Mancuso Francesco, Dodd Christopher A, Murray David W, Pandit Hemant
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
Orthopaedics and Traumatology Unit, "Santa Maria della Misericordia" University Hospital, Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy.
J Orthop Traumatol. 2016 Sep;17(3):267-75. doi: 10.1007/s10195-016-0402-2. Epub 2016 May 9.
Symptomatic osteoarthritis (OA) of the knee develops often in association with anterior cruciate ligament (ACL) deficiency. Two distinct pathologies should be recognised while considering treatment options in patients with end-stage medial compartment OA and ACL deficiency. Patients with primary ACL deficiency (usually traumatic ACL rupture) can develop secondary OA (typically presenting with symptoms of instability and pain) and these patients are typically young and active. Patients with primary end stage medial compartment OA can develop secondary ACL deficiency (usually degenerate ACL rupture) and these patients tend to be older. Treatment options in either of these patient groups include arthroscopic debridement, reconstruction of the ACL, high tibial osteotomy (HTO) with or without ACL reconstruction, unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). General opinion is that a functionally intact ACL is a fundamental prerequisite to perform a UKA. This is because previous reports showed higher failure rates when ACL was deficient, probably secondary to wear and tibial loosening. Nevertheless in some cases of ACL deficiency with end-stage medial compartment OA, UKA has been performed in isolation and recent papers confirm good short- to mid-term outcome without increased risk of implant failure. Shorter hospital stay, fewer blood transfusions, faster recovery and significantly lower risk of developing major complications like death, myocardial infarction, stroke, deep vein thrombosis (as compared to TKA) make the UKA an attractive option, especially in the older patients. On the other hand, younger patients with higher functional demands are likely to benefit from a simultaneous or staged ACL reconstruction in addition to UKA to regain knee stability. These procedures tend to be technically demanding. The main aim of this review was to provide a synopsis of the existing literature and outline an evidence-based treatment algorithm.
膝关节症状性骨关节炎（OA）常与前交叉韧带（ACL）损伤相关。在考虑终末期内侧间室OA合并ACL损伤患者的治疗方案时，应认识到两种不同的病理情况。原发性ACL损伤（通常为创伤性ACL断裂）患者可发展为继发性OA（典型表现为不稳定和疼痛症状），这些患者通常年轻且活跃。原发性终末期内侧间室OA患者可发展为继发性ACL损伤（通常为退变的ACL断裂），这些患者往往年龄较大。这两类患者的治疗方案包括关节镜清理、ACL重建、有或无ACL重建的高位胫骨截骨术（HTO）、单髁膝关节置换术（UKA）和全膝关节置换术（TKA）。一般观点认为，功能完整的ACL是进行UKA的基本前提。这是因为先前的报告显示，ACL损伤时失败率较高，可能继发于磨损和胫骨松动。然而，在一些ACL损伤合并终末期内侧间室OA的病例中，单独进行了UKA，最近的文献证实其短期至中期效果良好，且植入物失败风险未增加。与TKA相比，UKA住院时间短、输血少、恢复快，发生死亡、心肌梗死、中风、深静脉血栓等主要并发症的风险显著降低，这使得UKA成为一个有吸引力的选择，尤其是在老年患者中。另一方面，功能需求较高的年轻患者除UKA外，可能还会从同期或分期的ACL重建中获益，以恢复膝关节稳定性。这些手术往往技术要求较高。本综述的主要目的是概述现有文献，并概述基于证据的治疗算法。
