title: Satisfactory outcomes following combined unicompartmental knee replacement and anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  There exist limited options for treatment of patients with combined medial compartment arthritis and anterior cruciate ligament (ACL) deficiency. Ideal treatment is one that offers lasting relief of symptoms not compromising any future surgery. Unicompartmental knee replacement has shown consistently good results in the relatively young and active population, but there is a high reported incidence of failure up to 20%, if performed in ACL-deficient knees. One of the recognized treatment modality is combined ACL reconstruction and unicompartmental arthroplasty. A systematic review was conducted looking at the demographics, techniques, complications and outcome of combined ACL reconstruction with unicompartmental knee arthroplasty.
  
  
  METHODS
  A systematic literature search within the online Medline, PubMed Database, EMBASE, Web of Science, Cochrane and Google Scholar was carried out until October 2016 to identify relevant articles. A study was defined eligible if it met the following inclusion criteria: the surgical procedure combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction; patient's clinical and/or functional outcomes were reported; any complications intra-operatively and post-operatively were reported; and the full-text articles, written in English, German, Italian, Dutch or Spanish, were available. Quality and risk of bias assessments were done using standardized criteria set.
  
  
  RESULTS
  A total of 8 studies met the inclusion criteria encompassing 186 patients who were treated with simultaneous ACL reconstruction and unicompartmental knee arthroplasty. The mean age was 50.5 years (range from 44 to 56) with a mean follow-up of 37.6 months (range from 24 to 60). There was an improvement in mean Oxford Score from 27.5 to 36.8. Complications reported included tibial inlay dislocation (n = 3), conversion to a total knee arthroplasty (n = 1), infection requiring two-stage revision (n = 2), deep-vein thrombosis (n = 1), stiffness requiring manipulation under anaesthesia (n = 1), retropatellar pain requiring arthroscopic adhesiolysis (n = 1).
  
  
  CONCLUSIONS
  Unicompartmental knee arthroplasty combined with ACL reconstruction can be a valid treatment option for selected patients, with combined medial unicompartmental knee osteoarthritis and ACL deficiency.
  
  
  METHODS
  Systematic Review of Level IV Studies, Level IV.
authors.affiliation: Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK. volpinandrea@hotmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Volpin
authors.affiliation: Department of Trauma and Orthopaedics, Manipal Hospital, Bangalore, India.
authors.forename: S G
authors.initials: SG
authors.lastname: Kini
authors.affiliation: Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, s' Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands.
authors.forename: D E
authors.initials: DE
authors.lastname: Meuffels
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome
keywords: Anterior cruciate ligament; Knee arthroplasty; Partial knee replacement; Unicompartmental knee replacement