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Erschienen in: Clinical Orthopaedics and Related Research® 1/2014

01.01.2014 | Symposium: 2013 Knee Society Proceedings

Unicondylar Arthroplasty in Knees With Deficient Anterior Cruciate Ligaments

verfasst von: Gerard A. Engh, MD, Deborah J. Ammeen, BS

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 1/2014

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Abstract

Background

Historically, a functional ACL has been a prerequisite for patients undergoing unicondylar knee arthroplasty (UKA). However, this premise has not been rigorously tested.

Questions/purposes

We compared (1) the survivorship free from revision and (2) the failure mechanisms of UKAs in ACL-deficient knees and UKAs in ACL-intact knees performed over the same time interval.

Methods

Between November 2000 and July 2008, a fixed bearing UKA was performed in 72 patients (81 knees) with intraoperatively confirmed ACL deficiency. Five patients (five knees) with preoperative instability underwent ACL reconstruction and were excluded from analysis. Of the remaining 67 patients (76 knees) without preoperative instability, implant status was known for 68 UKAs in 60 patients. Survivorship and failure mechanisms for these knees were compared to those of 706 UKAs in ACL-intact knees performed during the same time interval by the same surgeon using the same implant system. Minimum followup for the ACL-deficient group was 2.9 years (mean, 6 years; range, 2.9–10 years).

Results

Revision rates between UKAs with and without intact ACLs were similar in the absence of clinical instability (p = 0.58). Six-year UKA survivorship was 94% (95% CI: 88%–100%) in ACL-deficient knees and 93% (95% CI: 91%–96%) in ACL-intact knees (p = 0.89). Five knees (7%) in the ACL-deficient group were revised: disease progression (two), loose tibia (one), persistent pain (one), and revised elsewhere/reason unknown (one). Thirty-six knees in the ACL-intact group underwent revision (5%): aseptic loosening (13), revised elsewhere/reason unknown (11), disease progression (three), tibial subsidence/fracture (four), infection (three), pain (one), and lateral compartment overload (one).

Conclusions

At 6 years, deficiency of the ACL in patients without clinical knee instability did not impact the survivorship of UKAs compared to UKAs performed in knees with intact ACLs.

Level of Evidence

Level III, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
Literatur
1.
Zurück zum Zitat Ahlbäck S. Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Diagn (Stockh). 1968;suppl 277:7–72. Ahlbäck S. Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Diagn (Stockh). 1968;suppl 277:7–72.
2.
Zurück zum Zitat Argenson JN, Komistek RD, Aubaniac JM, Dennis DA, Northcut EJ, Anderson DT, Agostini S. In vivo determination of knee kinematics for subjects implanted with a unicompartmental arthroplasty. J Arthroplasty. 2002;17:1049–1054.PubMedCrossRef Argenson JN, Komistek RD, Aubaniac JM, Dennis DA, Northcut EJ, Anderson DT, Agostini S. In vivo determination of knee kinematics for subjects implanted with a unicompartmental arthroplasty. J Arthroplasty. 2002;17:1049–1054.PubMedCrossRef
3.
Zurück zum Zitat Blunn GW, Walker PS, Joshi A, Hardinge K. The dominance of cyclic sliding in producing wear in total knee replacements. Clin Orthop Relat Res. 1991;273:253–260.PubMed Blunn GW, Walker PS, Joshi A, Hardinge K. The dominance of cyclic sliding in producing wear in total knee replacements. Clin Orthop Relat Res. 1991;273:253–260.PubMed
4.
Zurück zum Zitat Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery: 10-year minimum follow-up period. J Arthroplasty. 1996;11:782–788.PubMedCrossRef Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery: 10-year minimum follow-up period. J Arthroplasty. 1996;11:782–788.PubMedCrossRef
5.
Zurück zum Zitat Christensen N. Unicompartmental prosthesis for gonarthrosis: a nine-year series of 575 knees from a Swedish hospital. Clin Orthop Relat Res. 1991;273:165–169.PubMed Christensen N. Unicompartmental prosthesis for gonarthrosis: a nine-year series of 575 knees from a Swedish hospital. Clin Orthop Relat Res. 1991;273:165–169.PubMed
6.
Zurück zum Zitat Deschamps G, Lapeyre B. [Rupture of the anterior cruciate ligament: a frequently unrecognized cause of failure of unicompartmental knee prostheses. Apropos of a series of Lotus prostheses with follow-up of more than 5 years] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1987;73:544–551.PubMed Deschamps G, Lapeyre B. [Rupture of the anterior cruciate ligament: a frequently unrecognized cause of failure of unicompartmental knee prostheses. Apropos of a series of Lotus prostheses with follow-up of more than 5 years] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1987;73:544–551.PubMed
7.
Zurück zum Zitat Goodfellow J, O’Connor J. The anterior cruciate ligament in knee arthroplasty: a risk factor with constrained meniscal prostheses. Clin Orthop Relat Res. 1992;276:245–252.PubMed Goodfellow J, O’Connor J. The anterior cruciate ligament in knee arthroplasty: a risk factor with constrained meniscal prostheses. Clin Orthop Relat Res. 1992;276:245–252.PubMed
8.
Zurück zum Zitat Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am. 2004;86:506–511.PubMed Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am. 2004;86:506–511.PubMed
9.
Zurück zum Zitat Kozinn SC, Scott R. Current concepts review: unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989;71:145–150.PubMed Kozinn SC, Scott R. Current concepts review: unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989;71:145–150.PubMed
Metadaten
Titel
Unicondylar Arthroplasty in Knees With Deficient Anterior Cruciate Ligaments
verfasst von
Gerard A. Engh, MD
Deborah J. Ammeen, BS
Publikationsdatum
01.01.2014
Verlag
Springer US
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 1/2014
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-2982-y

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