Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Deficiency

  • Thomas W. Hamilton
  • Hemant PanditEmail author


The management of the arthritic anterior cruciate ligament (ACL)-deficient knee remains a significant challenge to surgeons, as these patients are often young with high functional demands. While unicompartmental knee arthroplasty (UKA) would appear to have significant advantages, it has historically been considered contraindicated due to an increased incidence of aseptic loosening.

Around one-third of knees undergoing arthroplasty have been reported as being ACL deficient, with half of these being contraindicated for UKA, based on the pathoanatomy of disease, most commonly due to involvement of both tibiofemoral compartments.

Ten case series, 308 knees, have reported the outcomes of UKA implanted in the setting of ACL deficiency (four series without, six series with ACL reconstruction) at a mean follow-up of 5 years. Overall, the results of UKA alone are inferior to UKA with ACL reconstruction, with the results of UKA with ACL reconstruction being comparable to published outcomes of UKA in the ACL-intact knee.

In arthritic ACL-deficient knees who meet indications for UKA, good outcomes following UKA with ACL reconstruction are seen, with this choice of management having significant advantages in this challenging patient group.


Unicompartmental knee arthroplasty Anterior cruciate ligament Patient selection Clinical outcomes Implant survival 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK
  2. 2.Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of LeedsLeedsUK

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