Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
Department of Trauma and Orthopaedics, Manipal Hospital, Bangalore, India.
Knee Surg Sports Traumatol Arthrosc. 2018 Sep;26(9):2594-2601. doi: 10.1007/s00167-017-4536-4. Epub 2017 Mar 31.
There exist limited options for treatment of patients with combined medial compartment arthritis and anterior cruciate ligament (ACL) deficiency. Ideal treatment is one that offers lasting relief of symptoms not compromising any future surgery. Unicompartmental knee replacement has shown consistently good results in the relatively young and active population, but there is a high reported incidence of failure up to 20%, if performed in ACL-deficient knees. One of the recognized treatment modality is combined ACL reconstruction and unicompartmental arthroplasty. A systematic review was conducted looking at the demographics, techniques, complications and outcome of combined ACL reconstruction with unicompartmental knee arthroplasty.
A systematic literature search within the online Medline, PubMed Database, EMBASE, Web of Science, Cochrane and Google Scholar was carried out until October 2016 to identify relevant articles. A study was defined eligible if it met the following inclusion criteria: the surgical procedure combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction; patient's clinical and/or functional outcomes were reported; any complications intra-operatively and post-operatively were reported; and the full-text articles, written in English, German, Italian, Dutch or Spanish, were available. Quality and risk of bias assessments were done using standardized criteria set.
A total of 8 studies met the inclusion criteria encompassing 186 patients who were treated with simultaneous ACL reconstruction and unicompartmental knee arthroplasty. The mean age was 50.5 years (range from 44 to 56) with a mean follow-up of 37.6 months (range from 24 to 60). There was an improvement in mean Oxford Score from 27.5 to 36.8. Complications reported included tibial inlay dislocation (n = 3), conversion to a total knee arthroplasty (n = 1), infection requiring two-stage revision (n = 2), deep-vein thrombosis (n = 1), stiffness requiring manipulation under anaesthesia (n = 1), retropatellar pain requiring arthroscopic adhesiolysis (n = 1).
Unicompartmental knee arthroplasty combined with ACL reconstruction can be a valid treatment option for selected patients, with combined medial unicompartmental knee osteoarthritis and ACL deficiency.
Systematic Review of Level IV Studies, Level IV.
对于合并内侧间室关节炎和前交叉韧带（ACL）缺失的患者，治疗方法有限。理想的治疗方法是提供持久的症状缓解，而不影响任何未来的手术。单髁膝关节置换术在相对年轻和活跃的人群中一直显示出良好的效果，但如果在 ACL 缺失的膝关节中进行，报告的失败率高达 20%。公认的治疗方法之一是联合 ACL 重建和单髁关节成形术。对 ACL 重建联合单髁膝关节置换术的人口统计学、技术、并发症和结果进行了系统评价。
对在线 Medline、PubMed 数据库、EMBASE、Web of Science、Cochrane 和 Google Scholar 进行系统文献检索，以确定相关文章。如果满足以下纳入标准，则定义为符合研究条件：手术联合单髁膝关节置换术和前交叉韧带重建；报告了患者的临床和/或功能结果；报告了术中及术后的任何并发症；以及可以获取全文，以英语、德语、意大利语、荷兰语或西班牙语书写的文章。使用标准化标准进行质量和风险偏倚评估。
共有 8 项研究符合纳入标准，共纳入 186 例同时接受 ACL 重建和单髁膝关节置换术的患者。平均年龄为 50.5 岁（44-56 岁），平均随访时间为 37.6 个月（24-60 个月）。牛津评分从 27.5 分提高到 36.8 分。报告的并发症包括胫骨嵌体脱位（n=3）、转为全膝关节置换术（n=1）、需要两期翻修的感染（n=2）、深静脉血栓形成（n=1）、需要在全身麻醉下进行手法松解的僵硬（n=1）、需要关节镜粘连松解的髌后疼痛（n=1）。
对于合并内侧单间室骨关节炎和 ACL 缺失的特定患者，单髁膝关节置换术联合 ACL 重建可能是一种有效的治疗选择。
四级研究的系统评价，四级。
