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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2012

01-06-2012 | Knee

How much of the PCL is really preserved during the tibial cut?

Authors: Georg Matziolis, Saskia Mehlhorn, Nicole Schattat, Gerd Diederichs, Robert Hube, Carsten Perka, Doerte Matziolis

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2012

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Abstract

Purpose

There are two different techniques for retaining the posterior cruciate ligament (PCL) in total knee arthroplasty. The attachment of the PCL can be spared during resection of the tibial plateau, so that a small posterior bone block remains. In contrast to this, many surgeons resect the tibial plateau completely and detach a part of the tibial PCL attachment from the resected material. The objective of this study was to determine how big this part is in an anatomical resection of the tibial plateau with 0° and 7° slope and whether it is gender-dependent.

Methods

Two hundred consecutive patients who had undergone MRI of a knee joint were included. Patients were excluded if they were younger than 18 years or had dysplasia of the knee joint or injuries of the posterior cruciate ligament. The MRIs of 182 knees that fulfilled the inclusion criteria were analysed. For each knee, an anatomical tibial resection with 0° and 7° posterior slope was simulated, and the parts of the tibial PCL attachment that were resected and retained were determined.

Results

Given a measured tibial resection with 0° slope, 45 ± 28% of the tibial PCL attachment was removed in the men, compared with 46 ± 30% in the women (n.s.). Given a resection with 7° slope, 69 ± 24% of the tibial PCL attachment was removed in the men and 67 ± 25% in the women. This corresponded to a complete resection in 19 men (20%) and 16 women (24%).

Conclusions

Independently of gender, the anatomical resection of the tibia leads to the removal of a considerable part of the tibial PCL attachment, if this is not spared in the form of a bone block during resection. This becomes increasingly relevant with higher posterior slope of the resection plane. In the case of a cruciate-retaining surgical technique, the retention of the posterior tibial cortical bone in the area of attachment of the PCL is therefore strongly recommended.

Level of evidence

II.
Literature
1.
van den Boom LG, Brouwer RW, van den Akker-Scheek I et al (2009) Retention of the posterior cruciate ligament versus the posterior stabilized design in total knee arthroplasty: a prospective randomized controlled clinical trial. BMC Musculoskelet Disord 10:119PubMedCrossRef
2.
Brooks P (2009) Seven cuts to the perfect total knee. Orthopedics 32(9):27
3.
Carson E, Deng X, Allen A et al (2007) Evaluation of in situ graft forces of a 2-bundle tibial inlay posterior cruciate ligament reconstruction at various flexion angles. Arthroscopy 23:488–495PubMedCrossRef
4.
Chaudhary R, Beaupre L, Johnston D (2008) Knee range of motion during the first two years after use of posterior cruciate-stabilizing or posterior cruciate-retaining total knee prostheses. A randomized clinical trial. J Bone Joint Surg Am 90:2579–2586PubMedCrossRef
5.
Christen B, Neukamp M, Aghayev E (2011) No difference in anterior tibial translation with and without posterior cruciate ligament in less invasive total knee replacement. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-011-1560-7
6.
Dennis D, Komistek R, Mahfouz M et al (2003) Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res 416:37–57PubMedCrossRef
7.
Edwards A, Bull A, Amis A (2007) The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy 23:284–290PubMedCrossRef
8.
Freeman M, Pinskerova V (2003) The movement of the knee studied by magnetic resonance imaging. Clin Orthop Relat Res 410:35–43PubMedCrossRef
9.
Freeman M, Pinskerova V (2005) The movement of the normal tibio-femoral joint. J Biomech 38:197–208PubMedCrossRef
10.
Kim Y, Choi Y, Kim J (2009) Range of motion of standard and high-flexion posterior cruciate-retaining total knee prostheses a prospective randomized study. J Bone Joint Surg Am 91:1874–1881PubMedCrossRef
11.
Lattanzio P, Petrella R (1998) Knee proprioception: a review of mechanisms, measurements, and implications of muscular fatigue. Orthopedics 21:463–470PubMed
12.
Mihalko W, Creek A, Mary M et al (2011) Mechanoreceptors found in a posterior cruciate ligament from a well-functioning total knee arthroplasty retrieval. J Arthroplasty 26:504.e9–504.e12CrossRef
13.
Suggs J, Kwon Y, Durbhakula S et al (2009) In vivo flexion and kinematics of the knee after TKA: comparison of a conventional and a high flexion cruciate-retaining TKA design. Knee Surg Sports Traumatol Arthrosc 17:150–156PubMedCrossRef
14.
Takahashi M, Matsubara T, Doi M et al (2006) Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:1055–1059PubMedCrossRef
15.
Yue B, Varadarajan K, Moynihan A et al (2011) Kinematics of medial osteoarthritic knees before and after posterior cruciate ligament retaining total knee arthroplasty. J Orthop Res 29:40–46PubMedCrossRef
Metadata
Title
How much of the PCL is really preserved during the tibial cut?
Authors
Georg Matziolis
Saskia Mehlhorn
Nicole Schattat
Gerd Diederichs
Robert Hube
Carsten Perka
Doerte Matziolis
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1696-5

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