The options for treatment of the young active patient with isolated symptomatic osteoarthritis of the medial compartment and pre-existing deficiency of the anterior cruciate ligament are limited. The indications for the unicompartimental knee prosthesis are selective. Misalignment femoral-tibia, varo-valgus angle more than 7°, over-weight, and knee instability were considered to be a contraindication.

The potential longevity of the implant and levels of activity of the patient may preclude total knee replacement, and tibial osteotomy and unicompartmental knee arthroplasty are unreliable because of the ligamentous instability.

Therefore, we combined reconstruction of the anterior cruciate ligament first and unicompartmental arthroplasty of the knee.

We included in this study six patients, three males and three female, mean age 53.6 years, that presented only osteoarthritis of medial femoral condyle and ACL deficiency.

In the first group included 2 patients, we performed arthroscopy ACL reconstruction with hamstring and unicompartimental knee prosthesis one-step, and in the second group included 4 patients, we performed the same surgical procedure in two-step.

The clinical and radiological data at a minimum of 1.5 years at follow-up. We evaluated all patients with KOOS score, and IKDC score.

At the last follow-up, no patient had radiological evidence of component loosening, no infection, no knee remainder instability. The subjective and objective outcome assessed with the scale documented satisfactory average results, both in patients of first group and in those of second group.

ACL deficiency induced knee osteoarthritis for incorrect knee biomechanics, and all patients could be submit a total knee replacement.

What method for preventing it? This combined surgical treatment seems to be a viable treatment option for young active patients with symptomatic arthritis of the medial compartment, in whom the anterior cruciate ligament has been ruptured.

Future developments and more data are necessary for standardised surgical approach.

In this report a novel surgical treatment of proximal humerus fractures with shoulder hemiarthroplasty through an anterolateral acromial approach is presented. This access allows a drastic reduction of the risk of iatrogenic neurovascular complications and was developed to allow less invasive treatment of proximal humerus fractures with an easy control of the tuberosities which are often dislocated. Furthermore, this access allows the conservation of the anatomical integrity of the rotator cuff muscle which is fundamental in older patients. After removal of the humeral head, by this antero-lateral approach a better visibility of glenoid cavity is achieved thus allowing a more correct prosthesis components placement and a easier fixation of the tuberosity around the prosthesis using strong non-absorbable suture.

Over a 2-years period, 24 patients (age 68.9, range 53–83, 17 females and 7 males) with either displaced 4-parts fractures, according to Neer classification, or fracturedislocations of the humeral proximal third, were surgically treated trought a shoulder hemiarthroplasty with direct antero-lateral acromial approach. Clinical and functional assessments were performed at 3, 6, 12, and 18 months including the determination of the Constant Score, the radiographic assessment in an antero-posterior and axillary view of the humerus, a photographic documentation of the injured shoulder function as compared with the non-injured extremity and the assessment of the upper limb motion with a motion analysis system.

An increase in mean Constant Score and ranges of motion was observed over the follow-up-period. At 12-months follow-up the Constant Score was 62.2 points (range 41–91) out of a total of 100. Patients at 12 months showed a mean active flexion of the shoulder in the sagittal plane of 45.8 degrees (range 19.1–89.4); the mean active abduction was 49.4 degrees (range 26.1–90.8) with forearm turned down and 57.1 degrees (range 16.7–119.2) with forearm turned up; the range of rotation was 30.9 degrees (range 26.2–35.6). Nevertheless, all patients were able to perform the activity with a relatively pain-free shoulder.

The results obtained in the present study are comparable with the literature data, where other surgical approaches were used. Due to its conservative features, the presented surgical approach may represent a good alternative in shoulder hemiarthroplasty.