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

Foissey, Constant; Batailler, Cécile; Shatrov, Jobe; Servien, Elvire; Lustig, Sébastien

doi:10.1007/s00264-022-05544-5

Cited by 8 publications

(5 citation statements)

References 39 publications

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“…Foissey et al reported on 10 patients after robotic-assisted UKR combined to hamstring ACL reconstruction after an average follow-up of 45 months. The mean post-operative International Knee postoperative function score was 93, mean Tegner score was 4.5 [ 10 ]. Two patients underwent arthroscopic arthrolysis following postoperative arthrofibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, more recently, ACL-deficient patients with isolated medial OA demonstrated to benefit from fixedbearing UKR implanted with a lower grade of tibial slope in order to compensate for anterior tibial translation [6]. However, to overcome the potential risks of posterior femoral shift brought by ACL insufficiency and increased incidence of aseptic loosening, a surgical strategy allowing concomitant UKR and ACL reconstruction has been successfully proposed (Table 1) [7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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Unicompartmental knee replacement combined with anterior cruciate ligament reconstruction provides comparable results to total knee replacement with no increased risk of complications

Legnani,

Borgo,

Macchi

et al. 2024

SICOT-J

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Introduction: There is controversy about the management of unicompartmental knee osteoarthritis (OA) in young, active patients with anterior cruciate ligament (ACL) insufficiency. This study compares the subjective, radiological, and functional results of total knee replacement (TKR) vs. combined medial unicompartmental knee replacement (UKR) with ACL reconstruction. Method: Twelve patients suffering from medial OA and ACL deficiency with varus knee deformity and/or tibial slope <10° and absence of patellofemoral-related problems were eligible for combined UKR and ACL reconstruction (Group A). Twenty-six patients matched for age, male/female ratio and body mass index who received TKR in the same time frame were included as a control group (Group B). Oxford Knee Score (OKS), WOMAC index of osteoarthritis, Knee Osteoarthritis Outcome Score (KOOS), and routine X-rays were used for assessment. Results: Ten years after surgery, the mean overall KOOS score, OKS, WOMAC index increased from preoperatively, showing a statistically significant difference (p < 0.001). In terms of KOOS, OKS, or WOMAC scores at the most recent follow-up, there was no discernible difference between the groups (p = n.s.). Three years following surgery, one female patient in group A received revision TKR due to the lateral compartment’s osteoarthritis developing and the patient’s pain persisting. Concerning radiographic assessment, at the most recent follow-up (average 7.9 years in group A and 8.8 years in group B), there were no radiographic indications of implant loosening or proof of pathologic radiolucent lines. Conclusions: UKR combined with ACL restoration offers clinical and radiographic outcomes comparable to TKR 10 years following surgery with no elevated risk of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unicompartmental knee replacement combined with anterior cruciate ligament reconstruction provides comparable results to total knee replacement with no increased risk of complications

Legnani,

Borgo,

Macchi

et al. 2024

SICOT-J

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“…The functional scores of the patients significantly improved after surgery, and the survival rate was 91.4% at the 14.5year follow-up [16]. In another study, Foissey et al performed ACLR combined with robot-guided FB UKA on 10 patients using autologous tendons, and 9 patients returned to sports, but 2 patients underwent arthroscopic release surgery for joint stiffness [17]. In order to avoid the occurrence of bearing dislocation, the FB prosthesis was used.…”

Section: Discussionmentioning

confidence: 99%

Unicompartmental knee arthroplasty combined with posterior cruciate ligament reconstruction: a case report

Zheng,

Du,

Chu

et al. 2024

BMC Musculoskelet Disord

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Background In this study, we present the unique case of a patient with knee osteoarthritis (OA) of the medial compartment and posterior cruciate ligament (PCL) deficiency who underwent simultaneous medial unicompartmental knee arthroplasty (UKA) and PCL reconstruction. Case presentation A 49-year-old male patient presented with a 1-year history of pain and instability in the left knee. The patient had previously experienced a trauma-related injury to the PCL of the left knee that was left untreated. Imaging and physical examination confirmed the presence of left medial knee OA along with PCL rupture. To address these issues, the patient underwent UKA combined with PCL reconstruction. The patient’s Lysholm score was 47 before surgery and 81 three months after surgery, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 29 before surgery and 18 three months after surgery, and the International Knee Documentation Committee (IKDC) subjective score was 56.3 before surgery and 74.7 three months after surgery. Six months after surgery, the patient's gait returned to normal, and he was able to jog. Conclusion This case report presents the first instance of UKA combined with PCL reconstruction and introduces a novel treatment approach for patients suffering from medial knee OA and ligament injury.

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“…According to Foissey et al, 10 patients underwent robotically assisted UKR in addition to hamstring ACL surgery after an average follow-up of 45 months. The patients’ mean International Knee postoperative function score was 93, and their average Tegner score was 4.5 [ 32 ]. Jaber et al followed up 23 patients who had undergone mobile-bearing UKR in addition to ACL repair for ten years.…”

Section: Reported Outcomesmentioning

confidence: 99%

“…In one patient, an undisplaced fracture of the anterior cortex of the medial tibial plateau was reported, while an iatrogenic grade 2 injury to the medial collateral ligament treated conservatively was observed in another subject [ 34 ]. Post-operative stiffness requiring arthroscopic arthrolysis occurred two and three months after surgery in two patients, respectively; in both cases, the patient had fully recovered their flexion at the last follow-up [ 32 ]. Infrequent prosthetic failures requiring revision were related to implant infection or symptomatic lateral osteoarthritis progression [ 9 , 14 , 16 , 17 , 20 ].…”

Section: Complicationsmentioning

confidence: 99%

Management of Medial Femorotibial Knee Osteoarthritis in Conjunction with Anterior Cruciate Ligament Deficiency: Technical Note and Literature Review

Legnani,

Ventura,

Mangiavini

et al. 2024

JCM

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In recent years, there has been increased interest in the management of medial femorotibial knee osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency. Traditional treatment modalities included conservative therapy, high tibial osteotomy with or without ACL reconstruction, and total knee replacement. Since younger patients with higher physical demands are more likely to suffer from this pathological condition, reduced invasiveness, faster recovery time, and improved knee kinematics are preferred to allow for satisfying clinical and functional outcomes. Thus, a new surgical strategy combining medial unicompartmental knee replacement (UKR) and ACL reconstruction has been proposed to allow bone stock preservation, to reduce surgical morbidity and recovery time, and ultimately to improve joint kinematics and clinical outcomes. Based on the data present in the literature, in the setting of unicompartmental OA in association with ACL deficiency, UKR combined with ACL reconstruction provided encouraging early results. Studies evaluating the outcomes of combined ACL reconstruction and UKR demonstrate promising results in select patient populations. Improved knee stability, pain relief, functional recovery, and patient satisfaction improved after surgery. Moreover, the combined approach offered advantages such as reduced surgical trauma, faster rehabilitation, and preservation of native knee anatomy compared with traditional treatment strategies. However, still, high-level studies on this topic are lacking; therefore, more comparative studies reporting long-term outcomes are needed to support the potential of this combined procedure to become mainstream. In this paper, we discuss the relevant features and rationale behind the indications and technique of this combined surgical procedure, to help surgeons choose the correct therapeutic approach for a patient with concomitant medial OA and ACL insufficiency. Continued advancements in surgical techniques, patient selection criteria, and rehabilitation strategies will further enhance the success of this combined approach, offering hope to individuals with concomitant ACL injuries and unicompartmental knee OA.

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

Cited by 8 publications

References 39 publications

Unicompartmental knee replacement combined with anterior cruciate ligament reconstruction provides comparable results to total knee replacement with no increased risk of complications

Unicompartmental knee replacement combined with anterior cruciate ligament reconstruction provides comparable results to total knee replacement with no increased risk of complications

Unicompartmental knee arthroplasty combined with posterior cruciate ligament reconstruction: a case report

Management of Medial Femorotibial Knee Osteoarthritis in Conjunction with Anterior Cruciate Ligament Deficiency: Technical Note and Literature Review

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