Anterior Cruciate Ligament Deficiency is Not Always a Contraindication for Medial Unicompartmental Knee Arthroplasty: A Retrospective Study in Nondesigner’s Japanese Hospital

An intact anterior cruciate ligament (ACL) is thought to be prerequisite for successful unicompartmental knee arthroplasty (UKA), but recent studies reported successful midterm results of UKA in ACL-deficient (ACLD) knees. We hypothesized that ACLD is not always a contraindication for medial UKA when preoperative radiographs showed typical anteromedial knee patterns.

From April 2012 to March 2016, 401 Oxford mobile-bearing UKAs in 282 patients were retrospectively identified from our database. Patients whose ACL was severely damaged, but preoperative X-rays showed typical anteromedial osteoarthritis patterns, were categorized into the ACLD group. From intraoperative data, those whose ACL was intact were categorized into the ACL functional (ACLF) group. There were 32 and 369 knees in the ACLD and ACLF groups, respectively, and mean follow-up periods were 66.1 and 63.8 months for the ACLD and ACLF groups, respectively. We compared the postoperative clinical outcome and component survivorship, with an endpoint of component revision, between ACLD groups and ACLF groups.

In both groups, the Oxford knee score, Knee Society score, Tegner activity score, and knee range of motion in extension were improved after surgery. The UKA component survival rate at five years was 100% in the ACLD group and 98.9% in the ACLF group. There were no significant differences between the groups.

Mid-term clinical outcomes of Oxford mobile-bearing UKA in ACLD knees were similar to those in ACLF knees. ACL deficiency is not always a contraindication for medial unicompartmental knee arthroplasty in patients with typical anteromedial osteoarthritis radiographs.