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Published in: MUSCULOSKELETAL SURGERY 2/2015

01-08-2015 | Original Article

Retained versus resected posterior cruciate ligament in mobile-bearing total knee replacement: a retrospective, clinical and functional assessment

Authors: D. Enea, V. Cigna, C. Sgolacchia, L. Tozzi, A. Verdenelli, A. Gigante

Published in: MUSCULOSKELETAL SURGERY | Issue 2/2015

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Abstract

Purpose

Fully conforming, mobile-bearing total knee replacement (TKR) was initially designed using a posterior cruciate-sacrificing (CS) technique. Rotating-platform TKR that could also be performed retaining the posterior cruciate developed afterwards. The purpose of this study was to compare the clinical and functional outcomes of patients who had either cruciate-retaining (CR) or cruciate-sacrificing (CS) TKR at a minimum follow-up of 2 years with the same prosthetic design.

Methods

One hundred and two consecutive TKR (88 patients) were performed at the same institution either with CS (56 TKR—49 patients) or with CR (46 TKR—39 patients) technique. Patients were followed at a minimum of 2 years. Patients were evaluated for articular range of motion, complication rate (infection, loosening) and clinical outcome measures included the pain and functional components of the Knee Society Score.

Results

The two groups (CS, CR) were homogeneous. At final follow-up, no significant difference was seen between the two surgical techniques in terms of ROM, pain and functional level, and revision rate.

Conclusions

This study showed that for this given mobile-bearing, fully conforming prosthetic design, sacrificing or resecting the PCL does not influence the clinical and functional outcomes at a minimum of 2-year follow-up. Surgeons may indifferently choose one of the two options (CS, CR) according to their preferences.

Level of evidence

Case series, level IV.
Literature
1.
go back to reference Verra WC, van den Boom LG, Jacobs W, Clement DJ, Wymenga AA, Nelissen RG (2013) Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis. Cochrane Database Syst Rev 10:CD004803PubMed Verra WC, van den Boom LG, Jacobs W, Clement DJ, Wymenga AA, Nelissen RG (2013) Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis. Cochrane Database Syst Rev 10:CD004803PubMed
2.
go back to reference Roh YW, Jang J, Choi WC, Lee JK, Chun SH, Lee S, Seong SC, Lee MC (2012) Preservation of the posterior cruciate ligament is not helpful in highly conforming mobile-bearing total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 21:2850–2859PubMedCrossRef Roh YW, Jang J, Choi WC, Lee JK, Chun SH, Lee S, Seong SC, Lee MC (2012) Preservation of the posterior cruciate ligament is not helpful in highly conforming mobile-bearing total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 21:2850–2859PubMedCrossRef
3.
go back to reference McIlwraith CW, Frisbie DD, Rodkey WG, Kisiday JD, Werpy NM, Kawcak CE, Steadman JR (2011) Evaluation of intra-articular mesenchymal stem cells to augment healing of microfractured chondral defects. Arthroscopy 27:1552–1561PubMedCrossRef McIlwraith CW, Frisbie DD, Rodkey WG, Kisiday JD, Werpy NM, Kawcak CE, Steadman JR (2011) Evaluation of intra-articular mesenchymal stem cells to augment healing of microfractured chondral defects. Arthroscopy 27:1552–1561PubMedCrossRef
4.
go back to reference Ishii Y, Noguchi H, Takeda M, Sato J, Toyabe S (2011) Prediction of range of motion 2 years after mobile-bearing total knee arthroplasty: PCL-retaining versus PCL-sacrificing. Knee Surg Sports Traumatol Arthrosc 19:2002–2008PubMedCrossRef Ishii Y, Noguchi H, Takeda M, Sato J, Toyabe S (2011) Prediction of range of motion 2 years after mobile-bearing total knee arthroplasty: PCL-retaining versus PCL-sacrificing. Knee Surg Sports Traumatol Arthrosc 19:2002–2008PubMedCrossRef
5.
go back to reference Hanratty BM, Thompson NW, Wilson RK, Beverland DE (2007) The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant. J Bone Joint Surg Br 89:915–918PubMedCrossRef Hanratty BM, Thompson NW, Wilson RK, Beverland DE (2007) The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant. J Bone Joint Surg Br 89:915–918PubMedCrossRef
6.
go back to reference Hirsch HS, Lotke PA, Morrison LD (1994) The posterior cruciate ligament in total knee surgery. Save, sacrifice, or substitute? Clin Orthop Relat Res 309:64–68PubMed Hirsch HS, Lotke PA, Morrison LD (1994) The posterior cruciate ligament in total knee surgery. Save, sacrifice, or substitute? Clin Orthop Relat Res 309:64–68PubMed
7.
go back to reference Evans MC, Parsons EM, Scott RD, Thornhill TS, Zurakowski D (2006) Comparative flexion after rotating-platform vs fixed-bearing total knee arthroplasty. J Arthroplasty 21:985–991PubMedCrossRef Evans MC, Parsons EM, Scott RD, Thornhill TS, Zurakowski D (2006) Comparative flexion after rotating-platform vs fixed-bearing total knee arthroplasty. J Arthroplasty 21:985–991PubMedCrossRef
8.
go back to reference Parsley BS, Conditt MA, Bertolusso R, Noble PC (2006) Posterior cruciate ligament substitution is not essential for excellent postoperative outcomes in total knee arthroplasty. J Arthroplasty 21:127–131PubMedCrossRef Parsley BS, Conditt MA, Bertolusso R, Noble PC (2006) Posterior cruciate ligament substitution is not essential for excellent postoperative outcomes in total knee arthroplasty. J Arthroplasty 21:127–131PubMedCrossRef
9.
go back to reference Kim YH, Kim JS, Park JW, Joo JH (2011) Comparison of the low contact stress and press fit condylar rotating-platform mobile-bearing prostheses in total knee arthroplasty: a prospective randomized study. J Bone Joint Surg Am 93:1001–1007PubMed Kim YH, Kim JS, Park JW, Joo JH (2011) Comparison of the low contact stress and press fit condylar rotating-platform mobile-bearing prostheses in total knee arthroplasty: a prospective randomized study. J Bone Joint Surg Am 93:1001–1007PubMed
10.
go back to reference Conditt MA, Noble PC, Bertolusso R, Woody J, Parsley BS (2004) The PCL significantly affects the functional outcome of total knee arthroplasty. J Arthroplasty 19:107–112PubMedCrossRef Conditt MA, Noble PC, Bertolusso R, Woody J, Parsley BS (2004) The PCL significantly affects the functional outcome of total knee arthroplasty. J Arthroplasty 19:107–112PubMedCrossRef
11.
go back to reference Misra AN, Hussain MR, Fiddian NJ, Newton G (2003) The role of the posterior cruciate ligament in total knee replacement. J Bone Joint Surg Br 85:389–392PubMedCrossRef Misra AN, Hussain MR, Fiddian NJ, Newton G (2003) The role of the posterior cruciate ligament in total knee replacement. J Bone Joint Surg Br 85:389–392PubMedCrossRef
12.
go back to reference Andriacchi TP, Galante JO (1988) Retention of the posterior cruciate in total knee arthroplasty. J Arthroplasty 3(Suppl):S13–S19PubMedCrossRef Andriacchi TP, Galante JO (1988) Retention of the posterior cruciate in total knee arthroplasty. J Arthroplasty 3(Suppl):S13–S19PubMedCrossRef
13.
go back to reference Dejour D, Deschamps G, Garotta L, Dejour H (1999) Laxity in posterior cruciate sparing and posterior stabilized total knee prostheses. Clin Orthop Relat Res 364:182–193PubMedCrossRef Dejour D, Deschamps G, Garotta L, Dejour H (1999) Laxity in posterior cruciate sparing and posterior stabilized total knee prostheses. Clin Orthop Relat Res 364:182–193PubMedCrossRef
14.
go back to reference Chouteau J, Lerat JL, Testa R, Moyen B, Banks SA (2009) Sagittal laxity after posterior cruciate ligament-retaining mobile-bearing total knee arthroplasty. J Arthroplasty 24:710–715PubMedCrossRef Chouteau J, Lerat JL, Testa R, Moyen B, Banks SA (2009) Sagittal laxity after posterior cruciate ligament-retaining mobile-bearing total knee arthroplasty. J Arthroplasty 24:710–715PubMedCrossRef
15.
go back to reference Bae DK, Song SJ, Cho SD (2011) Clinical outcome of total knee arthroplasty with medial pivot prosthesis a comparative study between the cruciate retaining and sacrificing. J Arthroplasty 26:693–698PubMedCrossRef Bae DK, Song SJ, Cho SD (2011) Clinical outcome of total knee arthroplasty with medial pivot prosthesis a comparative study between the cruciate retaining and sacrificing. J Arthroplasty 26:693–698PubMedCrossRef
16.
go back to reference Kwak JY, Jeong JH, Lee SH, Jung HJ, Jung YB (2012) Comparison of the clinical outcomes after total knee arthroplasty with the LCS rotating platform mobile bearing knee system and the PFC Sigma RP-F mobile bearing knee system. Clin Orthop Surg 4:256–262PubMedCentralPubMedCrossRef Kwak JY, Jeong JH, Lee SH, Jung HJ, Jung YB (2012) Comparison of the clinical outcomes after total knee arthroplasty with the LCS rotating platform mobile bearing knee system and the PFC Sigma RP-F mobile bearing knee system. Clin Orthop Surg 4:256–262PubMedCentralPubMedCrossRef
17.
go back to reference Stiehl JB, Voorhorst PE (1999) Total knee arthroplasty with a mobile-bearing prosthesis: comparison of retention and sacrifice of the posterior cruciate ligament in cementless implants. Am J Orthop (Belle Mead NJ) 28:223–228 Stiehl JB, Voorhorst PE (1999) Total knee arthroplasty with a mobile-bearing prosthesis: comparison of retention and sacrifice of the posterior cruciate ligament in cementless implants. Am J Orthop (Belle Mead NJ) 28:223–228
18.
go back to reference Zaki SH, Rafiq I, Kapoor A, Raut V, Gambhir AK, Porter ML (2007) Medium-term results with the Press Fit Condylar (PFC) Sigma knee prosthesis the Wrightington experience. Acta Orthop Belg 73:55–59PubMed Zaki SH, Rafiq I, Kapoor A, Raut V, Gambhir AK, Porter ML (2007) Medium-term results with the Press Fit Condylar (PFC) Sigma knee prosthesis the Wrightington experience. Acta Orthop Belg 73:55–59PubMed
19.
go back to reference Arthur CH, Wood AM, Keenan AC, Clayton RA, Walmsley P, Brenkel I (2013) Ten-year results of the press fit condylar sigma total knee replacement. Bone Joint J 95-B:177–180PubMedCrossRef Arthur CH, Wood AM, Keenan AC, Clayton RA, Walmsley P, Brenkel I (2013) Ten-year results of the press fit condylar sigma total knee replacement. Bone Joint J 95-B:177–180PubMedCrossRef
20.
go back to reference Linder R, Muller H, Grenz-Farenholtz B, Wagner C, Stockheim M, Verheyen F (2012) Replacement of endoprosthetic implants within a two years follow-up period: a statutory health insurance routine data analysis. BMC Musculoskelet Disord 13:223–227PubMedCentralPubMedCrossRef Linder R, Muller H, Grenz-Farenholtz B, Wagner C, Stockheim M, Verheyen F (2012) Replacement of endoprosthetic implants within a two years follow-up period: a statutory health insurance routine data analysis. BMC Musculoskelet Disord 13:223–227PubMedCentralPubMedCrossRef
21.
go back to reference Pedersen AB, Mehnert F, Odgaard A, Schroder HM (2012) Existing data sources for clinical epidemiology: the Danish Knee Arthroplasty Register. Clin Epidemiol 4:125–135PubMedCentralPubMedCrossRef Pedersen AB, Mehnert F, Odgaard A, Schroder HM (2012) Existing data sources for clinical epidemiology: the Danish Knee Arthroplasty Register. Clin Epidemiol 4:125–135PubMedCentralPubMedCrossRef
22.
go back to reference Asaid R, Williams I, Hyde D, Tiang T (2013) Infection rates following hip and knee joint arthroplasty: large referral centre versus a small elective-only hospital. Eur J Orthop Surg Traumatol 23:165–168PubMedCrossRef Asaid R, Williams I, Hyde D, Tiang T (2013) Infection rates following hip and knee joint arthroplasty: large referral centre versus a small elective-only hospital. Eur J Orthop Surg Traumatol 23:165–168PubMedCrossRef
23.
go back to reference Nakama GY, Peccin MS, Almeida GJ, Lira Neto Ode A, Queiroz AA, Navarro RD (2012) Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases. Cochrane Database Syst Rev 10:6193 Nakama GY, Peccin MS, Almeida GJ, Lira Neto Ode A, Queiroz AA, Navarro RD (2012) Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases. Cochrane Database Syst Rev 10:6193
24.
go back to reference Pilling RW, Moulder E, Allgar V, Messner J, Sun Z, Mohsen A (2012) Patellar resurfacing in primary total knee replacement: a meta-analysis. J Bone Joint Surg Am 94:2270–2278PubMedCrossRef Pilling RW, Moulder E, Allgar V, Messner J, Sun Z, Mohsen A (2012) Patellar resurfacing in primary total knee replacement: a meta-analysis. J Bone Joint Surg Am 94:2270–2278PubMedCrossRef
25.
go back to reference Signorelli JJ, Bernini PM, Shirreffs TG (2011) Uncemented total knee arthroplasty: 2-year follow-up of 100 knees with a rotating platform, cruciate-retaining design. J Arthroplasty 26:427–431PubMedCrossRef Signorelli JJ, Bernini PM, Shirreffs TG (2011) Uncemented total knee arthroplasty: 2-year follow-up of 100 knees with a rotating platform, cruciate-retaining design. J Arthroplasty 26:427–431PubMedCrossRef
26.
go back to reference Stiehl JB, Dennis DA, Komistek RD, Keblish PA (2000) In vivo kinematic comparison of posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg 13:13–18PubMed Stiehl JB, Dennis DA, Komistek RD, Keblish PA (2000) In vivo kinematic comparison of posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg 13:13–18PubMed
27.
go back to reference Stiehl JB, Voorhorst PE, Keblish P, Sorrells RB (1997) Comparison of range of motion after posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg 10:216–220PubMed Stiehl JB, Voorhorst PE, Keblish P, Sorrells RB (1997) Comparison of range of motion after posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg 10:216–220PubMed
Metadata
Title
Retained versus resected posterior cruciate ligament in mobile-bearing total knee replacement: a retrospective, clinical and functional assessment
Authors
D. Enea
V. Cigna
C. Sgolacchia
L. Tozzi
A. Verdenelli
A. Gigante
Publication date
01-08-2015
Publisher
Springer Milan
Published in
MUSCULOSKELETAL SURGERY / Issue 2/2015
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI
https://doi.org/10.1007/s12306-014-0345-9

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