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J Knee Surg 2020; 33(11): 1152-1156
DOI: 10.1055/s-0039-1692647
Original Article

Unicompartmental Knee Replacement Combined to Anterior Cruciate Ligament Reconstruction: Midterm Results

Alberto Ventura
1   IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Articular Surgery Center, Milano, Italy
,
Claudio Legnani 
1   IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Articular Surgery Center, Milano, Italy
,
Clara Terzaghi
2   Istituto Clinico Villa Aprica, Department of Orthopaedics, Como, Italy
,
Vittorio Macchi
1   IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Articular Surgery Center, Milano, Italy
,
Enrico Borgo
1   IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Articular Surgery Center, Milano, Italy
› Author Affiliations Funding This research was supported by the Italian Ministry of Health.
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Abstract

A study was conducted to retrospectively evaluate the outcomes of combined medial unicompartmental knee replacement (UKR) and anterior cruciate ligament (ACL) reconstruction. The hypothesis was that this procedure would lead to satisfying results in patients affected by medial osteoarthritis and ACL insufficiency. Fourteen patients with ACL deficiency and concomitant medial compartment symptomatic osteoarthritis were treated from 2006 to 2010. Twelve of them were followed-up for an average time of 7.8 year (range: 6–10 years). Assessment included Knee Osteoarthritis Outcome score (KOOS), Oxford Knee score (OKS), American Knee Society scores (AKSS), Western Ontario and McMaster (WOMAC) index of osteoarthritis, Tegner's activity level, objective examination including instrumented laxity test with KT-1000 arthrometer, and standard X-rays. KOOS score, OKS, WOMAC index, and the AKSS improved significantly at follow-up (p < 0.001). There was no clinical evidence of instability in any of the knees as evaluated with clinical and instrumented laxity testing (p < 0.001). No pathologic radiolucent lines were observed around the components. In one patient, a total knee prosthesis was implanted due to the progression of signs of osteoarthritis in the lateral compartment 3 years after primary surgery. UKR combined with ACL reconstruction is an effective therapeutic option for the treatment of combined medial unicompartmental knee osteoarthritis and ACL deficiency and confirms subjective and objective clinical improvement up to 8 years after surgery. This study reflects level IV evidence.

Keywords

unicompartmental knee replacement - medial osteoarthritis - anterior cruciate ligament - ACL reconstruction


Publication History

Received: 09 March 2018

Accepted: 05 May 2019

Article published online:
03 July 2019

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Simon D, Mascarenhas R, Saltzman BM, Rollins M, Bach Jr BR, MacDonald P. The relationship between anterior cruciate ligament injury and osteoarthritis of the knee. Adv Orthop 2015; 2015: 928301
    CrossrefPubMedGoogle Scholar
  • 2 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
    CrossrefPubMedGoogle Scholar
  • 3 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
    CrossrefPubMedGoogle Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 van der Woude JAD, Wiegant K, van Heerwaarden RJ. et al. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 876-886
    CrossrefPubMedGoogle Scholar
  • 6 Dervin GF, Conway AF, Thurston P. Combined anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty: surgical technique. Orthopedics 2007; 30 (5, Suppl): 39-41
    PubMedGoogle Scholar
  • 7 Krishnan SRSR, Randle R. ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res 2009; 4: 43
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Williams III RJ, Wickiewicz TL, Warren RF. Management of unicompartmental arthritis in the anterior cruciate ligament-deficient knee. Am J Sports Med 2000; 28 (05) 749-760
    CrossrefPubMedGoogle Scholar
  • 10 Brown NM, Sheth NP, Davis K. et al. Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty 2012; 27 (8, Suppl) 86-90
    CrossrefPubMedGoogle Scholar
  • 11 Ghomrawi HM, Eggman AA, Pearle AD. Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the U.S. J Bone Joint Surg Am 2015; 97 (05) 396-402
    CrossrefPubMedGoogle Scholar
  • 12 Fergusson CM. Management of the young patient with an osteoarthritic knee. In: Allum RL, Fergusson CM, Thomas NP. , eds. Clinical Challenges in Orthopaedics: The Knee. London, United Kingdom: Taylor & Francis; 2000: 1-12
    Google Scholar
  • 13 Li Y, Zhang H, Zhang J, Li X, Song G, Feng H. 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 2015; 31 (03) 507-519
    CrossrefPubMedGoogle Scholar
  • 14 Chiba K, Yonekura A, Miyamoto T, Osaki M, Chiba G. Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results. Arch Orthop Trauma Surg 2017; 137 (03) 303-310
    CrossrefPubMedGoogle Scholar
  • 15 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
    CrossrefPubMedGoogle Scholar
  • 16 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
    CrossrefPubMedGoogle Scholar
  • 17 Volpin A, Kini SG, Meuffels DE. Satisfactory outcomes following combined unicompartmental knee replacement and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26 (09) 2594-2601
    CrossrefPubMedGoogle Scholar
  • 18 Goodfellow J, O'Connor J, Pandit H, Dodd C, Murray D. Unicompartmental Arthroplasty with the Oxford Knee. 1st ed. Oxford: Oxford University Press; 2006: 117-128
    Google Scholar
  • 19 Liddle AD, Judge A, Pandit H, Murray DW. 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 2014; 384 (9952): 1437-1445
    CrossrefPubMedGoogle Scholar
  • 20 Yucens M, Aydemir AN. Trends in anterior cruciate ligament reconstruction in the last decade: a web-based analysis. J Knee Surg 2018; ; ( e-pub ahead of print) DOI: 10.1055/s-0038-1655764.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Adravanti P, Dini F, de Girolamo L, Cattani M, Rosa MA. Single-bundle versus double-bundle anterior cruciate ligament reconstruction: a prospective randomized controlled trial with 6-year follow-up. J Knee Surg 2017; 30 (09) 898-904
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Rubinstein Jr. RA, Shelbourne KD, VanMeter CD, McCarroll JC, Rettig AC. Isolated autogenous bone-patellar tendon-bone graft site morbidity. Am J Sports Med 1994; 22 (03) 324-327
    CrossrefPubMedGoogle Scholar
  • 23 Brown MJ, Carter T. ACL allograft: advantages and when to use. Sports Med Arthrosc Rev 2018; 26 (02) 75-78
    CrossrefPubMedGoogle Scholar
  • 24 Legnani C, Zini S, Borgo E, Ventura A. Can graft choice affect return to sport following revision anterior cruciate ligament reconstruction surgery?. Arch Orthop Trauma Surg 2016; 136 (04) 527-531
    Google Scholar
  • 25 Kim SG, Kim SH, Kim JG, Jang KM, Lim HC, Bae JH. Hamstring autograft maturation is superior to tibialis allograft following anatomic single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1281-1287
    PubMedGoogle Scholar