Limited options exist for young and active patients suffering from medial compartment osteoarthritis (OA) and anterior cruciate ligament (ACL) deficiency. To face this challenging scenario, combined ACL reconstruction and unicompartmental knee arthroplasty (UKA) has been proposed.
The purpose of this study was to retrospectively evaluate clinical, functional and radiographic outcomes following combined ACL reconstruction and fixed-bearing UKA. The hypothesis was that this procedure would lead to satisfying results in patients affected by medial osteoarthritis secondary to ACL insufficiency.
Fourteen patients with ACL deficiency and concomitant medial compartment symptomatic OA were treated from 2006 to 2010. All of them underwent autologous hamstring ACL reconstruction and fixed-bearing medial UKA in the same sitting. Twelve patients were successfully followed-up after an average time of 7.8 years (range: 6-10 years). Assessment included Knee Osteoarthritis Outcome score (KOOS), Oxford Knee score (OKS), American Knee Society scores (AKSS), Western Ontario and McMaster (WOMAC) index of osteoarthritis, Tegner's activity level, objective examination including instrumented laxity test with KT-1000 arthrometer, and standard X- rays.
KOOS score, OKS, WOMAC index, and AKSS improved significantly at follow-up (p < 0.001). There was no clinical evidence of instability in any of the knees as evaluated with clinical and instrumented laxity testing (p < 0.001). No pathologic radiolucent lines were observed around the components. In one patient, a total knee prosthesis was implanted due to the progression of OA in the lateral compartment 3 years after primary surgery.
Medial fixed-bearing UKA combined with ACL reconstruction is an effective therapeutic option for the treatment of combined medial unicompartmental knee OA and ACL deficiency and confirms subjective and objective clinical improvement up to 8 years after surgery.