Midterm (10 year average) results of ACl deficient knees following non mobile UKA: Can we achieve high survivorship and excellent outcomes?
ESSKA Academy. Briggs K. 11/08/19; 285248; epEKA-54 Topic: Open Surgery
Karen Briggs
Karen Briggs
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Introduction: The purpose of this study was to determine if patients with an ACL deficient knee that are clinically stable and selected with a standardized algorithm may undergo UKA and have outcomes equal to those patients with a UKA and an intact ACL.
Methods: Patients with an ACL deficient knee who underwent non mobile cemented UKA by a single surgeon between 2002 and 2010 were identified. Knees were defined as ACL deficient(ACL-D) if there was a torn or absent ACL on MRI, which was verified at knee arthroscopy, performed prior to the UKA implantation on the same day. The inclusion criteria included isolated compartment osteoarthritis, primary UKA, painful knee restricting activities of daily living, absence of rotational instability on physical exam, absence of a pivot shift or positive Lachman. The ACL-D patients were matched with intact ACL and UKA patients as a comparison group. Patients were matched with age at follow-up, gender, side of the knee (medial versus lateral UKA), and BMI. The primary patient reported outcome variable was the KOOS function score. In addition,Lysholm, WOMAC were collected. Failure was defined as conversion to TKA. Objective variables at follow up included opposite compartment joint space, range of motion, and Lachman.
Results: 20 ACL-D patients met the inclusion criteria and were matched with 20 ACL intact patients(17 medial UKA and 3 lateral UKAs in each group). Two patients (10%) failed in each group. The average follow-up was 10.years (range 7 to 14.3) for both groups. The ACL-D patients showed significant improvement from pre- to post-operative in KOOS Function (79±12 to 95±6;p=.003) and KOOS quality of life (39±14 to 77±22;p=0.001). Ninety-one percent of patients reached MCID for the Lysholm score, 70% for WOMAC and 70% for KOOS function. There were no significant differences in any outcome scores postoperatively between the ACL-D and ACL Intact. Average extension for both groups was 0° and flexion was 133° for ACL -D and 132° for ACL intact. No collapse in opposite side joint space was seen in the ACL-def=7.4mm and the ACL-intact=6.3mm.
Conclusions: UKA in the ACL deficient knee in this cohort resulted in excellent mid-term outcomes. Maintenance of joint space in the opposite compartment, excellent range of motion, and outcome scores reached MCID. The ACL-D group had equivalent outcome scores compared to the ACL intact group.
Introduction: The purpose of this study was to determine if patients with an ACL deficient knee that are clinically stable and selected with a standardized algorithm may undergo UKA and have outcomes equal to those patients with a UKA and an intact ACL.
Methods: Patients with an ACL deficient knee who underwent non mobile cemented UKA by a single surgeon between 2002 and 2010 were identified. Knees were defined as ACL deficient(ACL-D) if there was a torn or absent ACL on MRI, which was verified at knee arthroscopy, performed prior to the UKA implantation on the same day. The inclusion criteria included isolated compartment osteoarthritis, primary UKA, painful knee restricting activities of daily living, absence of rotational instability on physical exam, absence of a pivot shift or positive Lachman. The ACL-D patients were matched with intact ACL and UKA patients as a comparison group. Patients were matched with age at follow-up, gender, side of the knee (medial versus lateral UKA), and BMI. The primary patient reported outcome variable was the KOOS function score. In addition,Lysholm, WOMAC were collected. Failure was defined as conversion to TKA. Objective variables at follow up included opposite compartment joint space, range of motion, and Lachman.
Results: 20 ACL-D patients met the inclusion criteria and were matched with 20 ACL intact patients(17 medial UKA and 3 lateral UKAs in each group). Two patients (10%) failed in each group. The average follow-up was 10.years (range 7 to 14.3) for both groups. The ACL-D patients showed significant improvement from pre- to post-operative in KOOS Function (79±12 to 95±6;p=.003) and KOOS quality of life (39±14 to 77±22;p=0.001). Ninety-one percent of patients reached MCID for the Lysholm score, 70% for WOMAC and 70% for KOOS function. There were no significant differences in any outcome scores postoperatively between the ACL-D and ACL Intact. Average extension for both groups was 0° and flexion was 133° for ACL -D and 132° for ACL intact. No collapse in opposite side joint space was seen in the ACL-def=7.4mm and the ACL-intact=6.3mm.
Conclusions: UKA in the ACL deficient knee in this cohort resulted in excellent mid-term outcomes. Maintenance of joint space in the opposite compartment, excellent range of motion, and outcome scores reached MCID. The ACL-D group had equivalent outcome scores compared to the ACL intact group.
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