COMBINED UNICOMPARTMENTAL KNEE ARTHROPLASTY AND ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN TREATMENT OF OSTEOARTHRITIS AND ANTERIOR CRUCIATE LIGAMENT INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TIANShaoqi ¹ , WANGBin ² , LIULun ¹ , HAChengzhi ¹ , WANGYuanhe ¹ , LIUJiangjun ¹ , LIQicai ¹ , YANGXu ¹ ,  SUNKang ¹

1. Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shangdong, 266000, P. R. China;
2. Department of Orthopaedics, the Third People's Hospital of Qingdao;

Corresponding author：

SUNKang, Email: sunkang_qy@aliyun.com

Keywords：

Knee; Osteoarthritis; Anterior cruciate ligament; Unicompartmental knee arthroplasty

DOI：

10.7507/1002-1892.20150312

Video：

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Objective To explore the short- and mid-term effectivenesses of combined unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament (ACL) reconstruction for osteoarthritis (OA) and ACL injury. Methods Between January 2006 and January 2014, 32 patients with knee OA and ACL injury were treated by combined UKA and ACL reconstruction. There were 12 males and 20 females, aged 41-63 years (mean, 50 years); 17 left knees and 15 right knees were involved. The causes of ACL injury were sports injury (25 cases) and traffic accident injury (7 cases), including 27 cases of old injury and 5 cases of acute injury. Pain of the medial compartment of the knee and unstable knee joint were the main clinical symptoms. Preoperative X-ray films showed (3.1±0.6)° of varus deformity. Results All incisions healed by first intention, without complication. The patients were followed up 16-112 months (mean, 55 months). Mobile bearing dislocation occurred in 2 cases after operation, and was cured after replacing much thicker mobile bearings. X-ray films showed (4.0±0.7)° of valgus at last follow-up. There was no loosening of the prosthesis. Physiological radiolucent line (<1 mm) was observed around the tibial component in 10 patients. The Oxford Knee Score (OKS), Knee Society Score (KSS) clinical score, KSS functional score, and Tegner activity score at last follow-up were improved significantly (P<0.05). The range of motion (ROM) of the operated knee was (123.5±2.8)°, and the posterior slope of the tibial component was (3.9±1.2)° at last follow-up; a significant correlation was found between ROM and posterior slope according to the Pearson's correlation (r=0.392, P=0.031). Conclusion Combined UKA and ACL reconstruction has good short- and mid-term effectivenesses for OA and ACL injury.

Citation： TIANShaoqi, WANGBin, LIULun, HAChengzhi, WANGYuanhe, LIUJiangjun, LIQicai, YANGXu, SUNKang. COMBINED UNICOMPARTMENTAL KNEE ARTHROPLASTY AND ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN TREATMENT OF OSTEOARTHRITIS AND ANTERIOR CRUCIATE LIGAMENT INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(12): 1457-1461. doi: 10.7507/1002-1892.20150312 Copy

1.	Krishnan SR, Randle R. ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res, 2009, 4:43.
2.	Ohdera T, Tokunaga J, Kobayashi A. Unicompartmental knee arthroplasty for lateral gonarthrosis:midterm results. J Arthroplasty, 2001, 16(2):196-200.
3.	Patil S, Colwell CW Jr, Ezzet KA, et al. Can normal knee kinematics be restored with unicompartmental knee replacement? J Bone Joint Surg (Am), 2005, 87(2):332-338.
4.	Kozinn SC, Scott R. Current concepts review:unicondylar knee arthroplasty. J Bone Joint Surg (Am), 1989, 71(1):145-150.
5.	Goodfellow J, O'Connor J. The anterior cruciate ligament in knee arthroplasty. A risk-factor with unconstrained meniscal prostheses. Clin Orthop Relat Res, 1992, (276):245-252.
6.	Robertsson O, Knutson K, Lewold S, et al. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg (Br), 2001, 83(1):45-49.
7.	孙康, 田少奇, 张积华, 等. 膝关节单室置换的近期疗效. 中华骨科杂志, 2009, 29(7):648-652.
8.	Lyman S, Koulouvaris P, Sherman S, et al. Epidemiology of anterior cruciate ligament reconstruction:trends, readmissions, and subsequent knee surgery. J Bone Joint Surg (Am), 2009, 91(10):2321-2328.
9.	Goodfellow J, O'Connor J, Dodd C, et al. Unicompartmental arthroplasty with the Oxford knee. New York:Oxford University Press, 2006:29-67, 117-128.
10.	Repicci JA, Eberle RW. Minimally invasive surgical technique for unicondylar knee arthroplasty. J South Orthop Assoc, 1999, 8(1):20-27.
11.	Fu FH, Cohen SB. Single-Bundle ACL Reconstruction Technique:Hamstring Autograft//Current Concepts in ACL Reconstruction. Pittsburgh:SLACK Incorporated, 2008:201-212.
12.	Gulati A, Chau R, Pandit HG, et al. The incidence of physiological radiolucency following Oxford unicompartmental knee replacement and its relationship to outcome. J Bone Joint Surg (Br), 2009, 91(7):896-902.
13.	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(9):1216-1220.
14.	Mancuso F, Hamilton TW, Kumar V, et al. Clinical outcome after UKA and HTO in ACL deficiency:a systematic review. Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].
15.	Pandit H, Beard DJ, Jenkins C, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg (Br), 2006, 88(7):887-892.
16.	Tinius M, Hepp P, Becker R. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1):81-87.
17.	Pandit H, Van Duren BH, Gallagher JA, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty:in vivo kinematics. Knee, 2008, 15(2):101-106.
18.	Müller PE, Pellengahr C, Witt M, et al. Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. J Arthroplasty, 2004, 19(3):296-301.
19.	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):506-511.
20.	Tibrewal SB, Grant KA, Goodfellow JW. The radiolucent line beneath the tibial components of the Oxford meniscal knee. J Bone Joint Surg (Br), 1984, 66(4):523-528.
21.	Aleto TJ, Berend ME, Ritter MA, et al. Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplasty, 2008, 23(2):159-163.

1. Krishnan SR, Randle R. ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res, 2009, 4:43.
2. Ohdera T, Tokunaga J, Kobayashi A. Unicompartmental knee arthroplasty for lateral gonarthrosis:midterm results. J Arthroplasty, 2001, 16(2):196-200.
3. Patil S, Colwell CW Jr, Ezzet KA, et al. Can normal knee kinematics be restored with unicompartmental knee replacement? J Bone Joint Surg (Am), 2005, 87(2):332-338.
4. Kozinn SC, Scott R. Current concepts review:unicondylar knee arthroplasty. J Bone Joint Surg (Am), 1989, 71(1):145-150.
5. Goodfellow J, O'Connor J. The anterior cruciate ligament in knee arthroplasty. A risk-factor with unconstrained meniscal prostheses. Clin Orthop Relat Res, 1992, (276):245-252.
6. Robertsson O, Knutson K, Lewold S, et al. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg (Br), 2001, 83(1):45-49.
7. 孙康, 田少奇, 张积华, 等. 膝关节单室置换的近期疗效. 中华骨科杂志, 2009, 29(7):648-652.
8. Lyman S, Koulouvaris P, Sherman S, et al. Epidemiology of anterior cruciate ligament reconstruction:trends, readmissions, and subsequent knee surgery. J Bone Joint Surg (Am), 2009, 91(10):2321-2328.
9. Goodfellow J, O'Connor J, Dodd C, et al. Unicompartmental arthroplasty with the Oxford knee. New York:Oxford University Press, 2006:29-67, 117-128.
10. Repicci JA, Eberle RW. Minimally invasive surgical technique for unicondylar knee arthroplasty. J South Orthop Assoc, 1999, 8(1):20-27.
11. Fu FH, Cohen SB. Single-Bundle ACL Reconstruction Technique:Hamstring Autograft//Current Concepts in ACL Reconstruction. Pittsburgh:SLACK Incorporated, 2008:201-212.
12. Gulati A, Chau R, Pandit HG, et al. The incidence of physiological radiolucency following Oxford unicompartmental knee replacement and its relationship to outcome. J Bone Joint Surg (Br), 2009, 91(7):896-902.
13. 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(9):1216-1220.
14. Mancuso F, Hamilton TW, Kumar V, et al. Clinical outcome after UKA and HTO in ACL deficiency:a systematic review. Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].
15. Pandit H, Beard DJ, Jenkins C, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg (Br), 2006, 88(7):887-892.
16. Tinius M, Hepp P, Becker R. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1):81-87.
17. Pandit H, Van Duren BH, Gallagher JA, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty:in vivo kinematics. Knee, 2008, 15(2):101-106.
18. Müller PE, Pellengahr C, Witt M, et al. Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. J Arthroplasty, 2004, 19(3):296-301.
19. 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):506-511.
20. Tibrewal SB, Grant KA, Goodfellow JW. The radiolucent line beneath the tibial components of the Oxford meniscal knee. J Bone Joint Surg (Br), 1984, 66(4):523-528.
21. Aleto TJ, Berend ME, Ritter MA, et al. Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplasty, 2008, 23(2):159-163.

Chinese Journal of Reparative and Reconstructive Surgery

COMBINED UNICOMPARTMENTAL KNEE ARTHROPLASTY AND ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN TREATMENT OF OSTEOARTHRITIS AND ANTERIOR CRUCIATE LIGAMENT INJURY

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