Clinical outcome after UKA and HTO in ACL deficiency: a systematic review

Mancuso, Francesco; Hamilton, Thomas W.; Kumar, Vijay; Murray, David; Pandit, Hemant

doi:10.1007/s00167-014-3346-1

Cited by 49 publications

(52 citation statements)

References 45 publications

(65 reference statements)

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“…25,27,32 Suggestions range from isolated ACLR over isolated osteotomy (with and without slope modification) and combined approaches using 1-or 2-staged concepts to unicondylar arthroplasty with or without ACLR. 4,5,18,20,21,23,25,27,28,30,[32][33][34] Interestingly, Williams et al 32 found better results in patients with a combined procedure compared with isolated osteotomy at short-term follow-up. Given these encouraging results, this might be seen more as a standard procedure instead of a salvage procedure.…”

Section: Discussionmentioning

confidence: 99%

“…However, young patients with a high degree of unicompartmental osteoarthritis and chronic ACL insufficiency are especially difficult to treat because total knee arthroplasty (TKA) is not a desirable option, and an intact ACL is seen as a precondition for unicondylar knee arthroplasty (UKA). 4 Although promising short-term to midterm results of combined UKA and ACLR have been reported, for these patients, a joint-preserving procedure might be more favorable. 34 Therefore the purpose of this study was to determine survivorship and functional results of high tibial osteotomy (HTO) combined with ACLR and a CR procedure (abrasion/microfracture) in patients with Kellgren-Lawrence grade 3 and 4 osteoarthritis with full-thickness large-area cartilage defects, chronic ACL insufficiency, and varus malalignment.…”

mentioning

confidence: 98%

“…1,2 In combination with pre-existing or acquired varus deformity, medial unicompartmental osteoarthritis is common, with a rather posteriorly located pattern of arthritis due to anterior subluxation. [2][3][4] Anterior cruciate ligament reconstruction (ACLR) can reliably restore stability but is controversially discussed in patients with advanced osteoarthritis. 5,6 In recent years, osteotomies have gained increasing popularity to address unicompartmental osteoarthritis.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Combined Biplanar High Tibial Osteotomy, Anterior Cruciate Ligament Reconstruction, and Abrasion/Microfracture in Severe Medial Osteoarthritis of Unstable Varus Knees

Schuster¹,

Schulz²,

Richter³

2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 99%

See 1 more Smart Citation

Combined Biplanar High Tibial Osteotomy, Anterior Cruciate Ligament Reconstruction, and Abrasion/Microfracture in Severe Medial Osteoarthritis of Unstable Varus Knees

Schuster¹,

Schulz²,

Richter³

2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The biomechanical rationale for this procedure is correction of malalignment and redistribution of stress on the joint [22]. The classic indication for high tibial osteotomy includes unicompartmental osteoarthritis of the knee and is especially recommended for young patients with high activity demands [23,24]. For properly selected patients, studies have proven that it offers satisfactory pain relief and functional outcome.…”

Section: Discussionmentioning

confidence: 99%

Higher risk of revision in total knee arthroplasty after high tibial osteotomy: a systematic review and updated meta-analysis

Chen

Yang

et al. 2020

BMC Musculoskelet Disord

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Background: High tibial osteotomy is commonly performed in young patients with high activity demand. Several studies have reported outcome of HTO. The reported 10-year survival ranged from 79 to 97.6%. The reported 15-year survival ranged from 56 to 65.5%, resulting in the need for conversion to TKA. Primary TKA now provides satisfactory long-term outcome in terms of function and survival. Researches have been conducted to compare clinical outcome between primary TKA and TKA after HTO to see if TKA should be the prior treatment rather than HTO in some cases. But the results were inconsistent. This study aims to compare the risk of revision and other parameters between total knee arthroplasty after high tibial osteotomy and primary total knee arthroplasty. Methods: Searches and screens of the relevant literature were conducted, after which data were extracted and pooled analysis was performed to compare the clinical outcomes between the two groups. Results: A total of 14 studies with 144,692 cases were included. Pooled analysis showed significantly more revisions and complications, and more tibial component loosening and impingement in postoperative X-ray in the HTO-TKA group. Surgical complexity during conversion to total knee arthroplasty was summarised and listed in table. Conclusion: High tibial osteotomy offers satisfactory pain relief and functional outcome in selected patients with high activity demand. However, the need for subsequent TKA should be noted, which might be a technically challenging procedure with significantly higher risk of revision comparing to primary TKA.

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“…[10][11][12] Bone-conserving options are preferred for younger patients with partial thickness medial cartilage damage with intact lateral and patellofemoral compartment who are more active and have higher physical demands. 2,3,13,14 Recently a treatment option combining medial UKR and ACL reconstruction has been developed. 3,[6][7][8][15][16][17] However, still limited experience exists in this field.…”

mentioning

confidence: 99%

Unicompartmental Knee Replacement Combined to Anterior Cruciate Ligament Reconstruction: Midterm Results

et al. 2019

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A study was conducted to retrospectively evaluate the outcomes of combined medial unicompartmental knee replacement (UKR) and anterior cruciate ligament (ACL) reconstruction. The hypothesis was that this procedure would lead to satisfying results in patients affected by medial osteoarthritis and ACL insufficiency. Fourteen patients with ACL deficiency and concomitant medial compartment symptomatic osteoarthritis were treated from 2006 to 2010. Twelve of them were followed-up for an average time of 7.8 year (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 the 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 signs of osteoarthritis in the lateral compartment 3 years after primary surgery. UKR combined with ACL reconstruction is an effective therapeutic option for the treatment of combined medial unicompartmental knee osteoarthritis and ACL deficiency and confirms subjective and objective clinical improvement up to 8 years after surgery. This study reflects level IV evidence.

show abstract

Clinical outcome after UKA and HTO in ACL deficiency: a systematic review

Abstract: IV.

Cited by 49 publications

References 45 publications

Combined Biplanar High Tibial Osteotomy, Anterior Cruciate Ligament Reconstruction, and Abrasion/Microfracture in Severe Medial Osteoarthritis of Unstable Varus Knees

Combined Biplanar High Tibial Osteotomy, Anterior Cruciate Ligament Reconstruction, and Abrasion/Microfracture in Severe Medial Osteoarthritis of Unstable Varus Knees

Higher risk of revision in total knee arthroplasty after high tibial osteotomy: a systematic review and updated meta-analysis

Unicompartmental Knee Replacement Combined to Anterior Cruciate Ligament Reconstruction: Midterm Results

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