title: Clinical outcome after UKA and HTO in ACL deficiency: a systematic review.
abstract: OBJECTIVE
  In the treatment of medial osteoarthritis secondary to anterior cruciate ligament (ACL) injury there is no consensus about optimum treatment, with both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) being viable options. The aim of this review was to compare the outcomes of these treatments, both with or without ACL reconstruction.
  
  
  METHODS
  EMBASE, MEDLINE and the Clinical Trials Registers were searched to identify relevant studies. Studies meeting pre-defined inclusion criteria were assessed independently by two researchers for methodological quality and data extracted.
  
  
  RESULTS
  Twenty-six studies involving 771 patients were identified for inclusion. No randomized controlled trials were identified. Seventeen studies reported outcomes following HTO and nine studies reported outcomes following UKA. HTO patients were significantly younger than those receiving UKA, and ACL reconstruction patients were younger than non-reconstructed patients. Treatment with HTO ACL reconstruction had the lowest revision rate (0.62/100 observed component years) but the highest rate of complications (4.61/100 observed component years). Too little data were available to test for differences in outcome between different surgical techniques or prosthesis designs.
  
  
  CONCLUSIONS
  Limited conclusions about the optimum treatment can be made due to the absence of controlled trials. In patients treated with HTO ACL reconstruction, the high complication rate likely outweighs its minimally superior survival. Outcomes following UKA ACL reconstruction are similar to outcomes for UKA in the ACL intact knee without any increase in complications. As such in patients meeting indications for UKA, UKA ACL reconstruction should be performed with further work required to identify the optimum treatment in other patient groups.
  
  
  METHODS
  IV.
authors.affiliation: Clinic of Orthopaedics and Traumatology, University of Udine, Udine, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mancuso
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hamilton
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
authors.forename: David W
authors.initials: DW
authors.lastname: Murray
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK. hemant.pandit@ndorms.ox.ac.uk.
authors.forename: Hemant
authors.initials: H
authors.lastname: Pandit
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007718:Knee Injuries / Q000150:complications / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000209:etiology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D012086:Reoperation
keywords: Anterior cruciate ligament deficiency; Anterior cruciate ligament reconstruction; High tibial osteotomy; Medial compartment osteoarthritis; Unicompartmental knee arthroplasty