Objective: To investigate the effect of anterior cruciate ligament (ACL) integrity on the short- and mid-term effectiveness of mobile-bearing medial unicompartmental knee arthroplasty (UKA).
Methods: The clinical data of 128 patients with anteromedial osteoarthritis who underwent mobile-bearing medial UKA between June 2019 and June 2021 was retrospectively analyzed. According to the integrity of ACL structure under direct vision during operation, the patients were divided into normal group (30 cases), synovial defect group (53 cases), and longitudinal split group (45 cases). There was no significant difference in gender, age, body mass index, preoperative knee range of motion (ROM), hip-knee-ankle angle (HKA), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and other baseline data among the 3 groups ( P>0.05). The knee ROM, KSS score (including clinical and functional scores), WOMAC score (including pain, stiffness, and function scores) before operation and at last follow-up, the Lysholm score, International Knee Documentation Committee (IKDC) score, and Forgetting Joint Score (FJS-12) at last follow-up were recorded and compared among the 3 groups. Imaging examination was performed to evaluate the wear of cartilage in the lateral tibiofemoral compartment and patellofemoral compartment of the knee joint. HKA and posterior tibial slope (PTS) were measured at last follow-up.
Results: All the patients of 3 groups were followed up 22-56 months (mean, 40.4 months). There was no significant difference in follow-up time among the 3 groups ( P>0.05). At last follow-up, imaging examination showed no obvious cartilage wear progression of the lateral tibiofemoral compartment and patellofemoral compartment, and no adverse events such as aseptic loosening of the prosthesis, dislocation of the removable pad, or infection occurred during the follow-up. At last follow-up, knee ROM, HKA, KSS scores, and WOMAC scores of the 3 groups significantly improved when compared with preoperative ones ( P<0.05). There was no significant difference in the changes of the above indicators before and after operation, and also the Lysholm score, IKDC score, FJS-12 score, and PTS among the 3 groups ( P>0.05).
Conclusion: The integrity of ACL has no significant effect on the short- and mid-term effectiveness of mobile-bearing medial UKA.
目的: 探讨前交叉韧带（anterior cruciate ligament，ACL）的完整性对内侧活动平台膝关节单髁置换术（unicompartmental knee arthroplasty，UKA）术后短中期临床疗效的影响。.
方法: 回顾分析2019年6月—2021年6月接受内侧活动平台UKA的128例前内侧骨关节炎患者临床资料，根据术中直视下ACL结构的完整程度，分为正常组（30例）、滑膜缺损组（53例）及纵裂组（45例）。3组患者性别、年龄、身体质量指数及术前膝关节活动度（range of motion，ROM）、髋-膝-踝角（hip-knee-ankle angle，HKA）、膝关节协会评分（KSS）、西安大略与麦克马斯特大学骨关节炎指数（WOMAC）评分等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较术前及末次随访时3组患者膝关节ROM、KSS评分（包括临床和功能评分）、WOMAC评分（包括疼痛、僵硬和功能评分），以及末次随访时Lysholm评分、国际膝关节文献委员会（IKDC）评分、关节遗忘评分（FJS-12）。影像学检查评估膝关节外侧胫股间室及髌股间室软骨有无磨损，测量末次随访时HKA及胫骨后倾角（posterior tibial slope，PTS）。.
结果: 术后3组患者均获随访，随访时间22～56个月，平均40.4个月；3组间随访时间比较差异无统计学意义（ P>0.05）。末次随访时影像学检查均未见膝关节外侧胫股间室及髌股间室软骨有明显磨损进展，随访期间均未出现假体无菌性松动、活动衬垫脱位、感染等不良事件。末次随访时，膝关节ROM、HKA、KSS各项评分及WOMAC各项评分均较术前显著改善，差异有统计学意义（ P<0.05）；但3组间上述各指标手术前后差值以及Lysholm评分、IKDC评分、FJS-12评分和PTS比较差异均无统计学意义（ P>0.05）。.
结论: ACL的完整性对稳定膝关节内侧活动平台UKA术后短中期临床疗效无明显影响。.
Keywords: Mobile-bearing prosthesis; anterior cruciate ligament; knee osteoarthritis; unicompartmental knee arthroplasty.