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Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patients presenting anterior cruciate ligament (ACL) deficiency and isolated osteoarthritis of the medial compartment are treated either with biplanar osteotomy or with total knee arthroplasty (TKA). However, these patients between the forties and fifties are often very active in daily life and feel limited due to their knee. In order to follow the idea of preserving as much as possible from the joint, the concept of unicondylar joint replacement in conjunction with ACL reconstruction has been followed. There seems to be a limited experience with this concept. The purpose of the follow-up study was to evaluate the midterm clinical and functional outcome.

Methods

Twenty-seven patients were followed up for 53 months. The mean age of the 11 men and 16 women was 44 years. All patients were treated by combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction.

Results

The Knee Society Score improved significantly from 77.1 ± 11.6 points to 166.0 ± 12.1 points (P ≤ 0.01). No revision surgery was required and no radiolucent lines were observed on the radiographs at the time of follow-up. The anterior translation showed less than 5 mm in 24 patients and 5 mm in the remaining 3 patients.

Conclusions

The midterm clinical data have shown that combined surgery of UKA and anterior cruciate ligament reconstruction has revealed promising results. The restored knee stability seems to prevent the failure of UKA. However, long-term follow-up studies are required in these patients who received partial joint replacement fairly early in their life.

Level of evidence

IV.

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References

  1. Ackroyd CE, Whitehouse SL, Newman JH, Joslin CC (2002) A comparative study of the medial St Georg sled and kinematic total knee arthroplasties. Ten-year survivorship. J Bone Joint Surg Br 84:667–672

    Article  PubMed  CAS  Google Scholar 

  2. Aleto TJ, Berend ME, Ritter MA, Faris PM, Meneghini RM (2008) Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplasty 23:159–163

    Article  PubMed  Google Scholar 

  3. Balasch H, Schiller M, Friebel H, Hoffmann F (1999) Evaluation of anterior knee joint instability with the Rolimeter. A test in comparison with manual assessment and measuring with the KT-1000 arthrometer. Knee Surg Sports Traumatol Arthrosc 7:204–208

    Article  PubMed  CAS  Google Scholar 

  4. Banks SA, Fregly BJ, Boniforti F, Reinschmidt C, Romagnoli S (2005) Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc 13:551–556

    Article  PubMed  Google Scholar 

  5. Bartley RE, Stulberg SD, Robb WJ, Sweeney HJ (1994) Polyethylene wear in unicompartmental knee arthroplasty. Clin Orthop Relat Res 299:18–24

    PubMed  Google Scholar 

  6. Becker R, John M, Neumann WH (2004) Clinical outcomes in the revision of unicondylar arthoplasties to bicondylar arthroplasties. A matched-pair study. Arch Orthop Trauma Surg 124:702–707

    Article  PubMed  Google Scholar 

  7. Biau DJ, Landreau P, Gravelau N (2010) Monitoring surgical performance: an application of industrial quality process control to anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1263–1268

    Article  PubMed  Google Scholar 

  8. Clayton RA, Court-Brown CM (2008) The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury 39:1338–1344

    Article  PubMed  Google Scholar 

  9. Collier MB, Engh CA, McAuley JP, Engh GA (2007) Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am 89:1306–1314

    Article  PubMed  Google Scholar 

  10. Demange MK, Camanho GL, Pécora JR, Gobbi RG, Tirico LE, Albuquerque, RF (2010) Simultaneous anterior cruciate ligament reconstruction and computer-assisted open-wedge high tibial osteotomy: a report of eight cases. Knee. doi:10.1016/j.knee.2010.11.004

  11. Dervin GF, Conwa AF, Thurston P (2007) Combined anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty: surgical technique. Orthopedics 30:39–41

    PubMed  Google Scholar 

  12. Deschamps G, Lapeyre B (1987) 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 73:544–551

    PubMed  CAS  Google Scholar 

  13. Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R (2010) High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J 30:131–140

    PubMed  Google Scholar 

  14. Engh GA, Ammeen D (2004) Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement? Clin Orthop Relat Res 428:170–173

    Article  PubMed  Google Scholar 

  15. Felts E, Parratte S, Pauly V, Aubaniac JM, Argenson JN (2010) Function and quality of life following medial unicompartmental knee arthroplasty in patients 60 years of age or younger. Orthop Traumatol Surg Res 96:861–867

    Article  PubMed  CAS  Google Scholar 

  16. Fisher J, Jennings LM, Galvin AL, Jin ZM, Stone MH, Ingham E (2010) 2009 knee society presidential guest lecture: polyethylene wear in total knees. Clin Orthop Relat Res 468:12–18

    Article  PubMed  Google Scholar 

  17. Gleeson RE, Evans R, Ackroyd CE, Webb J, Newman JH (2004) Fixed or mobile bearing unicompartmental knee replacement? A comparative cohort study. Knee 11:379–384

    Article  PubMed  CAS  Google Scholar 

  18. Gulati A, Chau R, Pandit HG, Gray H, Price AJ, Dodd CA, Murray DW (2009) The incidence of physiological radiolucency following Oxford unicompartmental knee replacement and its relationship to outcome. J Bone Joint Surg Br 91:896–902

    Article  PubMed  CAS  Google Scholar 

  19. Heijne A, Werner S (2010) A 2-year follow-up of rehabilitation after ACL reconstruction using patellar tendon or hamstring tendon grafts: a prospective randomised outcome study. Knee Surg Sports Traumatol Arthrosc 18:805–813

    Article  PubMed  Google Scholar 

  20. Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am 86-A:506–511

    PubMed  Google Scholar 

  21. Imhoff AB, Linke RD, Agneskirchner J (2004) Corrective osteotomy in primary varus, double varus and triple varus knee instability with cruciate ligament replacement. Orthopade 33:201–207

    Article  PubMed  CAS  Google Scholar 

  22. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  23. Kendoff D, Koulalis D, Citak M, Voos J, Pearle AD (2010) Open wedge valgus tibial osteotomies: affecting the distinct ACL bundles. Knee Surg Sports Traumatol Arthrosc 18:1501–1507

    Article  PubMed  Google Scholar 

  24. Kim YH, Choi Y, Kim JS (2010) Osteolysis in well-functioning fixed- and mobile-bearing TKAs in younger patients. Clin Orthop Relat Res 468:3084–3093

    Article  PubMed  Google Scholar 

  25. Kort NP, van Raay JJ, Cheung J, Jolink C, Deutman R (2007) Analysis of Oxford medial unicompartmental knee replacement using the minimally invasive technique in patients aged 60 and above: an independent prospective series. Knee Surg Sports Traumatol Arthrosc 15:1331–1334

    Article  PubMed  Google Scholar 

  26. Koskinen E, Paavolainen P, Eskelinen A, Pulkkinen P, Remes V (2007) Unicondylar knee replacement for primary osteoarthritis: a prospective follow-up study of 1, 819 patients from the Finnish Arthroplasty Register. Acta Orthop 78:128–135

    Article  PubMed  Google Scholar 

  27. Kretzer JP, Jakubowitz E, Reinders J, Lietz E, Moradi B, Hofmann K, Sonntag R (2011) Wear analysis of unicondylar mobile bearing and fixed bearing knee systems: a knee simulator study. Acta Biomater 7:710–715

    Article  PubMed  Google Scholar 

  28. Krishnan SR, Randle R (2009) ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res 4:43

    Article  PubMed  Google Scholar 

  29. Lee AH, Young BJ, Jung HJ, Song KS, Young BK (2010) Combined reconstruction for posterolateral rotatory instability with anterior cruciate ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 18:1219–1225

    Article  PubMed  Google Scholar 

  30. Li G, Papannagari R, DeFrate LE, Yoo JD, Park SE, Gill TJ (2007) The effects of ACL deficiency on mediolateral translation and varus-valgus rotation. Acta Orthop 78:355–360

    Article  PubMed  Google Scholar 

  31. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG (2009) Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am 91:2321–2328

    Article  PubMed  Google Scholar 

  32. Mahfouz, Komistek RD, Dennis DA, Hoff WA (2004) In vivo assessment of the kinematics in normal and anterior cruciate ligament-deficient knees. J Bone Joint Surg Am 86-A(Suppl 2):56–61

    PubMed  Google Scholar 

  33. McEwen HM, Barnett PI, Bell CJ, Farrar R, Auger DD, Stone MH, Fisher J (2005) The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech 38:357–365

    Article  PubMed  CAS  Google Scholar 

  34. Meredick RB, Vance KJ, Appleby D, Lubowitz JH (2008) Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med 36:1414–1421

    Article  PubMed  Google Scholar 

  35. Möller E, Weidenhielm L, Werner S (2009) Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long-term follow-up. Knee Surg Sports Traumatol Arthrosc 17:786–794

    Article  PubMed  Google Scholar 

  36. Murray DW, Goodfellow JW, O’Connor JJ (1998) The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 80:983–989

    Article  PubMed  CAS  Google Scholar 

  37. Müller PE, Pellengahr C, Witt M, Kircher J, Refior HJ, Jansson V (2004) Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. J Arthroplasty 19:296–301

    Article  PubMed  Google Scholar 

  38. Newman J, Pydisetty RV, Ackroyd C (2009) Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 91:52–57

    PubMed  CAS  Google Scholar 

  39. Pandit H, Jenkins C, Barker K, Dodd CA, Murray DW (2006) The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. J Bone Joint Surg Br 88:54–60

    Article  PubMed  CAS  Google Scholar 

  40. Pandit H, Van Duren BH, Gallagher JA, Beard DJ, Dodd CA, Gill HS, Murray DW (2008) Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee 15:101–106

    Article  PubMed  CAS  Google Scholar 

  41. Price AJ, Svärd U (2011) A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 469:174–179

    Article  PubMed  Google Scholar 

  42. Ravirarj A, Anand A, Kodikal G, Chandrashekar M, Pai S (2010) A comparison of early and delayed arthroscopically-assisted reconstruction of anterior cruciate ligament using hamstring autograft. J Bone Joint Surg Br 92:521–526

    Article  Google Scholar 

  43. Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg Br 83:45–49

    Article  PubMed  CAS  Google Scholar 

  44. Sawatari T, Tsumura H, Iesaka K, Furushiro Y, Torisu T (2005) Three-dimensional finite element analysis of unicompartmental knee arthroplasty–the influence of tibial component inclination. J Orthop Res 23:549–554

    Article  PubMed  CAS  Google Scholar 

  45. Song MH, Kim BH, Ahn SJ, Yoo SH, Lee MS (2009) Early complications after minimally invasive mobile-bearing medial unicompartmental knee arthroplasty. J Arthroplasty 24:1281–1284

    Article  PubMed  Google Scholar 

  46. Tabor OB, Tabor OB, Bernard M, Wan JY (2005) Unicompartmental knee arthroplasty: long-term success in middle-age and obese patients. J Surg Orthop Adv 14:59–63

    PubMed  Google Scholar 

  47. Tibrewal SB, Grant KA, Goodfellow JW (1984) The radiolucent line beneath the tibial components of the Oxford meniscal knee. J Bone Joint Surg Br 66:523–528

    PubMed  CAS  Google Scholar 

  48. van Eck CF, Schreiber VM, Liu TT, Fu FH (2010) The anatomic approach to primary, revision and augmentation anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1154–1163

    Article  PubMed  Google Scholar 

  49. White SH, Ludkowski PF, Goodfellow JW (1991) Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br 73:582–586

    PubMed  CAS  Google Scholar 

  50. Whittaker JP, Naudie DD, McAuley JP, McCalden RW, MacDonald SJ, Bourne RB (2010) Does bearing design influence midterm survivorship of unicompartmental arthroplasty? Clin Orthop Relat Res 468:73–81

    Article  PubMed  Google Scholar 

  51. Williams RJ 3rd, Kelly BT, Wickiewicz TL, Altchek DW, Warren RF (2003) The short-term outcome of surgical treatment for painful varus arthritis in association with chronic ACL deficiency. J Knee Surg 16:9–16

    PubMed  Google Scholar 

  52. Yamaguchi S, Gamada K, Sasho T, Kato H, Sonoda M, Banks SA (2009) In vivo kinematics of anterior cruciate ligament deficient knees during pivot and squat activities. Clin Biomech (Bristol, Avon) 24:71–76

    Article  Google Scholar 

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Authors and Affiliations

  1. Center for Joint Surgery, Knee Group, Praxisklinik- Stollberg, Hohensteiner Strasse 56, 09366, Stollberg, Germany

    Marco Tinius

  2. Department of Orthopaedic, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany

    Pierre Hepp

  3. Department of Orthopaedic and Trauma Surgery, City-Hospital, Brandenburg, Germany

    Roland Becker

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  1. Marco Tinius
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  2. Pierre Hepp
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Correspondence to Marco Tinius.

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Tinius, M., Hepp, P. & Becker, R. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20, 81–87 (2012). https://doi.org/10.1007/s00167-011-1528-7

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  • DOI: https://doi.org/10.1007/s00167-011-1528-7

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