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. 2012 Apr 1;1(4):64-70.
doi: 10.1302/2046-3758.14.2000024. Print 2012 Apr.

The role of the posterior cruciate ligament in total knee replacement

M A Ritter  1 , K E Davis, J B Meding, A Farris
Affiliations

The role of the posterior cruciate ligament in total knee replacement

M A Ritter et al. Bone Joint Res. .

Abstract

Objectives: The purpose of this study was to examine the effect of posterior cruciate ligament (PCL) retention, PCL recession, and PCL excision during cruciate-retaining total knee replacement.

Methods: A total of 3018 anatomic graduated component total knee replacements were examined; 1846 of these retained the PCL, 455 PCLs were partially recessed, and in 717 the PCL was completely excised from the back of the tibia.

Results: Clinical scores between PCL groups favored excision for flexion (p < 0.0001), and recession and retention for stairs (p < 0.0001). There was a mild difference in long-term all-cause aseptic survivorship between PCL-retained (96.4% at 15 years) combined with PCL-recessed groups (96.6% at 15 years) when compared with the PCL-excised group (95.0% at 15 years) (p = 0.0411, Wilcoxon; p = 0.0042, log-rank), as well as tibial or femoral loosening, which reported prosthesis survival of 97.8% at 15 years for PCL-retained knees, 98.2% for recessed knees, and 96.4% for excised knees (p = 0.0934, Wilcoxon; p = 0.0202, log-rank).

Conclusions: Despite some trade off in clinical performance, if the PCL is detached at the time of operation, conversion to a posterior-stabilised prosthesis may not be necessarily required as long as stability in the anteroposterior and coronal planes is achieved.

Keywords: Excision; Knee; PCL; Posterior cruciate ligament; Recession; Release; TKR.

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Conflict of interest statement

ICMJE Conflict of Interest:None declared

Figures

Fig. 1
Fig. 1
Kaplan-Meier curve showing the all-cause aseptic survival for total knee replacements with the posterior cruciate ligament retained, partially recessed and excised.
Fig. 2
Fig. 2
Kaplan-Meier curve showing the survival of total knee replacements with the posterior cruciate ligament retained, released and excised, with aseptic femoral or tibial revision as the endpoints.
Fig. 3
Fig. 3
Graph showing the mean Knee Society knee scores for the groups with retention, recession and excision of the posterior cruciate ligament.
Fig. 4
Fig. 4
Graph showing the mean Knee Society function scores for the groups with retention, recession and excision of the posterior cruciate ligament.
Fig. 5
Fig. 5
Graph showing the mean Knee Society pain scores for the groups with retention, recession and excision of the posterior cruciate ligament.
Fig. 6
Fig. 6
Graph showing the mean Knee Society walking scores for the groups with retention, recession and excision of the posterior cruciate ligament.
Fig. 7
Fig. 7
Graph showing the mean Knee Society anteroposterior scores for the groups with retention, recession and excision of the posterior cruciate -ligament.
Fig. 8
Fig. 8
Graph showing the mean flexion for the groups with retention, recession and excision of the posterior cruciate ligament.
Fig. 9
Fig. 9
Graph showing the mean Knee Society stairs scores for the groups with retention, recession and excision of the posterior cruciate ligament.
See this image and copyright information in PMC

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