Foissey Constant, Batailler Cécile, Shatrov Jobe, Servien Elvire, Lustig Sébastien
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.
Sydney Orthopaedic Research Institute (SORI), St. Leonards, Sydney, Australia.
Int Orthop. 2023 Apr;47(4):963-971. doi: 10.1007/s00264-022-05544-5. Epub 2022 Aug 13.
Anterior cruciate ligament (ACL) deficiency can be a consequence or a cause of femoro-tibial osteoarthritis (OA). Several studies have published satisfactory outcomes of unicompartimental knee arthroplasty (UKA) and combined ACL reconstruction despite its absence classically being considered a contraindication. A major challenge in the ACL deficient knee is obtaining appropriate gap balancing and limb axis. Robotically assisted UKA allows for precise control of these factors; however, it's utilisation as a tool with combined ACL reconstruction and UKA has not been described. The purpose of this study was to evaluate the clinical and radiological outcomes of robotically assisted UKA with combined ACL reconstruction.
This was a retrospective single-centre study of ten patients operated by a single surgeon from 2016 to 2020. All surgery was performed using a cemented fixed bearing UKA prosthesis (Journey uni, Smith and Nephew®) (8 medial, 2 lateral) inserted with the assistance of an image-free robotic-assisted system (BlueBelt, Navio, Smith and Nephew®). All ACL reconstructions were performed using hamstring autograft. Clinical assessment included International Knee Score (IKS) score, Tegner score and patient satisfaction. Radiological assessment was performed to assess radiolucent lines, progression of OA in the other compartments, Hip-Knee-Ankle angle and Posterior Tibial Slope.
There were eight females (80%), mean age was 57 ± 7 [48-70], mean BMI was 26 ± 3 [22-31]. The mean follow-up was 45 months ± 13 months [24-66]. Mean post-operative IKS knee and function score were respectively 96 ± 4.5 [88-100] and 93 ± 8.2 [74-100], mean Tegner score was 4.5 ± 1.4 [3-6]. Nine patients (90%) returned to sport; one patient (10%) was dissatisfied because of residual pain preventing a return to a desired level of sport. 100% of the radiological objectives were achieved. No radiolucent lines were seen at the last follow-up. There were two re-operations (20%) for stiffness requiring arthroscopic arthrolysis at two and three months respectively following surgery, with full recovery of the flexion at the last follow-up in both cases. No other complications were observed.
Robotic UKA associated with ACL reconstruction provides satisfactory early patient outcomes and accurate implant positioning. The first results in terms of return to sports were promising.
前交叉韧带（ACL）损伤可能是股骨-胫骨骨关节炎（OA）的结果或病因。多项研究已发表了单髁膝关节置换术（UKA）和联合ACL重建的满意结果，尽管经典上认为ACL缺失是UKA的禁忌症。ACL损伤膝关节的一个主要挑战是获得合适的间隙平衡和肢体轴线。机器人辅助UKA能够精确控制这些因素；然而，其作为联合ACL重建和UKA的工具的应用尚未见报道。本研究的目的是评估机器人辅助UKA联合ACL重建的临床和放射学结果。
这是一项对2016年至2020年由一名外科医生为10例患者实施手术的回顾性单中心研究。所有手术均使用骨水泥固定承重UKA假体（Journey uni，史赛克公司）（8例内侧，2例外侧），在无图像机器人辅助系统（BlueBelt，Navio，史赛克公司）辅助下植入。所有ACL重建均使用自体腘绳肌腱。临床评估包括国际膝关节评分（IKS）、Tegner评分和患者满意度。进行放射学评估以评估透亮线、其他关节间OA的进展、髋-膝-踝角和胫骨后倾。
有8名女性（80%），平均年龄为57±7岁[48 - 70岁]，平均体重指数为26±3[22 - 31]。平均随访时间为45个月±13个月[24 - 66个月]。术后IKS膝关节和功能评分分别为96±4.5[88 - 100]和93±8.2[74 - 100]，平均Tegner评分为4.5±1.4[3 - 6]。9名患者（90%）恢复运动；1名患者（10%）因残留疼痛无法恢复到期望的运动水平而不满意。100%的放射学目标得以实现。末次随访时未见透亮线。有2例（20%）因僵硬分别在术后2个月和3个月进行了再次手术，行关节镜下松解术，末次随访时两例患者的屈曲均完全恢复。未观察到其他并发症。
机器人辅助UKA联合ACL重建可提供满意的早期患者结果和准确的植入物定位。在恢复运动方面的初步结果很有前景。
