decreases, reducing from the maximum stress of 4.71 MPa to 2.61 MPa, with a mean value of 3.73 MPa. This represents a reduction of 44.72%, and the statistical significance is (P < 0.05). However, under the other three loads, there was no significant statistical significance (P > 0.05). Conclusion This study suggests that the integrity of the ACL plays a protective role in performing medial UKA. However, this protective effect is limited when performing medial UKA. When the knee joint only has varying degrees of ACL injury, even ACL rupture, and the remaining structures of the knee joint are intact with anterior-posterior stability in the knee joint, it should not be considered a contraindication for medial UKA.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anterior cruciate ligament injury should not be considered a contraindication for medial unicompartmental knee arthroplasty: Finite element analysis

Ou,

Ye,

Pan

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

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“…UKA has also been shown to be effective in various difficult scenarios, including reoperation following high tibial osteotomy (HTO) failure and UKA combined with anterior cruciate ligament reconstruction (ACLR) for treating unicompartmental OA with compromised anterior cruciate ligament function, all of which have demonstrated satisfactory outcomes [2,3]. The indication for traditional UKA is intact ligament function [4]. Studies have shown that for patients with unicompartmental OA of the knee and anterior cruciate ligament (ACL) injury, combining UKA with ACL reconstruction (ACLR) can yield satisfactory outcomes [5,6].…”

Section: Introductionmentioning

confidence: 99%

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

Zheng,

Du,

Chu

et al. 2024

BMC Musculoskelet Disord

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Background In this study, we present the unique case of a patient with knee osteoarthritis (OA) of the medial compartment and posterior cruciate ligament (PCL) deficiency who underwent simultaneous medial unicompartmental knee arthroplasty (UKA) and PCL reconstruction. Case presentation A 49-year-old male patient presented with a 1-year history of pain and instability in the left knee. The patient had previously experienced a trauma-related injury to the PCL of the left knee that was left untreated. Imaging and physical examination confirmed the presence of left medial knee OA along with PCL rupture. To address these issues, the patient underwent UKA combined with PCL reconstruction. The patient’s Lysholm score was 47 before surgery and 81 three months after surgery, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 29 before surgery and 18 three months after surgery, and the International Knee Documentation Committee (IKDC) subjective score was 56.3 before surgery and 74.7 three months after surgery. Six months after surgery, the patient's gait returned to normal, and he was able to jog. Conclusion This case report presents the first instance of UKA combined with PCL reconstruction and introduces a novel treatment approach for patients suffering from medial knee OA and ligament injury.

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“…Surgical decisions in patients with end-stage knee osteoarthritis (KOA) are directly subject to the functional status of the anterior cruciate ligament (ACL). For patients with anteromedial osteoarthritis (AMOA), a functionally intact ACL is usually considered to be a prerequisite for unicompartmental knee arthroplasty (UKA) [ 1 – 3 ], although no significant difference has been found between ACL-intact and ACL-deficient UKAs in terms of some knee joint functional scores [ 4 ]. Surgeons tend to perform total knee arthroplasty (TKA) or UKA in combination with ACL reconstruction in patients with ACL deficiency and antero-posterior instability.…”

Section: Introductionmentioning

confidence: 99%

“…, although no significant difference has been found between ACL-intact and ACL-deficient UKAs in terms of some knee joint functional scores [4]. Surgeons tend to perform total knee arthroplasty (TKA) or UKA in combination with ACL reconstruction in patients with ACL deficiency and antero-posterior instability.…”

mentioning

confidence: 99%

Is conventional magnetic resonance imaging superior to radiography in the functional integrity evaluation of anterior cruciate ligament in patients with knee osteoarthritis?

Yu,

Wang,

Wang

et al. 2024

Arthroplasty

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Background The functional integrity of the anterior cruciate ligament (ACL) influences surgical decision-making in patients with knee osteoarthritis (KOA). This study aimed to compare the diagnostic value of radiography and magnetic resonance imaging (MRI) in determining the functional status of ACL. Methods We analyzed 306 knees retrospectively using preoperative hip-to-ankle anteroposterior standing (APS) radiographs, anteroposterior (AP) and lateral knee radiographs, AP valgus stress (VS) force radiographs, and standard orthogonal MRI. Based on the intraoperative visualization, the knees were grouped into ACL functionally-intact and ACL functionally-deficient (ACLD) groups. The diagnostic validity and reliability were calculated based on the radiograph parameters such as hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), posterior tibial slope (PTS), sagittal tibiofemoral subluxation (STFS), coronal tibiofemoral subluxation (CTFS), joint line convergence angle (JLCA), the maximum wear point of the proximal tibia plateau (MWPPT%), and MRI parameters including ACL grades and MWPPT%. Results HKA, MPTA, PTS, STFS, JLCA, and CTFS on APS and AP radiographs, and MWPPT% on radiographs and MRI showed a significant diagnostic value (P < 0.05). There were no statistically significant differences in the single parameters from radiographs and MRI. After constructing the logistic regression models, MRI showed higher sensitivity, specificity, and accuracy, reaching 96.8%, 79.9%, and 83.3%, respectively (P < 0.001). Conclusions In patients with KOA, the diagnostic value of single radiographic or MRI parameter in assessing the functional integrity of the ACL are equivalent. However, by constructing predictive models, MRI could significantly improve diagnostic validity compared with radiography.

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No Difference Unicompartmental Knee Arthroplasty for Medial Knee Osteoarthritis With or Without Anterior Cruciate Ligament Deficiency: A Systematic Review and Meta-analysis

Cited by 10 publications

References 37 publications

Anterior cruciate ligament injury should not be considered a contraindication for medial unicompartmental knee arthroplasty: Finite element analysis

Anterior cruciate ligament injury should not be considered a contraindication for medial unicompartmental knee arthroplasty: Finite element analysis

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

Is conventional magnetic resonance imaging superior to radiography in the functional integrity evaluation of anterior cruciate ligament in patients with knee osteoarthritis?

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