Advertisement

Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Deficiency

  • Thomas W. Hamilton
  • Hemant PanditEmail author
Chapter

Abstract

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.

Keywords

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

References

  1. 1.
    McLean SG, Mallett KF, Arruda EM. Deconstructing the anterior cruciate ligament: what we know and do not know about function, material properties, and injury mechanics. J Biomech Eng. 2015;137(2):020906.CrossRefPubMedGoogle Scholar
  2. 2.
    Chalmers PN, et al. Does ACL reconstruction alter natural history?: a systematic literature review of long-term outcomes. J Bone Joint Surg Am. 2014;96(4):292–300.CrossRefPubMedGoogle Scholar
  3. 3.
    Smith TO, et al. Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment. Knee. 2014;21(2):462–70.CrossRefPubMedGoogle Scholar
  4. 4.
    Relph N, Herrington L, Tyson S. The effects of ACL injury on knee proprioception: a meta-analysis. Physiotherapy. 2014;100(3):187–95.CrossRefPubMedGoogle Scholar
  5. 5.
    Fowler PJ, Regan WD. The patient with symptomatic chronic anterior cruciate ligament insufficiency. Results of minimal arthroscopic surgery and rehabilitation. Am J Sports Med. 1987;15(4):321–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Giove TP, et al. Non-operative treatment of the torn anterior cruciate ligament. J Bone Joint Surg Am. 1983;65(2):184–92.CrossRefPubMedGoogle Scholar
  7. 7.
    Hawkins RJ, Misamore GW, Merritt TR. Followup of the acute nonoperated isolated anterior cruciate ligament tear. Am J Sports Med. 1986;14(3):205–10.CrossRefPubMedGoogle Scholar
  8. 8.
    Kannus P, Jarvinen M. Conservatively treated tears of the anterior cruciate ligament. Long-term results. J Bone Joint Surg Am. 1987;69(7):1007–12.CrossRefPubMedGoogle Scholar
  9. 9.
    Kessler MA, et al. Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc. 2008;16(5):442–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Lohmander LS, et al. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. 2004;50(10):3145–52.CrossRefPubMedGoogle Scholar
  11. 11.
    McDaniel WJ Jr, Dameron TB Jr. The untreated anterior cruciate ligament rupture. Clin Orthop Relat Res. 1983;172:158–63.Google Scholar
  12. 12.
    Meuffels DE, et al. Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes. Br J Sports Med. 2009;43(5):347–51.CrossRefPubMedGoogle Scholar
  13. 13.
    Meunier A, Odensten M, Good L. Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: a randomized study with a 15-year follow-up. Scand J Med Sci Sports. 2007;17(3):230–7.PubMedGoogle Scholar
  14. 14.
    Myklebust G, et al. Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury: a follow-up study. Am J Sports Med. 2003;31(6):981–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Neuman P, et al. Prevalence of tibiofemoral osteoarthritis 15 years after nonoperative treatment of anterior cruciate ligament injury: a prospective cohort study. Am J Sports Med. 2008;36(9):1717–25.CrossRefPubMedGoogle Scholar
  16. 16.
    Noyes FR, et al. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am. 1983;65(2):154–62.CrossRefPubMedGoogle Scholar
  17. 17.
    Pattee GA, et al. Four to ten year followup of unreconstructed anterior cruciate ligament tears. Am J Sports Med. 1989;17(3):430–5.CrossRefPubMedGoogle Scholar
  18. 18.
    von Porat A, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. 2004;63(3):269–73.CrossRefGoogle Scholar
  19. 19.
    Harman MK, et al. Wear patterns on tibial plateaus from varus and valgus osteoarthritic knees. Clin Orthop Relat Res. 1998;352:149–58.Google Scholar
  20. 20.
    Rout R, et al. The pattern of cartilage damage in antero-medial osteoarthritis of the knee and its relationship to the anterior cruciate ligament. J Orthop Res. 2013;31(6):908–13.CrossRefPubMedGoogle Scholar
  21. 21.
    White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br. 1991;73(4):582–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Pandit H, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg Br. 2006;88(7):887–92.CrossRefPubMedGoogle Scholar
  23. 23.
    Shelbourne KD, Benner RW. Isolated anterior cruciate ligament reconstruction in the chronic ACL-deficient knee with degenerative medial arthrosis. J Knee Surg. 2007;20(3):216–22.CrossRefPubMedGoogle Scholar
  24. 24.
    Weston-Simons JS, 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(9):1216–20.CrossRefPubMedGoogle Scholar
  25. 25.
    Hasegawa A, et al. Anterior cruciate ligament changes in the human knee joint in aging and osteoarthritis. Arthritis Rheum. 2012;64(3):696–704.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Mullaji AB, et al. Cruciate ligaments in arthritic knees: a histologic study with radiologic correlation. J Arthroplasty. 2008;23(4):567–72.CrossRefPubMedGoogle Scholar
  27. 27.
    Deschamps G, Lapeyre B. Rupture of the anterior cruciate ligament: a frequently unrecognized cause of failure of unicompartmental knee prostheses. Apropos of a series of 79 Lotus prostheses with a follow-up of more than 5 years. Rev Chir Orthop Reparatrice Appar Mot. 1987;73(7):544–51.PubMedGoogle Scholar
  28. 28.
    Cloutier JM. Results of total knee arthroplasty with a non-constrained prosthesis. J Bone Joint Surg Am. 1983;65(7):906–19.CrossRefPubMedGoogle Scholar
  29. 29.
    Cloutier JM, Sabouret P, Deghrar A. Total knee arthroplasty with retention of both cruciate ligaments. A nine to eleven-year follow-up study. J Bone Joint Surg Am. 1999;81(5):697–702.CrossRefPubMedGoogle Scholar
  30. 30.
    Dodd M, et al. The pivot shift test is of limited clinical relevance in the arthritic anterior cruciate ligament-deficient knee. J Knee Surg. 2010;23(3):131–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Hill CL, et al. Cruciate ligament integrity in osteoarthritis of the knee. Arthritis Rheum. 2005;52(3):794–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Jenny JY, Jenny G. Preservation of anterior cruciate ligament in total knee arthroplasty. Arch Orthop Trauma Surg. 1998;118(3):145–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Lee GC, et al. Evaluation of the anterior cruciate ligament integrity and degenerative arthritic patterns in patients undergoing total knee arthroplasty. J Arthroplasty. 2005;20(1):59–65.CrossRefPubMedGoogle Scholar
  34. 34.
    Johnson AJ, et al. The ACL in the arthritic knee: how often is it present and can preoperative tests predict its presence? Clin Orthop Relat Res. 2013;471(1):181–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Berend KR, et al. Consensus statement on indications and contraindications for medial unicompartmental knee arthroplasty. J Surg Orthop Adv. 2015;24(4):252–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Boissonneault A, et al. No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2013;21(11):2480–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Hamilton TW, et al. Radiological Decision Aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation. Bone Joint J. 2016;98-B(10 Supple B):3–10.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Keyes GW, et al. The radiographic classification of medial gonarthrosis. Correlation with operation methods in 200 knees. Acta Orthop Scand. 1992;63(5):497–501.CrossRefPubMedGoogle Scholar
  39. 39.
    Mullaji AB, Marawar SV, Luthra M. Tibial articular cartilage wear in varus osteoarthritic knees: correlation with anterior cruciate ligament integrity and severity of deformity. J Arthroplasty. 2008;23(1):128–35.CrossRefPubMedGoogle Scholar
  40. 40.
    Phelan N, et al. A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1525–39.CrossRefPubMedGoogle Scholar
  41. 41.
    Hamilton TW, et al. Unicompartmental knee replacement: does the macroscopic status of the anterior cruciate ligament affect outcome? Knee. 2016;23(3):506–10.CrossRefPubMedGoogle Scholar
  42. 42.
    Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am. 2004;86-A(3):506–11.CrossRefGoogle Scholar
  43. 43.
    Engh GA, Ammeen DJ. Unicondylar arthroplasty in knees with deficient anterior cruciate ligaments. Clin Orthop Relat Res. 2014;472(1):73–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Goodfellow JW, et al. The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br. 1988;70(5):692–701.CrossRefPubMedGoogle Scholar
  45. 45.
    Krishnan SR, Randle R. ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res. 2009;4:43.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Tinius M, Hepp P, Becker R. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):81–7.CrossRefPubMedGoogle Scholar
  47. 47.
    Ventura A, et al. Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):675–80.CrossRefPubMedGoogle Scholar
  48. 48.
    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
  49. 49.
    Tian S, et al. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in knees with osteoarthritis and deficient anterior cruciate ligament. BMC Musculoskelet Disord. 2016;17:327.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Hamilton TW, et al. The interaction of caseload and usage in determining outcomes of unicompartmental knee arthroplasty: a meta-analysis. J Arthroplasty. 2017;32(10):3228–3237.e2.CrossRefPubMedGoogle Scholar
  51. 51.
    Pegg EC, et al. Behaviour of Anterior Cruciate Ligament (ACL) deficient knees after Unicompartmental Knee Arthroplasty (UKA), in American Academy of Orthopaedic Surgeons. 2015: Las Vegas.Google Scholar
  52. 52.
    Pandit H, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee. 2008;15(2):101–6.CrossRefPubMedGoogle Scholar
  53. 53.
    Pegg EC, et al. Sagittal kinematics of mobile unicompartmental knee replacement in anterior cruciate ligament deficient knees. Clin Biomech. 2016;31:33–9.CrossRefGoogle Scholar
  54. 54.
    Suero EM, et al. Effects of tibial slope changes in the stability of fixed bearing medial unicompartmental arthroplasty in anterior cruciate ligament deficient knees. Knee. 2012;19(4):365–9.CrossRefPubMedGoogle Scholar
  55. 55.
    Brown TD, Bartel DL, G. Implant Wear Symposium Engineering Work. What design factors influence wear behavior at the bearing surfaces in total joint replacements? J Am Acad Orthop Surg. 2008;16(Suppl 1):S101–6.CrossRefPubMedGoogle Scholar
  56. 56.
    Simpson DJ, et al. The effect of bearing congruency, thickness and alignment on the stresses in unicompartmental knee replacements. Clin Biomech (Bristol, Avon). 2008;23(9):1148–57.CrossRefGoogle Scholar
  57. 57.
    Blunn GW, et al. Wear in retrieved condylar knee arthroplasties. A comparison of wear in different designs of 280 retrieved condylar knee prostheses. J Arthroplasty. 1997;12(3):281–90.CrossRefPubMedGoogle Scholar
  58. 58.
    Mancuso F, et al. Medial unicompartmental knee arthroplasty in the ACL-deficient knee. J Orthop Traumatol. 2016;17(3):267–75.CrossRefPubMedPubMedCentralGoogle Scholar

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

Personalised recommendations