Huang Wenzhou, Tang Sen, Guo Yanren, Fu Xiaoling, Cheng Xigao, Sun Kuo
Department of Orthopedics, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, 330006, Nanchang, China.
Institute of Orthopedics of Jiangxi Province, Jiangxi, 330006, Nanchang, China.
Arch Orthop Trauma Surg. 2025 Apr 5;145(1):225. doi: 10.1007/s00402-025-05847-3.
Medial unicompartmental knee arthroplasty (mUKA) is indicated for anteromedial osteoarthritis (AMOA) with medial full thickness cartilage loss (FTCL). Previous studies have reported controversial outcomes in patients with partial thickness cartilage loss (PTCL) who undergo mUKA. However, there is no reliable way to predict which PTCL patients do well. The aim of the present study was to investigate whether Kellgren-Lawrence (KL) grade is associated with clinical outcomes following mUKA patients with PTCL.
Cartilage loss in the medial compartment was evaluated via MRI and intra-operatively according to the International Cartilage Repair Society (ICRS) classification system. Standing anteroposterior and lateral radiographs were taken to determine the KL grade. The patients, were grouped as having FTCL or PTCL with KL 0-2 and KL 3. The clinical data from the latest follow-up were assessed via the Forgotten Joint Score (FJS-12 score), the Oxford Knee Score (OKS), and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Postoperative complications were also observed and recorded.
We studied 40 knees of 39 patients with PTCL and matched them with 40 knees with FTCL for mUKAs. The groups were similar in terms of age, sex, operative side, BMI and follow-up. The mean OKS (P = 0.014), KOOS pain (P = 0.040), KOOS symptom (P = 0.028), and KOOS sport (P = 0.034) scores were significantly lower in the PTCL group than in the FTCL group. To evaluate the effect of the KL grade, patients were categorized into the following groups: FTCL, PTCL with KL 0-2 and KL 3. The mean OKS (P = 0.044), KOOS symptom (P = 0.047) and KOOS sport (P = 0.045) scores were significantly lower in the PTCL with KL 0-2 group. However, no significant difference was found between the FTCL and PTCL with KL 3 in terms of the FJS-12, OKS and KOOS scores. No patients had any complications requiring reoperation or surgical revision.
PTCL patients who have KL 3 AMOA are not contraindicated by mUKA when nonoperative treatment for those patients have otherwise failed. However, PTCL patients with KL 0-2 AMOA are not equally suited for treatment with mUKA, and other treatment options should be considered.
内侧单髁膝关节置换术（mUKA）适用于伴有内侧全层软骨损伤（FTCL）的前内侧骨关节炎（AMOA）。既往研究报道了接受mUKA治疗的部分厚度软骨损伤（PTCL）患者的疗效存在争议。然而，目前尚无可靠方法预测哪些PTCL患者预后良好。本研究的目的是调查Kellgren-Lawrence（KL）分级是否与PTCL患者接受mUKA后的临床结局相关。
根据国际软骨修复协会（ICRS）分类系统，通过MRI和术中评估内侧间室的软骨损伤情况。拍摄站立位前后位和侧位X线片以确定KL分级。患者被分为FTCL组或PTCL组，其中PTCL组又分为KL 0-2组和KL 3组。通过遗忘关节评分（FJS-12评分）、牛津膝关节评分（OKS）和膝关节损伤与骨关节炎转归评分（KOOS）评估最新随访时的临床数据。同时观察并记录术后并发症。
我们研究了39例PTCL患者的40个膝关节，并为其匹配了40个接受mUKA的FTCL膝关节。两组在年龄、性别、手术侧、BMI和随访时间方面相似。PTCL组的平均OKS评分（P = 0.014）、KOOS疼痛评分（P = 0.040）、KOOS症状评分（P = 0.028）和KOOS运动评分（P = 0.034）均显著低于FTCL组。为评估KL分级的影响，将患者分为以下几组：FTCL组、KL 0-2的PTCL组和KL 3的PTCL组。KL 0-2的PTCL组的平均OKS评分（P = 0.044）、KOOS症状评分（P = 0.047）和KOOS运动评分（P = 0.045）均显著较低。然而，在FJS-12、OKS和KOOS评分方面，FTCL组与KL 3的PTCL组之间未发现显著差异。没有患者出现需要再次手术或手术翻修的并发症。
对于非手术治疗失败的KL 3 AMOA的PTCL患者，mUKA并非禁忌。然而，KL 0-2 AMOA的PTCL患者并不同样适合mUKA治疗，应考虑其他治疗选择。
