Combine anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty with image-based robotic surgery: A current surgical technique

Unicompartmental knee arthroplasty (UKA) is a widely recognized treatment for isolated compartment osteoarthritis (OA). The absence of an intact anterior cruciate ligament (ACL), however, has traditionally been considered a contraindication due to its critical role in maintaining knee stability and joint kinematics. This article aims to provide a detailed description of the surgical technique for UKA with simultaneous ACL reconstruction. It offers a practical guide for surgeons interested in adopting this approach for young, active patients with ACL-deficient and medial or lateral compartment OA, utilizing an image-based robotic platform for both preoperative and intraoperative planning. Indications and contraindications for the combined treatment are also reported. This technique, described through intraoperative images and video, represents a promising, joint-preserving alternative to total knee arthroplasty for appropriately selected patients. This step-by-step approach allows for the assessment of congruence between the bone tunnels and the prosthetic components, enabling personalized implant positioning.