Case Report Hip Knee J.
Vol.
No.
2, 2024, pp.
p-ISSN: 2723-7818 e-ISSN: 2723-7826 http://dx.
org/10.
46355/hipknee.
UNICOMPARTMENTAL KNEE ARTHROPLASTY IN MEDIAL OSTEOARTHRITIS
KNEE WITH ANTERIOR CRUCIATE DEFICIENCY: A CASE REPORT
Fendy1 Soeradji Hospital Tirtonegoro Klaten.
Central Java.
Indonesia
ABSTRACT
Advantages of Unicompartmental Knee Arthroplasty (UKA) include the preservation of more tissue, maintenance of knee kinematics, and a faster recovery period.
However historically absence of an ACL could affect knee stability and lead to various degenerative changes, such as intra-articular damage and knee Case Presentation A 60-year-old female patient presented with severe left medial knee pain and functional limitations and persisted with conservative treatment.
Clinical examinations revealed tenderness over the medial joint line, a positive varus stress test, and a Lachman test.
Radiographic imaging confirmed severe medial compartment osteoarthritis with ACL deficiency without significant damage to other knee Patient was diagnosed with medial compartment osteoarthritis in an ACL-deficient knee.
UKA
using Oxford medial unicompartment implant was performed cement inserted into the medial compartment.
The patient followed a routine rehabilitation program.
At the 2 days after operation patient can full extension of the knee and flexion of the knee about 120 degrees with minimal pain.
Radiographic evaluation showed adequate implant positioning.
The discussion several studies have shown that with meticulous patient selection and accurate surgical technique.
UKA can yield favorable outcomes even in cases of ACL deficiency.
Preserving the ACL is critical to the success of UKA but achieving good results in ACL-deficient patients if the joint proves stable and well-balanced intraoperatively is possible.
The conclusion is UKA might be a viable option for patients with medial compartment osteoarthritis with ACL deficiency.
Keywords: Unicompartmental knee arthroplasty, osteoarthritis, anterior cruciate ligament deficiency, case This is an open access article under the CCAeBY-SA license.
Article History:
Corresponding Author:
Submission Revision Accepted : August 31st, 2024 : August 31st, 2024 : August 31st, 2024 Fendy Soeradji Hospital Tirtonegoro Klaten.
Central Java.
Indonesia fendyihkscito123@gmail.
UNICOMPARTMENTAL KNEE ARTHROPLASTY IN MEDIAL OSTEOARTHRITIS KNEE WITH ANTERIOR
CRUCIATE DEFICIENCY: A CASE REPORT
INTRODUCTION
Unicompartmental knee arthroplasty (UKA) is an effective surgical intervention for patients with isolated compartment osteoarthritis, offering advantages over total knee arthroplasty (TKA) such as preservation of knee kinematics, quicker recovery, and fewer complications .
However, the presence of anterior cruciate ligament (ACL) deficiency in patients poses a significant challenge for the application of UKA.
Traditionally.
ACL deficiency has been considered a contraindication for UKA due to concerns about joint stability, implant survival, and long-term outcomes .
This case report examines the feasibility and outcomes of UKA in a patient with medial compartment osteoarthritis and ACL deficiency.
PRESENTATION OF CASE
A 60-year-old female patient, a housewife, presented with severe left medial knee pain including physiotherapy, bracing, and nonsteroidal anti-inflammatory drugs (NSAID.
History of trauma was denied.
Clinical examinations revealed tenderness over the medial joint line, positive varus stress test, and a Lachman test indicating ACL deficiency.
Range of motion examination showed full extension and flexion about 150 degrees.
Radiographic anteroposterior imaging confirmed severe medial compartment osteoarthritis and an intact lateral compartment.
At lateral view
confirmed posteromedial osteoarthritis due to chronic anterior cruciate ligament
(A)
(B)
Figure 1.
(A) Anterior-posterior x-ray of the left knee, (B) Lateral view Given the localized nature of the osteoarthritis and the patient's desire to avoid TKA, a decision was made to proceed with UKA.
The surgical procedure was conducted using a minimally invasive Intraoperative confirmed the preoperative diagnosis, and a cemented Oxford partial knee replacement was implanted.
Care was taken to ensure proper alignment and balance of the knee joint.
Postoperatively, the patient was enrolled in a structured rehabilitation program focusing on restoring range of motion and strengthening periarticular muscles.
At the 2 days after operation patient can full extension of the knee and flexion of the knee about 120 degrees with minimal pain Copyright A 2024 the author.
| http://thehipkneejournal.
UNICOMPARTMENTAL KNEE ARTHROPLASTY IN MEDIAL OSTEOARTHRITIS KNEE WITH ANTERIOR
CRUCIATE DEFICIENCY: A CASE REPORT
Figure 3.
Post-operative images Figure 2.
UKA Implant Placement
DISCUSSION
Management of medial osteoarhtritis knee accompanied by ACL deficiency is a challenging dilemma for orthopedic UKA performed in ACL deficient knees shows higher failure rate due to the altered joint kinematics due to recurrent anterior translation of the tibia in relation to the femur, cause higher polyethylene wear and consequent osteolysis due to increased motion of the joint knee, the instability increases also risk of mobile bearing insert luxation .
Therefore, various strategies have been proposed including ACL reconstruction (ACLR), high tibial osteotomy (HTO) with or without ACLR.
UKA with or without ACLR and totzl knee arthroplasty (TKA).
TKA may be an overtreatment strategy if the degenerative changes are restricted solely to the medial compartment due to ACL deficiency or ACLR combined with HTO has been criticized as it shows a threefold higher rate of graft failure compared to UKA .
In medial osteoarthritis knee with ACL-D we can face two potential scenarios.
For elderly patients presenting lower activity levels.
OA is the primary disease with a concomitant secondary ACL deficiency.
For these patients a UKA without ACLR can technical aspects: reduction of the tibial slope and tensioning of the collateral Change of the posterior tibial slope contribute to tensioning of the collateral ligaments, increases collateral ligament tension.
It is recommended that the posterior tibial slope should not exceed 7A.
The successful outcome in this case contraindications of UKA in ACL-deficient Several studies have shown that with meticulous patient selection and precise surgical technique.
UKA can achieve favorable outcomes even in the presence of ACL deficiency .
The preservation of the ACL is crucial for the success of UKA.
however, in cases where the ACL is deficient, the procedure can still be viable if the joint is stable and wellbalanced intraoperatively.
The benefits of UKA, including less invasiveness, quicker recovery, and preservation of normal knee Copyright A 2024 the author.
| http://thehipkneejournal.
UNICOMPARTMENTAL KNEE ARTHROPLASTY IN MEDIAL OSTEOARTHRITIS KNEE WITH ANTERIOR
CRUCIATE DEFICIENCY: A CASE REPORT
kinematics, make it an attractive option for suitable patients .
CONCLUSIONS
This case report highlights the potential of UKA in patients with medial compartment osteoarthritis and ACL deficiency, emphasizing the importance of careful patient selection and surgical expertise.
The findings suggest that UKA can offer significant benefits in terms of pain relief and functional improvement for selected ACL-deficient patients.
Further research
with larger patient cohorts and longer
follow-up periods is necessary to establish
the long-term outcomes and refine the selection criteria for UKA in this patient
REFERENCES