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Good mid-term results seen after UKA and ACL reconstruction in younger patients
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SAN DEIGO — Patients who had staged or simultaneous ACL reconstructions and medial unicondylar arthroplasty in the same knee for osteoarthritis showed good clinical, radiologic and kinematic outcomes, according to a study conducted by British investigators.
“This is a viable treatment option for these younger, active patients,” Christopher A.F. Dodd, FRCS, of Oxford, United Kingdom, said at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
Dodd and colleagues studied 51 patients with a mean follow-up of 4 years who underwent ACL reconstruction and unicompartmental knee arthroplasty (UKA). The patients had a mean age of 51 years. The investigators compared the results of the group with those of a matched, consecutive series of patients who underwent UKA and had an intact ACL. Both groups received an Oxford partial knee replacement (Biomet). In the study group, staged reconstructions were performed in 18 patients and simultaneous procedures were done in 33 patients.
Dodd and colleagues used the Oxford Knee Score (OKS) and American Knee Society Score (AKSS) to determine the objective outcomes and functional levels of the patients. The investigators also assessed patients using the Tegner activity score.
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“The OKS shows the patients had end-stage arthritis with bone-on-bone,” Dodd said, noting that patients in the UKA/ACL reconstruction group showed a significant improvement from their preoperative Oxford scores. At last follow-up, the study group had a mean OKS of 41 points out of a possible 48 points. The mean OKS was 40 points in the group without an ACL reconstruction at their last follow-up. Dodd also noted that patients in the UKA/ACL group had high function according to AKSS measures.
Investigators observed five partial and no complete radiolucencies in the study group. The study revealed two revisions in the group that underwent only UKA and three revisions in the UKA/ACL reconstruction group. One patient in the UKA/ACL reconstruction group underwent an early revision for infection, and another had a bearing dislocation at 4 months. One patient’s osteoarthritis progressed to the lateral compartment and required a total knee arthroplasty with a cruciate-retaining implant.
“All but one patient were very pleased with the outcome,” Dodd said. “There was no correlation between tunnel positions and results, and there was a high level of clinical improvement in function across all the age groups.” – by Susan M. Rapp
Reference:
- Pandit HG, Jenkins C, Marks B, et al. ACL reconstruction and unicompartmental knee replacement: 8-year survivorship. Paper #415. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.
- Christopher A.F. Dodd, FRCS, can be reached at the Oxford Clinic for Specialist Surgery, Windmill Road, Headington Oxford OXON 0X3 7HE, United Kingdom; 44-1865-227424; email: cprior@oxfordclinic.org.uk.
- Disclosure: Dodd receives institutional and personal support from Biomet.
I do know of this work and have seen the early reports. It is interesting to see the 8-year review. The indications are very specific and there are only a few patients who are suitable. It should only be done by surgeons with considerable experience.
— Christopher E. Ackroyd, FRCS
Avon
Orthopaedic Hospital
Bristol, United Kingdom
Orthopaedics Today
Europe Editorial Board member
Disclosure: He has no relevant
financial disclosures.