Unicondylar arthroplasty and anterior cruciate ligament reconstruction, a comprehensive solution for medial osteoarthritis with ACL deficiency: Case report

Introduction and importance: Medial unicondylar knee arthroplasty (UKA) combined with anterior cruciate ligament (ACL) reconstruction offers a novel approach for patients with advanced medial compartment osteoarthritis and ACL deficiency. This combined procedure addresses both joint degeneration and instability, enhancing outcomes while preserving native tissue. Case presentation: A 50-year-old male with progressive pain and instability in the left knee, and a history of ACL reconstruction performed 10 years prior, underwent a medial UKA and revision ACL reconstruction using a transtibial technique with hamstring grafts. Postoperative evaluation demonstrated restored stability, proper implant positioning, and significant pain relief. Discussion: The integration of UKA and ACL reconstruction addresses the limitations traditionally associated with ACL deficiency in UKA candidates, such as instability and increased implant stress. This approach provides a tailored solution, particularly for younger or active patients with isolated medial osteoarthritis, by preserving native joint kinematics while ensuring long-term implant durability. Conclusion: This case demonstrates that combining UKA with ACL reconstruction is a viable and effective treatment strategy for selected patients, achieving pain relief, stability, and functional recovery. It underscores the importance of careful surgical planning and patient selection to optimize outcomes.