J Knee Surg 2022; 35(10): 1087-1090
DOI: 10.1055/s-0040-1722322
Original Article

Outcomes of Combined Unicondylar Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction

Hakan Aslan
1   Department of Orthopaedics and Traumatology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
,
1   Department of Orthopaedics and Traumatology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
› Author Affiliations

Abstract

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.



Publication History

Received: 10 December 2019

Accepted: 12 November 2020

Article published online:
05 February 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Banks SA, Fregly BJ, Boniforti F, Reinschmidt C, Romagnoli S. Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc 2005; 13 (07) 551-556
  • 2 Tinius M, Hepp P, Becker R. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20 (01) 81-87
  • 3 Ackroyd CE, Whitehouse SL, Newman JH, Joslin CC. A comparative study of the medial St Georg sled and kinematic total knee arthroplasties. Ten-year survivorship. J Bone Joint Surg Br 2002; 84 (05) 667-672
  • 4 Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 2009; 91 (01) 52-57
  • 5 Schwab PE, Lavand'homme P, Yombi JC, Thienpont E. Lower blood loss after unicompartmental than total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3494-3500
  • 6 Mancuso F, Hamilton TW, Kumar V, Murray DW, Pandit H. Clinical outcome after UKA and HTO in ACL deficiency: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24 (01) 112-122
  • 7 Weston-Simons JS, Pandit H, Jenkins C. et al. 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 2012; 94 (09) 1216-1220
  • 8 Lee YS, Jeong YM, Sim JA. et al. 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 2013; 21 (03) 702-707
  • 9 Zhang Q, Zhang Q, Guo W, Liu Z, Cheng L, Zhu G. No need for use of drainage after minimally invasive unicompartmental knee arthroplasty: a prospective randomized, controlled trial. Arch Orthop Trauma Surg 2015; 135 (05) 709-713
  • 10 Dervin GF, Conway AF, Thurston P. Combined anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty: surgical technique. Orthopedics 2007; 30 (5, Suppl): 39-41
  • 11 Krishnan SR, Randle R. ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res 2009; 4: 43
  • 12 Pandit H, Beard DJ, Jenkins C. et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg Br 2006; 88 (07) 887-892
  • 13 McEwen HM, Barnett PI, Bell CJ. et al. The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech 2005; 38 (02) 357-365
  • 14 Ventura A, Legnani C, Terzaghi C, Iori S, Borgo E. Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 675-680
  • 15 Kennedy JA, Molloy J, Mohammad HR, Mellon SJ, Dodd CAF, Murray DW. Mid- to long-term function and implant survival of ACL reconstruction and medial Oxford UKR. Knee 2019; 26 (04) 897-904
  • 16 Engh GA, Ammeen D. Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement?. Clin Orthop Relat Res 2004; (428) 170-173
  • 17 Mahfouz MR, Komistek RD, Dennis DA, Hoff WA. In vivo assessment of the kinematics in normal and anterior cruciate ligament-deficient knees. J Bone Joint Surg Am 2004; 86-A (Suppl. 02) 56-61
  • 18 Bartley RE, Stulberg SD, Robb III WJ, Sweeney HJ. Polyethylene wear in unicompartmental knee arthroplasty. Clin Orthop Relat Res 1994; (299) 18-24
  • 19 Pandit H, Van Duren BH, Gallagher JA. et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee 2008; 15 (02) 101-106
  • 20 Gleeson RE, Evans R, Ackroyd CE, Webb J, Newman JH. Fixed or mobile bearing unicompartmental knee replacement? A comparative cohort study. Knee 2004; 11 (05) 379-384
  • 21 Murray DW, Goodfellow JW, O'Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 1998; 80 (06) 983-989
  • 22 Whittaker JP, Naudie DD, McAuley JP, McCalden RW, MacDonald SJ, Bourne RB. Does bearing design influence midterm survivorship of unicompartmental arthroplasty?. Clin Orthop Relat Res 2010; 468 (01) 73-81
  • 23 Tian S, Wang B, Wang Y, Ha C, Liu L, Sun K. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in knees with osteoarthritis and deficient anterior cruciate ligament. BMC Musculoskelet Disord 2016; 17: 327
  • 24 Kretzer JP, Jakubowitz E, Reinders J. et al. Wear analysis of unicondylar mobile bearing and fixed bearing knee systems: a knee simulator study. Acta Biomater 2011; 7 (02) 710-715
  • 25 Rougraff BT, Heck DA, Gibson AE. A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis. Clin Orthop Relat Res 1991; (273) 157-164
  • 26 Price AJ, Dodd CA, Svard UG, Murray DW. Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Joint Surg Br 2005; 87 (11) 1488-1492
  • 27 Laurencin CT, Zelicof SB, Scott RD, Ewald FC. Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res 1991; (273) 151-156