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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2017

01-03-2017 | Knee

Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction

Authors: Alberto Ventura, Claudio Legnani, Clara Terzaghi, Stefano Iori, Enrico Borgo

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2017

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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.
Literature
1.
go back to reference 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 15:1833PubMed 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 15:1833PubMed
2.
go back to reference Biswal S, Brighton RW (2010) Results of unicompartmental knee arthroplasty with cemented, fixed-bearing prosthesis using minimally invasive surgery. J Arthroplasty 25:721–727CrossRefPubMed Biswal S, Brighton RW (2010) Results of unicompartmental knee arthroplasty with cemented, fixed-bearing prosthesis using minimally invasive surgery. J Arthroplasty 25:721–727CrossRefPubMed
3.
go back to reference 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 21:2480–2486CrossRefPubMed 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 21:2480–2486CrossRefPubMed
4.
go back to reference 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 27:86–90CrossRefPubMed 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 27:86–90CrossRefPubMed
5.
go back to reference Dawson J, Fitzpatrick R, Murray D, Carr A (1988) Questionnaire on the perception of patients about total knee replacement. J Bone Joint Surg Br 80:63–69CrossRef Dawson J, Fitzpatrick R, Murray D, Carr A (1988) Questionnaire on the perception of patients about total knee replacement. J Bone Joint Surg Br 80:63–69CrossRef
6.
go back to reference Dervin GF, Conway AF, Thurston P (2007) Combined anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty: surgical technique. Orthopedics 30:39–42PubMed Dervin GF, Conway AF, Thurston P (2007) Combined anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty: surgical technique. Orthopedics 30:39–42PubMed
7.
go back to reference 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 79:575–582CrossRefPubMed 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 79:575–582CrossRefPubMed
8.
go back to reference 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 428:170–173CrossRef 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 428:170–173CrossRef
9.
go back to reference 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 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
10.
go back to reference 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 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
11.
go back to reference Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rational of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14 Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rational of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
12.
go back to reference 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 7:710–715CrossRefPubMed 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 7:710–715CrossRefPubMed
13.
go back to reference Krishnan SRSR, Randle R (2009) ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res 4:43CrossRefPubMedPubMedCentral Krishnan SRSR, Randle R (2009) ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res 4:43CrossRefPubMedPubMedCentral
14.
go back to reference 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 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
15.
go back to reference 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 21:702–707CrossRefPubMed 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 21:702–707CrossRefPubMed
16.
go back to reference 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 31:507–519CrossRefPubMed 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 31:507–519CrossRefPubMed
17.
go back to reference 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 384:1437–1445CrossRefPubMed 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 384:1437–1445CrossRefPubMed
18.
19.
go back to reference 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 20:461–465CrossRefPubMed 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 20:461–465CrossRefPubMed
20.
go back to reference 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 88:887–892CrossRefPubMed 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 88:887–892CrossRefPubMed
21.
go back to reference Plancher KD, Dunn ASM, Petterson SC (2014) The anterior cruciate ligament. Deficient knee and unicompartmental arthritis. Clin Sports Med 33:43–55CrossRefPubMed Plancher KD, Dunn ASM, Petterson SC (2014) The anterior cruciate ligament. Deficient knee and unicompartmental arthritis. Clin Sports Med 33:43–55CrossRefPubMed
22.
go back to reference 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 28:88–96CrossRef 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 28:88–96CrossRef
23.
go back to reference 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 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
24.
go back to reference 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 23:184–187CrossRefPubMed 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 23:184–187CrossRefPubMed
25.
go back to reference 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 19:224–229CrossRefPubMed 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 19:224–229CrossRefPubMed
26.
go back to reference Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49 Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
27.
go back to reference Tinius M, Hepp P, Becker R (2012) Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:81–87CrossRefPubMed Tinius M, Hepp P, Becker R (2012) Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:81–87CrossRefPubMed
28.
go back to reference 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 94:1216–1220CrossRefPubMed 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 94:1216–1220CrossRefPubMed
29.
go back to reference 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 468:73–81CrossRefPubMed 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 468:73–81CrossRefPubMed
30.
go back to reference Williams RJ III, Wickiewicz TL, Warren RF (2000) Management of unicompartmental arthritis in the anterior cruciate ligament-deficient knee. Am J Sports Med 28:749–760CrossRefPubMed Williams RJ III, Wickiewicz TL, Warren RF (2000) Management of unicompartmental arthritis in the anterior cruciate ligament-deficient knee. Am J Sports Med 28:749–760CrossRefPubMed
31.
go back to reference 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 135:709–713CrossRefPubMed 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 135:709–713CrossRefPubMed
Metadata
Title
Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction
Authors
Alberto Ventura
Claudio Legnani
Clara Terzaghi
Stefano Iori
Enrico Borgo
Publication date
01-03-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3808-0

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