Elsevier

The Journal of Arthroplasty

Volume 23, Issue 7, October 2008, Pages 999-1004
The Journal of Arthroplasty

Original Article
A Recession of Posterior Cruciate Ligament in Posterior Cruciate-Retaining Total Knee Arthrosplasty

https://doi.org/10.1016/j.arth.2007.09.010Get rights and content

Abstract

The range of motion, the stability of the knee, and the prevalence of radiolucent lines in 68 posterior cruciate–retaining (CR) total knee arthroplasties (TKAs) with a retained, but balanced, posterior cruciate ligament were compared with those in 68 knees with a posterior cruciate–substituting (PS) TKAs in the 60 patients who were managed with simultaneous bilateral TKAs. The average range of motion in both groups (126° vs 129°) at the latest follow-up was not significantly different (P = .359). No significant difference in the sagittal laxity of the knee was seen between 2 groups. The prevalence of radiolucent lines was 7% in the CR TKA with a recession posterior cruciate ligament and 12% in the PS TKA group (P = .108). We feel that posterior stabilization is unnecessary in the PS flex knees.

Section snippets

Materials and Methods

Bilateral simultaneous TKAs were performed by the senior author in 148 consecutive patients during the same anesthetic session, with one side treated immediately after the other. Randomization of the use of a CR TKA or a PS TKA was determined from a sequential pool based on a table of random numbers. Of this group of 148 patients, 68 CR TKAs required PCL recession, and it is this cohort that is being studied. No patient was lost to follow-up, and all patients were enrolled in the present study.

Clinical Results

Clinical results are summarized in Table 1. The average preoperative Hospital for Special Surgery knee score was 48 points (range, 25-58 points) in the patients with Nexgen CR flex with a recession of PCL and 45 points (range, 38-51 points) in the patients with Nexgen PS flex. The average postoperative Hospital for Special Surgery knee score was 89 points (range, 72-100 points) in the patients with Nexgen CR flex with a recession of PCL and 88 points (range, 71-100 points) in the patients with

Discussion

Factors that may influence the sagittal laxity of the knee after a CR TKA include functional status of the PCL, the geometry of the prosthesis, and bone cuts including the posterior tibial slope. Theoretically, recession, or selective cutting, of some PCL fibers in the patients with CR TKA, may lead to sagittal plane instability of the knee and decreased function of the knee. Ochsner et al [9] reported a case of postoperative avulsion of the PCL with subsequent decreased function in CR TKA.

References (13)

There are more references available in the full text version of this article.

Cited by (9)

  • Posterior stabilized versus cruciate retaining total knee arthroplasty designs: Conformity affects the performance reliability of the design over the patient population

    2015, Medical Engineering and Physics
    Citation Excerpt :

    Of particular interest is to compare these two designs in terms of knee joint kinematics [11,12] and contact mechanics [13,14] since these factors substantially affect the aforementioned clinical outcomes. Several studies concluded the superiority of CR [15,16] or PS designs [11,12, 17–21] while others demonstrated no significant differences between these two designs [22–25]. This inconsistency perhaps comes from the inherent limitations of clinical investigations, e.g. small number of patients and large inter-patient variability [26,27].

  • Posterior Cruciate-Retaining Versus Posterior-Stabilized Total Knee Arthroplasty. A Meta-Analysis

    2013, Journal of Arthroplasty
    Citation Excerpt :

    Ultimately, there were 228 potentially relevant sources, from which 12 papers were selected (see Fig. 1) for comparison of flexion, ROM and complications. There were 8 papers that reported the means and standard deviations of flexion [19,23–25,28,30,31,35] and there were 6 papers that compared means and standard deviations of ROM [21,26–29,35]. Two papers compared both [28,35].

  • Incorrect Use of the Student t Test in Randomized Trials of Bilateral Hip and Knee Arthroplasty Patients

    2011, Journal of Arthroplasty
    Citation Excerpt :

    We eliminated 95 studies based on abstract or title, 8 did not use the t test, and 4 did not provide any details of their method of analysis. One additional study was identified through a review of the bibliographies of relevant publications, for a total of 40 randomized trials for systematic review [8-47]. All studies were published in English and represented a broad spectrum of orthopedic journals (Table 1).

View all citing articles on Scopus

No benefits or funds were received in support of the study.

View full text