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A Technique for Anterior Cruciate Ligament Reconstruction in the Setting of Unicompartmental Knee Arthroplasty.

ABSTRACT: Unicompartmental knee arthroplasty (UKA) is becoming a more prevalent treatment for medial-compartment arthritis. Traditionally, a competent anterior cruciate ligament (ACL) is required to achieve satisfactory results. This leads to the question of treatment for medial-compartment arthritis in the setting of an incompetent ACL. A treatment option for this subset of patients is concurrent UKA and ACL reconstruction; however, this technique addresses the cohort of patients with a previously stable UKA who sustain an injury to the ACL, leading to symptomatic instability. The purpose of this article is to detail a technique for ACL reconstruction in the setting of a previous UKA.

SUBMITTER: Dees RL

PROVIDER: S-EPMC7823143 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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A Technique for Anterior Cruciate Ligament Reconstruction in the Setting of Unicompartmental Knee Arthroplasty.

Dees Richard L RL Parker Anthony J AJ Glomset John L JL

Arthroscopy techniques 20210120 1

Unicompartmental knee arthroplasty (UKA) is becoming a more prevalent treatment for medial-compartment arthritis. Traditionally, a competent anterior cruciate ligament (ACL) is required to achieve satisfactory results. This leads to the question of treatment for medial-compartment arthritis in the setting of an incompetent ACL. A treatment option for this subset of patients is concurrent UKA and ACL reconstruction; however, this technique addresses the cohort of patients with a previously stable ...[more]

PMID: 33532233

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Anterior cruciate ligament avulsion fracture following medial unicompartmental knee arthroplasty: A case report.

Project description:IntroductionAnterior cruciate ligament (ACL) avulsion fracture after unicompartmental knee arthroplasty (UKA) has not been reported until recently. We describe a case of ACL avulsion fracture that developed after medial UKA.Case presentationA 57-year-old woman underwent UKA for right medial compartment osteoarthritis. She developed knee pain and swelling at 2 weeks after UKA, and radiographs showed an ACL avulsion fracture at 3 weeks after UKA. After conservative treatment failed, the fracture was fixed using screws. After 5 months from internal fixation, bone union was confirmed, and the screws were removed. At 16 months after removing screws, there was no further complication.DiscussionThe patient did not exhibit a fracture on the radiograph taken immediately after UKA. We carefully re-examined the radiographs and observed a 5-mm horizontal cement shadow on the lateral side of the tibial component. It is thought that excessive lateral resection of the proximal tibia during UKA may have resulted in a micro fracture and this outcome. In the present case, the posterior slope angle of the tibial component measured postoperatively was 11.5 degrees. The angle of more than 7 degrees along with excessive horizontal resection of the proximal tibia probably increased load on the ACL.ConclusionIf patients exhibit a horizontal cement shadow near the tibial component and a higher posterior slope angle of the tibial component on the radiograph after UKA, surgeons should be aware of possible ACL avulsion fracture and perform additional radiological examinations in patients with continuous knee pain and swelling.

| S-EPMC8099496 | biostudies-literature

Total knee arthroplasty after anterior cruciate ligament reconstruction: a narrative review.

Project description:Background and objectiveKnee replacement following anterior cruciate ligament (ACL) reconstruction can be demanding due to altered anatomy, soft tissue scars, bone loss, extensor mechanism complications, and knee instability. This narrative review summarizes the strategies and approaches to managing operative challenges in total knee arthroplasty (TKA) following ACL reconstruction.MethodsStudies reporting outcomes of patients who underwent TKA after ACL reconstruction were retrieved and assessed to be included in this review that synthesizes the available evidence highlighting the pitfalls encountered during surgery, the intraoperative challenges posed by ligament balancing and exposure, and the leading role of modular and retained implants.Key content and findingsTKA following ACL reconstruction has a high rate of intra-operative complications such as instability, bone loss, difficult exposure and demanding soft tissue balancing, representing a revision surgery rather than routine primary knee arthroplasty and a revision-oriented skill set and modular components are recommended to significantly optimize both surgical strategy and patient outcomes. With a rising incidence of ACL injuries and growing reconstructions, anticipating an increase in TKA procedures, this review aims to provide a call for rethinking clinical approaches to ensure effective and patient-centric care.ConclusionsThis narrative review seems to indicate that TKA after ACL reconstruction should be considered as revision surgery and modular components should be used. However, future prospective and high-quality studies are required to better clarify risk factors and give strong recommendations for this complex surgery.

| S-EPMC11304087 | biostudies-literature

Simultaneous medial unicompartmental knee replacement and anterior cruciate ligament reconstruction: a narrative review and technical note.

Project description:Background and objectiveReconstruction of the anterior cruciate ligament (ACL) simultaneously with medial unicompartmental knee arthroplasty (UKA) has been suggested as an alternative treatment in patients with ACL deficiency and localized osteoarthritis (OA) in young patients. The objectives of this review were to report the current concepts on the topic and describe an original surgical technique of simultaneous medial UKA and ACL reconstruction.MethodsA literature search was performed on PubMed, including articles written in English until June 2021. The articles regarding ACL reconstruction and UKA were reviewed using the narrative approach. Inclusion criteria: (I) original articles about ACL reconstruction and unicompartmental knee replacement; (II) written in English; (III) involving three or more cases. Two non-blinded authors reviewed the titles and abstracts of each article identified in the literature search.Key content and findingsThe articles regarding ACL reconstruction and UKA were reviewed using the narrative approach.ConclusionsThere is controversial evidence about performing the UKA simultaneously with an ACL reconstruction. Biomechanical and clinical studies show that the benefits of restoring good joint stability outweigh the possible risks associated with performing both surgeries at the same time. With this strategy, it is possible to obtain good clinical results with a high survival rate of the implant and patient satisfaction.

| S-EPMC10929284 | biostudies-literature

A new anterior cruciate ligament reconstruction fixation technique (quadrupled semitendinosus anterior cruciate ligament reconstruction with polyetheretherketone cage fixation).

Project description:Fixation of the graft during anterior cruciate ligament reconstruction surgery has been the subject of numerous technical innovations but still remains a challenge. This article describes a novel technique of graft fixation for hamstring tendon reconstruction: the Cage For One system (Sacimex, Aix-en-Provence, France). The technique uses only the semitendinosus tendon, which is looped to create a 4-strand graft. Leaving the gracilis tendon intact probably reduces the loss of knee flexion strength. The graft is indirectly anchored into both tunnels with polyetheretherketone cages by use of polyethylene terephthalate tape strips. Both cages and strips are magnetic resonance imaging compatible and do not create artifacts. The tunnels are drilled by an outside-in method with minimal incisions. This type of fixation creates a 360° bone contact at 1.5 cm in each tunnel and is compatible with double-bundle reconstruction. This easy-to-use novel technique of fixation for anterior cruciate ligament reconstruction produces a strong 4-strand graft while harvesting only the semitendinosus tendon and leaving the gracilis tendon intact to reduce flexion strength loss and preserve rotatory stability of the knee. It creates an immediate solid fixation that is independent of graft integration in the early postoperative period, allowing the patient to start immediate rehabilitation without the use of a brace.

| S-EPMC3678617 | biostudies-literature

Surgical Technique for Release of Anterior Interval Scarring of the Knee After Anterior Cruciate Ligament Reconstruction.

Project description:Postoperative scarring is a known complication after arthroscopic anterior ligament reconstruction of the knee. The anterior interval of the knee has been previously identified as a common location for anterior scar formation. The anterior interval is defined as the space between the infrapatellar fat pad and the anterior border of the tibia. Patients with anterior interval scarring often present with lack of terminal knee extension, anterior knee pain, decreased patellar mobility, and quadriceps atrophy. The goal of this paper is to describe the technique for anterior interval release of the knee.

| S-EPMC6153305 | biostudies-literature

Anterior cruciate ligament injury should not be considered a contraindication for medial unicompartmental knee arthroplasty: Finite element analysis

Project description: Not available

| S-EPMC10931476 | biostudies-literature

Combined, Pedicled Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction - "PAAR" Technique.

Project description:Despite constant development of surgical implants, instruments, and rehabilitation protocols, the outcomes of anterior cruciate ligament reconstruction remain unpredictable, and the failure rate of isolated procedures remains unacceptably high. Several factors possibly concerning suboptimal outcomes and risk of graft rerupture have been highlighted, among which are graft healing, tunnel position, and residual rotational instability. Recent studies have suggested that addressing anterolateral complex injury and enhancing graft healing properties might improve the outcomes of surgery. We propose a simple technique of combined anterior cruciate ligament and anterolateral ligament reconstruction using pedicled semitendinosus and gracilis tendons with a single femoral tunnel and no additional tibial tunnels.

| S-EPMC11519854 | biostudies-literature

Early failure with massive metallosis and posteromedial wear following atraumatic anterior cruciate ligament rupture after medial unicompartmental knee arthroplasty.

Project description:Severe metallosis following medial unicompartmental knee arthroplasty (UKA) is relatively rare. It is usually due to long-standing wear of the polyethylene component, resulting in frictional wear between the femoral and tibial metallic components. Biomechanical and cadaveric studies have shown the effects of anterior cruciate ligament (ACL) transection following medial UKA. We describe a case of a 58-year-old male who developed attritional rupture of the ACL 16 months following medial UKA leading on to early accelerated failure over the next 8 months. The patient underwent revision to total knee arthroplasty with good outcome. The clinical effect of spontaneous ACL transection on medial UKA causing abnormal posteromedial wear of polyethylene component and tibial tray, massive metallosis, and worsening of mechanical axis can be demonstrated in this case report.

| S-EPMC5859552 | biostudies-literature

Hamstring Braid Graft Technique for Anterior Cruciate Ligament Reconstruction.

Project description:Hamstring autograft is one of the most used grafts for anterior cruciate ligament (ACL) reconstruction, although there are several graft preparation techniques. It is extremely difficult to mimic the biomechanical properties of the native ACL; thus, it is important to achieve a proper graft configuration, diameter, and length. To avoid reruptures, an optimal and reproducible hamstring autograft is desired. Hamstring autograft has been traditionally devalued when compared with other options such as bone-patellar tendon-bone autograft. The purpose of this Technical Note is to describe in detail a hamstring braid graft configuration that could potentially overcome the past disadvantages of ACL reconstruction.

| S-EPMC6823734 | biostudies-literature

Remnant-Preserving Anterior Cruciate Ligament Reconstruction: Remnant Envelope Technique.

Project description:The awareness of anterior cruciate ligament (ACL) injuries and their treatment is increasing among athletes and within the general population, so patients report early to orthopaedic surgeons. Because we encounter a thick ACL stump during arthroscopic ACL reconstruction, an attempt is made to preserve this stump. Remnant preservation-although promising in terms of graft healing because it enhances cell proliferation, revascularization, and regeneration of the proprioceptive organs in the reconstructed ACL-does not come without complications, such as cyclops lesions, impingement, and extension loss. These problems can be detrimental to an athlete's return to his or her preinjury level after ACL reconstruction. Therefore, we describe a technique in which the ACL is reconstructed using hamstring autograft and suture passes are made through the remnant with an antegrade suture-passing device. After anatomic tunnel drilling, the remnant is tensioned, along with the reconstructed ACL, at the femoral end without the use of an extra implant. Femoral-side fixation is achieved with an adjustable-loop button (Procinch; Stryker) and a bio-composite interference screw (Biosure Regenesorb; Smith & Nephew) on the tibial end. As the sutured remnant is tensioned and knots are made over the button, the remnant envelopes the graft in the orientation of the native ACL, which can be helpful for early and better ligamentization of the graft. The potential advantages of this technique are as follows: orientation of the remnant along the collagen of the ACL graft; no loose ACL stump in the notch, thus preventing cyclops lesions; retention of the proprioceptive organs in the ligament; and no extra implant.

| S-EPMC7695627 | biostudies-literature

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