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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 1, pp 112–122 | Cite as

Clinical outcome after UKA and HTO in ACL deficiency: a systematic review

  • Francesco Mancuso
  • Thomas W. Hamilton
  • Vijay Kumar
  • David W. Murray
  • Hemant Pandit
Knee

Abstract

Purpose

In the treatment of medial osteoarthritis secondary to anterior cruciate ligament (ACL) injury there is no consensus about optimum treatment, with both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) being viable options. The aim of this review was to compare the outcomes of these treatments, both with or without ACL reconstruction.

Methods

EMBASE, MEDLINE and the Clinical Trials Registers were searched to identify relevant studies. Studies meeting pre-defined inclusion criteria were assessed independently by two researchers for methodological quality and data extracted.

Results

Twenty-six studies involving 771 patients were identified for inclusion. No randomized controlled trials were identified. Seventeen studies reported outcomes following HTO and nine studies reported outcomes following UKA. HTO patients were significantly younger than those receiving UKA, and ACL reconstruction patients were younger than non-reconstructed patients. Treatment with HTO ACL reconstruction had the lowest revision rate (0.62/100 observed component years) but the highest rate of complications (4.61/100 observed component years). Too little data were available to test for differences in outcome between different surgical techniques or prosthesis designs.

Conclusions

Limited conclusions about the optimum treatment can be made due to the absence of controlled trials. In patients treated with HTO ACL reconstruction, the high complication rate likely outweighs its minimally superior survival. Outcomes following UKA ACL reconstruction are similar to outcomes for UKA in the ACL intact knee without any increase in complications. As such in patients meeting indications for UKA, UKA ACL reconstruction should be performed with further work required to identify the optimum treatment in other patient groups.

Level of evidence

IV.

Keywords

Medial compartment osteoarthritis Anterior cruciate ligament deficiency Anterior cruciate ligament reconstruction High tibial osteotomy Unicompartmental knee arthroplasty 

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014

Authors and Affiliations

  • Francesco Mancuso
    • 1
  • Thomas W. Hamilton
    • 2
  • Vijay Kumar
    • 3
  • David W. Murray
    • 2
  • Hemant Pandit
    • 2
  1. 1.Clinic of Orthopaedics and TraumatologyUniversity of UdineUdineItaly
  2. 2.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)University of OxfordOxfordUK
  3. 3.All India Institute of Medical SciencesNew DelhiIndia

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