The Impact of Different Anterior Cruciate Ligament Status on Unicompartmental Knee Arthroplasty: Short Term Clinical and Functional Results

Abstract

Purpose: Purpose of this study is to compare the short-term results of unicompartmental knee arthroplasty applied stable knees regardless of the condition of the ACL and the application of unicompartmental knee arthroplasty and ACL reconstruction combined surgery applied to ACL deficient cases with anterior instability and to identify the condition and function of the ACL for success in this surgery. Patients and Methods: 80 out of the 105 patients who were operated in 2013-2015 and came for follow-up were included in the study and the patients were divided into four groups. The VAS pain score, KSS Score, WOMAC score, OKS questionnaires and joint range of motion measurements were conducted pre-operatively and post-operatively. One leg standing test, joint position sense measurement, and isokinetic muscle strength test were performed in post-operative controls. Results: There was no statistically significant difference between the demographic data and follow-up of the groups (p˃0.05). While there was a statistically significant difference in knee flexion between Group 2-Group 4 and Group 3-Group 4 in the pre-operative period, no difference was found in the post-operative period (p˃0.05). While there was no difference among the groups, knee joint range of motion in direction of extension declined in a statistically significant way in all four groups (p˂0.05). Pain felt postoperatively was the most in Group 1 and the least in Group 3. A statistically significant difference was found between Group 1 and Group 3 in the test performed with the eyes closed (p˂0.05). Conclusion: The presence of a functional anterior cruciate ligament is expected to make a positive contribution to surgical results especially in young patients with high activity expectation. Whether the patient’s ACL rupture is primary or secondary and his/her activity expectation should be effective in the choice of a surgical method.

Keywords

• Medial compartment osteoarthritis
• unicompartmental knee arthroplasty
• anterior cruciate ligament
• pain
• joint position sense
• muscle strength

Unikompartmantal Diz Artroplastisine Ön Çapraz Bağ Durumunun Etkisi: Kısa Dönem Klinik ve Fonksiyonel Sonuçlar

Abstract

Amaç: Bu çalışmanın amacı ön çapraz bağın durumuna bakılmaksızın stabil dizde uygulanan unikompartmantal diz artroplastisi ile anterior instabilitesi ve ön çapraz bağ eksikliği olan olgularda unikompartmantal diz artroplastisi ve ön çapraz bağ rekonstrüksiyonu uygulanan hastaların kısa dönem sonuçlarını karşılaştırmak ve unikompartmantal diz artroplastisinde cerrahinin başarını arttırmak için ön çapraz bağın durumunu ve işlevini belirlemektir. Hastalar ve Yöntem: 2013-2015 yıllarında opere edilen ve kontrole gelen 80 hasta çalışmaya dahil edildi ve hastalar dört gruba ayrıldı. Pre-operatif ve post-operatif VAS ağrı skoru, KSS Skoru, WOMAC skoru, OKS skoru ve eklem hareket açıklığı değerlendirmeleri yapıldı. Post-operatif kontrollerde tek ayak denge testi, eklem pozisyon hissi ölçümü ve izokinetik kas kuvvet testi uygulandı. Bulgular: Grupların demografik verileri arasında istatistiksel olarak anlamlı fark yoktu (p˃0,05). Grup 2-Grup 4 ve Grup 3-Grup 4 arasında pre-operatif dönemde diz fleksiyonunda istatistiksel olarak anlamlı fark bulunurken, post-operatif dönemde fark saptanmadı (p˃0,05). Diz ekstansiyonu dört grupta da istatistiksel olarak anlamlı düzeyde azaldı (p˂0,05). Post-operatif ağrı en fazla Grup 1'de, en az ise Grup 3'te görüldü. Gözler kapalı yapılan denge testinde Grup 1 ile Grup 3 arasında istatistiksel olarak anlamlı fark bulundu (p˂0,05). Sonuç: Özellikle aktivite beklentisi yüksek olan genç hastalarda fonksiyonel ön çapraz bağ varlığının cerrahi sonuçlara olumlu katkı sağlaması beklenmektedir. Hastanın ÖÇB yırtığının primer veya sekonder olması ile aktivite beklentisi cerrahi yöntemin seçiminde etkili olmalıdır.

Keywords

• medial kompartman osteoartriti
• unikompartmantal diz artroplastisi
• ön çapraz bağ
• ağrı
• eklem pozisyon hissi
• kas kuvveti

References

1. [1] Banks SA, Fregly BJ, Boniforti F, vd. 2005. Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surgery, Sport Traumatol Arthrosc, 13:551–6.
2. [2] Ackroyd CE, Whitehouse SL, Newman JH, vd. 2002. A comparative study of the medial St Georg Sled and Kinematic total knee arthroplasties Ten-Year Survivorship. J Bone Jt Surg Br, 84:667–72.
3. [3] Tinius M, Hepp P, Becker R. 2012. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surgery, Sport Traumatol Arthrosc, 20:81–7.
4. [4] Fergusson C. 2000. Management of the young patient with an osteoarthritic knee, ss1-12. Allum R, Fergusson C, Thomas N, ed. 2000. Clin. challenges Orthop. knee, Martin Dunitz Ltd, London.
5. [5] Lee SH, Jung YB, Jung HJ, et al. 2010. Combined reconstruction for posterolateral rotatory instability with anterior cruciate ligament injuries of the knee. Knee Surgery, Sport Traumatol Arthrosc, 18:1219–25.
6. [6] Li G, Papannagari R, DeFrate LE, et al. 2009. The effects of ACL deficiency on mediolateral translation and varus–valgus rotation. New Pub Med Journals Sweden, 78:355–60.
7. [7] Deschamps G, Lapeyre B. 1987. Rupture of the anterior cruciate ligament: a frequently unrecognized cause of failure of unicompartmental knee prostheses. Apropos of a series of 79 Lotus prostheses with a follow-up of more than 5 years. Rev Chir Orthop Reparatrice Appar Mot, 3:544–51.
8. [8] Pandit H, Beard DJ, Jenkins C, et al. 2006. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Jt Surg Br, 88:887–92.

9. [9] Boissonneault A, Pandit H, Pegg E, et al. 2013. No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament. Knee Surgery, Sport Traumatol Arthrosc, 21:2480–6.
10. [10] Bahl V, Goyal A, Jain V, et al. 2013. Effect of haemarthrosis on the rehabilitation of anterior cruciate ligament reconstruction-single bundle versus double bundle. J Orthop Surg Res, 5.
11. [11] Tüzün EH, Eker L, Aytar A, et al. 2005. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthr Cartil, 13:28–33.
12. [12] Barbara Springer CA, Raul Marin C, Cyhan T, et al. 2007. Normative Values for the Unipedal Stance Test with Eyes Open and Closed. J Geriatr Phys Ther, 30:8–15.
13. [13] Isaac SM, Barker KL, Danial IN, et al. 2007. Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. Knee, 14:212–7.
14. [14] Daşkapan A, Anaforoǧlu B, Özünlü Pekyavaş N, et al. 2013. Comparison of Mini-squats and Straight Leg Raises in Patients with Knee Osteoarthritis: A Randomized Controlled Clinical Trial. Arch Rheumatol, 28:016–26.
15. [15] Sébilo A, Casin C, Lebel B, et al. 2013. Clinical and technical factors influencing outcomes of unicompartmental knee arthroplasty: Retrospective multicentre study of 944 knees. Orthop Traumatol Surg Res, 99:S227-34.
16. [16] Berger RA, Meneghini RM, Jacobs JJ, et al. 2005. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Jt Surg, 87:999–1006.
17. [17] Mancuso F, Hamilton TW, Kumar V, et al. 2014. Clinical outcome after UKA and HTO in ACL deficiency: a systematic review. Knee Surg Sports Traumatol Arthrosc, 24:112–22.
18. [18] Engh GA, Ammeen DJ. 2014. Unicondylar arthroplasty in knees with deficient anterior cruciate ligaments knee. Clin Orthop Relat Res, 472:73–7.
19. [19] Krishnan SR, Randle R. 2009. ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis. J Orthop Surg Res, 4:43.
20. [20] Citak M, Bosscher MRF, Citak M, et al. 2011. Anterior cruciate ligament reconstruction after unicompartmental knee arthroplasty. Knee Surgery, Sport Traumatol Arthrosc, 19:1683–8.
21. [21] Pandit H, Van Duren BH, Gallagher JA, et al. 2008. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: In vivo kinematics. Knee 2008;15:101–6.
22. [22] Suggs JF, Li G, Park SE, et al. Knee biomechanics after UKA and its relation to the ACL—a robotic investigation. J Orthop Res, 24:588–94.