Original ArticleA Recession of Posterior Cruciate Ligament in Posterior Cruciate-Retaining Total Knee Arthrosplasty
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)
- et al.
Posterior polyethylene wear in posterior cruciate ligament–retaining total knee arthroplasty
J Arthroplasty
(1993) - et al.
Early, incapacitating instability of posterior cruciate ligament–retaining total knee arthroplasty
J Arthroplasty
(1998) - et al.
Posterior cruciate recession in total knee arthroplasty
J Arthroplasty
(1997) - et al.
Laxity in posterior cruciate sparing and posterior stabilized total knee prostheses
Clin Orthop
(1999) - et al.
Flexion instability after posterior cruciate retaining total knee arthroplasty
Clin Orthop
(1998) - et al.
A comparison of four models of total knee-replacement prostheses
J Bone Joint Surg Am
(1976)
Cited by (9)
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2011, Journal of ArthroplastyCitation 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).
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No benefits or funds were received in support of the study.