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Is combined robotically assisted unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction a good solution for the young arthritic knee?

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Abstract

Purpose

Anterior cruciate ligament (ACL) deficiency can be a consequence or a cause of femoro-tibial osteoarthritis (OA). Several studies have published satisfactory outcomes of unicompartimental knee arthroplasty (UKA) and combined ACL reconstruction despite its absence classically being considered a contraindication. A major challenge in the ACL deficient knee is obtaining appropriate gap balancing and limb axis. Robotically assisted UKA allows for precise control of these factors; however, it’s utilisation as a tool with combined ACL reconstruction and UKA has not been described. The purpose of this study was to evaluate the clinical and radiological outcomes of robotically assisted UKA with combined ACL reconstruction.

Methods

This was a retrospective single-centre study of ten patients operated by a single surgeon from 2016 to 2020. All surgery was performed using a cemented fixed bearing UKA prosthesis (Journey uni, Smith and Nephew®) (8 medial, 2 lateral) inserted with the assistance of an image-free robotic-assisted system (BlueBelt, Navio, Smith and Nephew®). All ACL reconstructions were performed using hamstring autograft. Clinical assessment included International Knee Score (IKS) score, Tegner score and patient satisfaction. Radiological assessment was performed to assess radiolucent lines, progression of OA in the other compartments, Hip-Knee-Ankle angle and Posterior Tibial Slope.

Results

There were eight females (80%), mean age was 57 ± 7 [48–70], mean BMI was 26 ± 3 [22–31]. The mean follow-up was 45 months ± 13 months [24–66]. Mean post-operative IKS knee and function score were respectively 96 ± 4.5 [88–100] and 93 ± 8.2 [74–100], mean Tegner score was 4.5 ± 1.4 [3–6]. Nine patients (90%) returned to sport; one patient (10%) was dissatisfied because of residual pain preventing a return to a desired level of sport. 100% of the radiological objectives were achieved. No radiolucent lines were seen at the last follow-up. There were two re-operations (20%) for stiffness requiring arthroscopic arthrolysis at two and three months respectively following surgery, with full recovery of the flexion at the last follow-up in both cases. No other complications were observed.

Conclusion

Robotic UKA associated with ACL reconstruction provides satisfactory early patient outcomes and accurate implant positioning. The first results in terms of return to sports were promising.

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Authors and Affiliations

  1. Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France

    Constant Foissey, Cécile Batailler, Elvire Servien & Sébastien Lustig

  2. Sydney Orthopaedic Research Institute (SORI), St. Leonards, Sydney, Australia

    Jobe Shatrov

  3. LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France

    Elvire Servien

  4. Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France

    Sébastien Lustig

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  1. Constant Foissey
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  2. Cécile Batailler
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  4. Elvire Servien
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  5. Sébastien Lustig
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Contributions

Constant Foissey: study design, data collection, statistical analysis, literature review and manuscript writing.

Cécile Batailler: study design, manuscript editing

Jobe Shatrov: literature review, manuscript editing

Elvire Servien: study design, manuscript editing

Sébastien Lustig: study design, supervision, literature review and manuscript editing

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Constant Foissey.

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Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Advisory Committee on Research Information Processing in the Field of Health (CCTIRS) approved this study on June 4, 2015 under number 15–430. For this type of study, formal consent is not required.

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. CF, CB and JS declare that they have no confict of interest. ES: Consultant for Corin. SL: Consultant for Stryker, Smith Nephew, Heraeus, Depuy Synthes; Institutional research support from Groupe Lepine, Amplitude; Editorial Board for Journal of Bone and Joint Surgery (Am)

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Level of evidence: retrospective, consecutive case series; Level IV

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Foissey, C., Batailler, C., Shatrov, J. et al. Is combined robotically assisted unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction a good solution for the young arthritic knee?. International Orthopaedics (SICOT) 47, 963–971 (2023). https://doi.org/10.1007/s00264-022-05544-5

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