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Anterior cruciate ligament reconstruction in association with medial unicompartmental knee replacement: a retrospective study comparing clinical and radiological outcomes of two different implant design

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Abstract

Purpose

Unicompartmental knee arthroplasty (UKA) combined with anterior cruciate ligament (ACL) reconstruction has recently been suggested as a feasible treatment option for young and active patients with medial compartment osteoarthritis (OA) and ACL deficiency. The aim of this study is to evaluate retrospectively the outcomes of two different implant designs in patients with medial OA secondary to traumatic ACL rupture, who underwent combined ACL reconstruction and unicompartmental knee replacement.

Methods

From January 2007, to December 2013, 24 patients with medial OA secondary to ACL rupture underwent medial unicompartmental knee arthroplasty (UKA) and ACL reconstruction. Nine patients received a mobile bearing UKA (Group 1) and fifteen a fixed-bearing one (Group 2). The mean follow-up was 53 ± 8.3 months for Group 1 and 42 ± 6.7 months for Group 2. Knee Society Score (KSS), Western Ontario and McMaster Index of Osteoarthritis (WOMAC) index and radiological evaluation used to assess the implant loosening alignment of the knee joint and tibial slope were recorded pre-operatively and at the last follow-up.

Results

At the final follow-up, all patients showed statistically significant clinical improvements with respect to the pre-operative values (p < 0.05). No significant difference was observed in WOMAC index and KSS both objective and functional between groups at the last follow-up (KSS obj. 73.4 ± 9.3 vs 77.3 ± 10.5; KSS funct. 86.2 ± 6.2 vs 84.7 ± 5.9; WOMAC 79.3 ± 7.3 vs 81.3 ± 7.6 for Group 1 and 2, respectively). No differences in radiolucent lines were found between the groups.

Conclusion

The use of different prosthesis design (fixed- or mobile-bearing) during a combined procedure of ACL reconstruction and medial unicompartmental arthroplasty does not affect the middle-term clinical and radiological outcomes.

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References

  1. Arden N, Nevitt MC (2006) Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol 20(1):3–25. https://doi.org/10.1016/j.berh.2005.09.007

    Article  PubMed  Google Scholar 

  2. Andriacchi TP (1994) Dynamics of knee malalignment. Orthop Clin North Am 25(3):395–403

  3. Felson DT, Nevitt MC, Zhang Y, Aliabadi P, Baumer B, Gale D, Li W, Yu W, Xu L (2002) High prevalence of lateral knee osteoarthritis in Beijing Chinese compared with Framingham Caucasian subjects. Arthritis Rheum 46(5):1217–1222. https://doi.org/10.1002/art.10293

    Article  PubMed  Google Scholar 

  4. Sharma L, Song J, Dunlop D, Felson D, Lewis CE, Segal N, Torner J, Cooke TD, Hietpas J, Lynch J, Nevitt M (2010) Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis 69(11):1940–1945. https://doi.org/10.1136/ard.2010.129742

    Article  PubMed  Google Scholar 

  5. Cooper C, Snow S, McAlindon TE, Kellingray S, Stuart B, Coggon D, Dieppe PA (2000) Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum 43(5):995–1000. https://doi.org/10.1002/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1

    Article  CAS  PubMed  Google Scholar 

  6. Faber KJ, Dill JR, Amendola A, Thain L, Spouge A, Fowler PJ (1999) Occult osteochondral lesions after anterior cruciate ligament rupture. Six-year magnetic resonance imaging follow-up study. Am J Sports Med 27(4):489–494

    Article  CAS  PubMed  Google Scholar 

  7. Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35(10):1756–1769. https://doi.org/10.1177/0363546507307396

    Article  PubMed  Google Scholar 

  8. Andriacchi TP, Briant PL, Bevill SL, Koo S (2006) Rotational changes at the knee after ACL injury cause cartilage thinning. Clin Orthop Relat Res 442:39–44

    Article  PubMed  Google Scholar 

  9. Baliunas AJ, Hurwitz DE, Ryals AB, Karrar A, Case JP, Block JA, Andriacchi TP (2002) Increased knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis Cartilage 10(7):573–579

    Article  CAS  PubMed  Google Scholar 

  10. Ingersoll CD, Grindstaff TL, Pietrosimone BG, Hart JM (2008) Neuromuscular consequences of anterior cruciate ligament injury. Clin Sports Med 27(3):383–404, vii. https://doi.org/10.1016/j.csm.2008.03.004

    Article  PubMed  Google Scholar 

  11. Goodfellow JW, Kershaw CJ, Benson MK, O'Connor JJ (1988) The Oxford knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br 70(5):692–701

    Article  Google Scholar 

  12. Palumbo BT, Scott RD (2014) Diagnosis and indications for treatment of unicompartmental arthritis. Clin Sports Med 33(1):11–21. https://doi.org/10.1016/j.csm.2013.06.001

    Article  PubMed  Google Scholar 

  13. Ventura A, Legnani C, Terzaghi C, Iori S, Borgo E (2015) Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Artrosc: Off J ESSKA. https://doi.org/10.1007/s00167-015-3808-0

    Article  PubMed  Google Scholar 

  14. Dejour H, Neyret P, Boileau P, Donell ST (1994) Anterior cruciate reconstruction combined with valgus tibial osteotomy. Clin Orthop Relat Res 299:220–228

    Google Scholar 

  15. Demey G, Magnussen RA, Lustig S, Servien E, Neyret P (2012) Total knee arthroplasty for advanced osteoarthritis in the anterior cruciate ligament deficient knee. Int Orthop 36(3):559–564. https://doi.org/10.1007/s00264-011-1306-7

    Article  PubMed  Google Scholar 

  16. Plancher KD, Dunn AS, Petterson SC (2014) The anterior cruciate ligament-deficient knee and unicompartmental arthritis. Clin Sports Med 33(1):43–55. https://doi.org/10.1016/j.csm.2013.08.006

    Article  PubMed  Google Scholar 

  17. Adravanti PB, Berend KR, Thienpont E (2017) ACL-deficient knee and unicompartmental OA: state of the art. JISAKOS 2:161–170. https://doi.org/10.1136/jisakos-2016-000066

    Article  Google Scholar 

  18. Volpin A, Kini SG, Meuffels DE (2017) Satisfactory outcomes following combined unicompartmental knee replacement and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Artrosc: Off J ESSKA. https://doi.org/10.1007/s00167-017-4536-4

    Article  PubMed  Google Scholar 

  19. Ko YB, Gujarathi MR, Oh KJ (2015) Outcome of unicompartmental knee arthroplasty: a systematic review of comparative studies between fixed and mobile bearings focusing on complications. Knee Surg Relat Res 27(3):141–148. https://doi.org/10.5792/ksrr.2015.27.3.141

    Article  Google Scholar 

  20. Naouar N, Kaziz H, Mouelhi T, Bouattour K, Mseddi M, Ben Ayeche ML (2016) Evaluation at long term follow up of medial unicompartmental knee arthroplasty in young patients. Tunis Med 94(1):66–71

  21. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Thienpont E, Parvizi J (2016) A new classification for the varus knee. J Arthroplast. https://doi.org/10.1016/j.arth.2016.03.034

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  24. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840

    CAS  PubMed  Google Scholar 

  25. Johal S, Nakano N, Baxter M, Hujazi I, Pandit H, Khanduja V (2018) Unicompartmental knee arthroplasty: the past, current controversies, and future perspectives. J Knee Surg. https://doi.org/10.1055/s-0038-1625961

    Article  PubMed  Google Scholar 

  26. Kim MS, Koh IJ, Sohn S, Jeong JH, In Y (2018) Unicompartmental knee arthroplasty is superior to high tibial osteotomy in post-operative recovery and participation in recreational and sports activities. Int Orthop. https://doi.org/10.1007/s00264-018-4272-5

    Article  PubMed  Google Scholar 

  27. Cavinatto L, Bronson MJ, Chen DD, Moucha CS (2018) Robotic-assisted versus standard unicompartmental knee arthroplasty-evaluation of manuscript conflict of interests, funding, scientific quality and bibliometrics. Int Orthop. https://doi.org/10.1007/s00264-018-4175-5

    Article  PubMed  Google Scholar 

  28. Affatato S, Caputo D, Bordini B (2018) Does the body mass index influence the long-term survival of unicompartmental knee prostheses? A retrospective multi-centre study. Int Orthop. https://doi.org/10.1007/s00264-018-4217-z

    Article  PubMed  Google Scholar 

  29. Mancuso F, Dodd CA, Murray DW, Pandit H (2016) Medial unicompartmental knee arthroplasty in the ACL-deficient knee. J Orthop Traumatol 17(3):267–275. https://doi.org/10.1007/s10195-016-0402-2

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kendoff D, Koulalis D, Citak M, Voos J, Pearle AD (2010) Open wedge valgus tibial osteotomies: affecting the distinct ACL bundles. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 18(11):1501–1507. https://doi.org/10.1007/s00167-010-1073-9

    Article  Google Scholar 

  31. Krishnan SR, Randle R (2009) ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res 4:43. https://doi.org/10.1186/1749-799X-4-43

    Article  PubMed  PubMed Central  Google Scholar 

  32. Tinius M, Ecker TM, Klima S, Tinius W, Josten C (2007) Minimally invasive unicondylar knee arthroplasty with simultaneous ACL reconstruction : treatment of medial compartment osteoarthritis and cruciate ligament defect. Unfallchirurg 110(12):1030–1038. https://doi.org/10.1007/s00113-007-1356-x

    Article  CAS  PubMed  Google Scholar 

  33. Tinius M, Hepp P, Becker R (2012) Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Artrosc: Off J ESSKA 20(1):81–87. https://doi.org/10.1007/s00167-011-1528-7

    Article  PubMed  Google Scholar 

  34. Dervin GF, Conway AF, Thurston P (2007) Combined anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty: surgical technique. Orthopedics 30(5 Suppl):39–41

    PubMed  Google Scholar 

  35. Pandit H, Beard DJ, Jenkins C, Kimstra Y, Thomas NP, Dodd CA, Murray DW (2006) Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg Br 88(7):887–892. https://doi.org/10.1302/0301-620X.88B7.17847

    Article  Google Scholar 

  36. Tian S, Wang B, Wang Y, Ha C, Liu L, Sun K (2016) Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in knees with osteoarthritis and deficient anterior cruciate ligament. BMC Musculoskelet Disord 17:327. https://doi.org/10.1186/s12891-016-1186-5

    Article  PubMed  PubMed Central  Google Scholar 

  37. Weston-Simons JS, Pandit H, Jenkins C, Jackson WF, Price AJ, Gill HS, Dodd CA, Murray DW (2012) 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 94(9):1216–1220. https://doi.org/10.1302/0301-620X.94B9.28881

    Article  Google Scholar 

  38. 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(4):523–528

    Article  Google Scholar 

  39. 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(7):896–902. https://doi.org/10.1302/0301-620X.91B7.21914

    Article  Google Scholar 

  40. 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(3):506–511

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy

    Andrea Tecame

  2. Department of Biomedical and Dental Sciences and Morphofunctional Imaging, School of Orthopaedics and Traumatology, University of Messina, Piazza Pugliatti 1, Messina, Italy

    Roberto Savica & Michele Attilio Rosa

  3. Department of Orthopaedic and Trauma Surgery, Città di Parma Clinic, Piazzale Athos Maestri 5, Parma, Italy

    Paolo Adravanti

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  1. Andrea Tecame
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  2. Roberto Savica
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  4. Paolo Adravanti
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Corresponding author

Correspondence to Andrea Tecame.

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Written informed consent was obtained from all patients before the beginning of the retrospective study in order to obtain the permission of recording sensible data. The study was conducted upon approval of the Institutional Review Board of our Institute (Prot. “UNIACL_ComEt CBM 42/18 OSS”).

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The authors declare that they have no conflict of interest.

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Tecame, A., Savica, R., Rosa, M.A. et al. Anterior cruciate ligament reconstruction in association with medial unicompartmental knee replacement: a retrospective study comparing clinical and radiological outcomes of two different implant design. International Orthopaedics (SICOT) 43, 2731–2737 (2019). https://doi.org/10.1007/s00264-019-04341-x

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  • DOI: https://doi.org/10.1007/s00264-019-04341-x

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