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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2013

01-12-2013 | Knee

Partial resection of the PCL insertion site during tibial preparation in cruciate-retaining TKA

Authors: Hans Feyen, Nick Van Opstal, Johan Bellemans

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2013

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Abstract

Purpose

Based on the anatomy of the tibial PCL insertion site, we hypothesized that at least part of it is damaged while performing a standard tibial cut in a PCL-retaining total knee replacement. The purpose of this study was to determine and quantify the amount of resection of the tibial PCL attachment with a 9 mm tibial cut with 3 degrees of posterior slope.

Methods

Twenty cadaver tibias were used. The borders of the PCL footprint were demarcated, and calibrated digital pictures were taken in order to determine the surface area. A standard tibial intramedullary guide was used to prepare and perform a tibial cut at a depth of 9 mm with 3 degrees posterior slope. After the tibial cut was made, a second digital picture was taken using the same methodology to measure the surface area of the remaining PCL insertion.

Results

The mean surface area of the intact tibial PCL footprint before the cut was 148.9 ± 25.8 mm2 and after the tibial cut 47.1 ± 28.0 mm2. On average, 68.8 ± 15.3 % of the surface area of the PCL insertion was removed.

Conclusion

The results of this study, therefore, indicate that the conventional technique for tibial preparation in cruciate-retaining total knee arthroplasty can result in damage or removal of a significant part of the tibial PCL insertion.
Literature
1.
Amis AA, Gupte CM, Bull AMJ, Edwards A (2006) Anatomy of the posterior cruciate ligaments and the meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 24:257–263CrossRef
2.
Arbuthnot JE, Wainwright O, Stables G, Rathinam M, Rowley DI, McNicholas MJ (2011) Dysfunction of the posterior cruciate ligament in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:893–898PubMedCrossRef
3.
Becker MW, Insall JN, Faris PM (1991) Bilateral total knee arthroplasty. One cruciate retaining and one cruciate substituting. Clin Orthop Relat Res 271:122–124PubMed
4.
Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H (2005) The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 13:193–196PubMedCrossRef
5.
Bolanos AA, Colizza WA, McCann PD, Gotlin RS, Wootten ME, Kahn BA, Insall JN (1998) A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties. J Arthroplasty 13:906–915PubMedCrossRef
6.
Clark CR, Rorabeck CH, MacDonald S, MacDonald D, Swafford J, Cleland D (2001) Posterior-stabilized and cruciate-retaining knee replacement: a randomized study. Clin Orthop Relat Res 392:208–212PubMedCrossRef
7.
Conditt MA, Noble PC, Bertolusso R, Woody J, Parsley BS (2004) The PCL significantly affects the functional outcome of total knee arthroplasty. J Arthroplast 19:107–112CrossRef
8.
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
9.
Dennis DA, Komistek RD, Kim RH, Sharma A (2010) Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res 468:102–107PubMedCrossRef
10.
Greiner P, Magnussen RA, Lustig S, Demey G, Neyret P, Servien E (2011) Computed tomography evaluation of the femoral and tibial attachments of the posterior cruciate ligament in vitro. Knee Surg Sports Traumatol Arthrosc 19:1876–1883PubMedCrossRef
11.
Jacobs WC, Clement DJ, Wymenga AB (2007) Retention versus sacrifice of the posterior cruciate ligament in total knee replacement for treatment of osteoarthritis and rheumatoid arthritis. Acta Orthop 76:757–768CrossRef
12.
Laskin RS, O’Flynn HM (1997) The Insall Award. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Problems and complications. Clin Orthop Relat Res 345:24–28PubMedCrossRef
13.
Maruyama S, Yoshiya S, Matsui N, Kuroda R, Kurosaka M (2004) Functional comparison of posterior cruciate-retaining versus posterior stabilized total knee arthroplasty. J Arthroplast 19:349–353CrossRef
14.
Matsuda S, Miura H, Nagamine R (1999) Knee stability in posterior cruciate ligament retaining total knee arthroplasty. Clin Orthop 366:169–173PubMedCrossRef
15.
Matziolis G, Melhorn S, Schattat N, Diederichs G, Hube R, Perka C, Matziolis D (2011) How much of the PCL is really preserved during the tibial cut. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-011-1696-5
16.
Misra AN, Hussain MRA, Fiddian NJ, Newton G (2003) The role of the posterior cruciate ligament in total knee replacement. J Bone Joint Surg Br 85:389–392PubMedCrossRef
17.
Montgomery RL, Goodman SB, Csongradi J (1993) Late rupture of the posterior cruciate ligament after total knee replacement. Iowa Orthop J 13:167–170PubMed
18.
Ochsner JL Jr, McFarland G, Baffes GC, Cook SD (1993) Posterior cruciate ligament avulsion in total knee arthroplasty. Orthop Rev 22:1121–1124PubMed
19.
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 Arthroplast 21:127–131CrossRef
20.
Pereira DS, Jaffe FF, Ortiguera C (1998) Posterior cruciate ligament-sparing versus posterior cruciate ligament-sacrificing arthroplasty. Functional results using the same prosthesis. J Arthroplast 13:138–144CrossRef
21.
Schwartz AJ, Della Valle CJ, Rosenberg AG, Jacobs JJ, Berger RA, Galante JO (2010) Cruciate-retaining TKA using a third-generation system with a four-pegged tibial component. Clin Orthop Relat Res 468:2160–2167PubMedCrossRef
22.
Shannon FJ, Cronin JJ, Cleary MS, Eustace SJ, Byrne JMO (2007) The posterior cruciate ligament-preserving total knee replacement: do we ‘preserve’ it? J Bone Joint Surg Br 89:766–771PubMed
23.
Sheps D, Otto D, Fernhout M (2005) The anatomic characteristics of the tibial insertion of the posterior cruciate ligament. Arthroscopy 21:820–825PubMedCrossRef
24.
Simmons S, Lephart S, Rubash H (1996) Proprioception following total knee arthroplasty with and without the posterior cruciate ligament. J Arthroplast 11:763–767CrossRef
25.
Sorger JI, Federle D, Kirk PG, Grood E, Cochran J, Levy M (1997) The posterior cruciate ligament in total knee arthroplasty. J Arthroplast 12:869–879CrossRef
26.
Swanik CB, Lephart SM, Rubash HE (2004) Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses. J Bone Joint Surg Am 86:328–334PubMed
27.
Takahashi M, Matsubara T, Doi M, Suzuki D, Nagano A (2006) Anatomical study of the femoral and tibial insertions of the anterolateral and the posteromedial bundles of human posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:1055–1059PubMedCrossRef
28.
Tajima G, Nozaki M, Iriuchishima T, Ingham SJM, Smolinski P, Fu FH (2009) Morphology of the tibial insertion of the posterior cruciate ligament. J Bone Joint Surg Am 91:859–866PubMedCrossRef
29.
Warren PJ, Olanlokun TK, Cobb AG, Bentley G (1993) Proprioception after knee arthroplasty. The influence of prosthetic design. Clin Orthop Relat Res 297:182–187PubMed
30.
Waslewski GL, Marson BM, Benjamin JB (1998) Early, incapacitating instability of posterior cruciate ligament-retaining total knee arthroplasty. J Arthroplast 13:763–767CrossRef
Metadata
Title
Partial resection of the PCL insertion site during tibial preparation in cruciate-retaining TKA
Authors
Hans Feyen
Nick Van Opstal
Johan Bellemans
Publication date
01-12-2013
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-012-1997-3

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