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Good mid-term results seen after UKA and ACL reconstruction

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SAN DEIGO — Patients who had staged or simultaneous ACL reconstructions and underwent subsequent medial unicondylar knee arthroplasty for osteoarthritis showed good clinical, radiologic and kinematic outcomes, according to a study conducted by British investigators.

“This is a viable treatment option in young and active patients,” Christopher A.F. Dodd, FRCS, of Oxford, U.K., said at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

Christopher A.F. Dodd

Dodd and colleagues compared the results of 51 patients with a mean follow-up of 4 years who underwent ACL reconstruction and unicompartmental knee arthroplasty (UKA) with a matched consecutive series of patients who underwent UKA without ACL reconstruction. Both groups received the Oxford UKA implant. In the study group, staged ACL 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 activity levels using the Tegner activity score.

“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 preoperative Oxford Knee Scores. At last follow-up, the group had a mean OKS of 41 points out of a possible 48 points. “Patients [also] had high AKSS functional scores,” Dodd noted.

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.”

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.

Disclosure: Dodd receives institutional and personal support from Biomet.

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