Total knee arthroplasty designed to accommodate the presence or absence of the posterior cruciate ligament (original) (raw)
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The Knee, 2010
The aim of this study was to investigate anteroposterior instability in the CKS and the PFC total knee arthroplasty (TKA) designs. Physical examinations, including VAS, IKS and WOMAC were performed in combination with a detailed fluoroscopic measurement technique for three-dimensional kinematic assessment of TKA design function. Anteroposterior instability rated with the IKS was not significantly different (p = 0.34), but patients with a CKS design showed more limitations according to the WOMAC joint stiffness total score, and for items regarding higher flexion activities in the WOMAC score for knee disability. Kinematic analyses showed that the CKS design tended to have more anterior sliding of the femur on the tibia during mid-and deep flexion activities. The sliding distance was larger at the medial than at the lateral side. This phenomenon has also been described for posterior cruciate ligament deficient knees. Furthermore, the CKS design showed a significantly lower range of tibial rotation (p < 0.05) from maximum extension to maximum flexion during deep knee bend activities. Kinematic differences can be ascribed to posterior cruciate ligament deficiency/laxity or differences in TKA designs.
Knee Surgery, Sports Traumatology, Arthroscopy, 2012
Purpose The purpose of this study is to investigate whether the preservation of the posterior cruciate ligament (PCL) can be helpful for improving kinematics and clinical outcome in highly conforming mobile-bearing total knee arthroplasty (TKA). Methods Ninety osteoarthritic knees were randomly allocated to either the PCL-preserving group or the PCLsacrificing group. Passive kinematics was recorded with a navigation system immediately after implantation. Three parameters (anterior/posterior translation, varus/valgus rotation, and internal/external rotation) were analysed from 0°to 120°flexion. Results The PCL-preserving group (42 knees) had more varus rotation over 90°flexion (p \ 0.05) and more anterior translation of the femur in all ranges of flexion (p \ 0.05) than those in the PCL-sacrificing group (44 knees). There was no difference in the internal/external rotation (p [ 0.05). The range of motion, functional scores, and radiographic results did not significantly differ between the two groups at the final follow-up. Three knees in the PCL-preserving group were revised: two presented with instability caused by traumatic attenuation of the PCL and one with subluxation of the insert due to a tight PCL. Conclusion The preservation of the PCL was not helpful for improving kinematics and clinical outcome in highly conforming mobile-bearing TKA. Level of evidence II.
Posterior cruciate ligament resection in total knee arthroplasty
The Bone & Joint Journal, 2019
AimsThe aim of this study was to assess the effect of posterior cruciate ligament (PCL) resection on flexion-extension gaps, mediolateral soft-tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilized (PS) total knee arthroplasty (TKA).Patients and MethodsThis prospective study included 110 patients with symptomatic osteoarthritis of the knee undergoing primary robot-assisted PS TKA. All operations were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess gaps before and after PCL resection in extension and 90° knee flexion. Measurements were made after excision of the anterior cruciate ligament and prior to bone resection. There were 54 men (49.1%) and 56 women (50.9%) with a mean age of 68 years (sd 6.2) at the time of surgery. The mean preoperative hip-knee-ankle deformity was 4.1° varus (sd 3.4).ResultsPCL resection incre...
Folia Morphologica, 2017
The aim of the study was to determine the degree of posterior cruciate ligament (PCL) degeneration and the reduction in the number of its mechanoreceptors, in patients with advanced degenerative joint disease. PCLs taken from study group of 50 patients in the mean age of 70.7 (53-84) years with a diagnosis of advanced idiopathic osteoarthritis undergoing condylar total knee arthroplasty were compared to those taken form the control group of 10 knee joints of cadavers. Groups were matched with regard to sex and age. Histological examination of PCLs of the study group showed changes of an inflammatory process and no significant signs of osteoarthritis in the control group. A close correlation was found between the severity of degenerative changes on the X-ray images according to the Ahlbäck scale, and the increased mucoid degeneration (p < 0.0001), the severity of the degeneration of the collagen structure (p < 0.0001) and the presence of proprioceptors of PCLs (p < 0.0001). Conserving the PCL by the use of type cruciate retaining knee arthroplasty does not guarantee the preservation of correct proprioceptive sensation.
Acta orthopaedica Belgica, 2009
Achieving a large range of motion (ROM) is a much-desired clinical outcome after total knee arthroplasty (TKA), especially in Asian and Middle Eastern cultures. TKA design plays an important role in providing the post-operative ROM. This study investigated the kinematics of a new high-flexion posterior cruciate ligament retaining total knee replacement, featuring an enlarged posterior condylar offset and a more conforming tibiofemoral articulation. Two flexion activities were compared to determine which provides higher flexion kinematics. Sixteen North American patients with 20 total knee implants were studied using fluoroscopy and shape matching techniques. Maximum skeletal flexion during a lunge activity averaged 120 degrees +/- 11 degrees, with 11 degrees +/- 4 degrees tibial internal rotation. Kneeling activities showed 11 degrees greater average maximum skeletal flexion (131 degrees +/- 13 degrees, p < 0.05) and 1 degrees less tibial internal rotation (10 degrees +/- 4 degre...
Cruciate-Retaining Total Knee Arthroplasty
Primary Total Knee Arthroplasty
The debate over the relative merits of substituting or retaining the posterior cruciate ligament (PCL) in total knee arthroplasty is still ongoing. The potential advantages of PCL preservation are a more natural femoral rollback, the presence of a structure critical for the proprioception, the maintenance of a native central stabilizer of the joint, and low shear stress on the bone-cement interface of the tibial component. Numerous retrospective studies of cruciate-retaining (CR) total knee arthroplasties have demonstrated consistently good clinical results and excellent intermediate and long-term survival. The main criticisms of the surgical technique are that the distal attachment of the PCL is vulnerable to injury and that balancing the PCL can be difficult; based on our experience, surgical tricks will be described to avoid the avulsion of the ligament and they will be discussed the main points to consider when you can find a discrepancy between flexion and extension stability. Based on the current evidence, we conclude that with a standardized technique, this type of implant should be preferred even in those cases where the sacrifice of the cruciate ligament seems to be the easiest way.
The PCL significantly affects the functional outcome of total knee replacement
The Journal of Arthroplasty, 2004
This study tests the hypothesis that patients receiving a posterior cruciate ligament (PCL)-retaining prosthesis have no difference in functional outcome compared to those receiving a cruciate-sacrificing, posterior-stabilized (PS) design. Fortynine patients underwent a total knee arthroplasty (TKA), performed by a single surgeon using the same implant design with either a PCL-retaining or a PS tibial insert. Each patient completed a self-administered, validated Total Knee Function Questionnaire as well as the SF-36. At 1-year follow-up, each patient's range of motion and Knee Society knee score were measured. There were no statistically significant differences between the 2 groups using the traditional measures of function following total knee replacement, including overall satisfaction with surgery. However, the TKFQ revealed that patients with PS knees reported greater functional limitations in squatting, kneeling, and gardening. Our results suggest that with the specific implant used in this study, substitution for the PCL with a spine and cam mechanism may not fully restore the functional capacity of the intact PCL, particularly in high-demand activities that involve deep flexion. Key words: total knee arthroplasty, outcome, post-arthroplasty function, posterior cruciate ligament.