Young, Unstable, and Arthritic: The Knee Surgeon’s Dilemma

The treatment of knee arthrosis in the young active patient poses a management dilemma for the orthopedic surgeon. This problem is further complicated when arthrosis is accompanied by symptomatic knee instability as a result of anterior cruciate ligament rupture. This article gives an overview of the physiological role of the anterior cruciate ligament, the mechanisms and diagnosis of ligament injury, the natural history after rupture, and the consequences of knee instability in relation to chondral damage and subsequent degenerative joint disease. We outline the management options and surgical guidelines for patients with unicompartmental arthritis in the anterior cruciate–deficient knee.