Skip to main content
Top
Published in: European Journal of Orthopaedic Surgery & Traumatology 8/2014

01-12-2014 | Original Article

Functional evaluation in cruciate-retaining-type TKA: anatomical relationship between tibial osteotomy level and PCL attachment

Authors: Masaya Aoki, Takaaki Shishido, Yasuhito Takahashi, Yoichi Katori, Kosuke Kubo, Taichiro Takamatsu, Kengo Yamamoto

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 8/2014

Login to get access

Abstract

Introduction

The level and morphology of posterior cruciate ligament (PCL) attachment vary greatly among individuals, and the function of the PCL after tibial osteotomy performed during total knee arthroplasty (TKA) surgery remains unclear. Therefore, we evaluated the resection amount of PCL attachment and the function of the residual PCL in cruciate-retaining (CR)-type TKA.

Methods

We examined 76 patients with knee osteoarthritis who had undergone CR-type TKA. The level of the tibial PCL attachment was measured by preoperative MRI and the amount resected into the tibial PCL attachment from the osteotomy level as well as the longitudinal diameter of the residual PCL by postoperative radiography. The relationships between these and joint gap tension value at flexion or amount of tibial posterior transfer by postoperative stress radiography were examined.

Results

The longitudinal diameter of the PCL attachment and the attachment level varied widely among patients. There were 39 patients (51 %) with tibial osteotomy level caudal to the PCL attachment. Flexion gap tension in patients with residual PCL (residual PCL group) was slightly higher than those without residual PCL (fully-resected group). There was no correlation between amount of PCL residual and joint gap tension at the flexion position. Even in those without residual PCL, no correlation was observed between the resected amount and flexion joint gap tension value. Comparison of amount of posterior transfer by postoperative stress radiography between those with and without residual PCL revealed no significant difference.

Conclusions

It was confirmed that the level and morphology of the PCL attachment vary greatly among individuals and the amount of PCL resected at tibial osteotomy during TKA surgery varies depending on the patient. The tension due to flexion position tended to decrease if the tibial osteotomy line was caudal to the PCL attachment; however, the amount of tibial posterior transfer due to stress was not changed.
Literature
1.
go back to reference Matsuda S, Miura H, Nagamine R, Urabe K, Matsunobu T, Iwamoto Y (1999) Knee stability in posterior cruciate ligament retaining total knee arthroplasty. Clin Orthop 366:169–173PubMedCrossRef Matsuda S, Miura H, Nagamine R, Urabe K, Matsunobu T, Iwamoto Y (1999) Knee stability in posterior cruciate ligament retaining total knee arthroplasty. Clin Orthop 366:169–173PubMedCrossRef
2.
go back to reference Dorr L, Scott R, Ranawat C (1985) Importance of retention of posterior cruciate ligament. In: Ranawat C (ed) Total-condylar knee arthroplasty. Springer, New York, pp 197–202CrossRef Dorr L, Scott R, Ranawat C (1985) Importance of retention of posterior cruciate ligament. In: Ranawat C (ed) Total-condylar knee arthroplasty. Springer, New York, pp 197–202CrossRef
3.
go back to reference Li E, Ritter MA (1995) The case for retension of the posterior cruciate ligament. J Arthroplasty 10:560–564PubMedCrossRef Li E, Ritter MA (1995) The case for retension of the posterior cruciate ligament. J Arthroplasty 10:560–564PubMedCrossRef
4.
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 309:64–68PubMed Hirsch HS, Lotke PA, Morrison LD (1994) The posterior cruciate ligament in total knee surgery: save, sacrifice, or substitute? Clin Orthop 309:64–68PubMed
5.
go back to reference Andriacchi TP, Galante JO (1998) Retention of the posterior cruciate in total knee arthroplasty. J Arthroplasty 3:S13–S19CrossRef Andriacchi TP, Galante JO (1998) Retention of the posterior cruciate in total knee arthroplasty. J Arthroplasty 3:S13–S19CrossRef
6.
go back to reference Kadoya Y, Kobayashi A, Komatsu T, Nakagawa S, Yamano Y (2001) Effects of posterior cruciate ligament resection on the tibiofemoral joint gap. Clin Orthop 391:210–217PubMedCrossRef Kadoya Y, Kobayashi A, Komatsu T, Nakagawa S, Yamano Y (2001) Effects of posterior cruciate ligament resection on the tibiofemoral joint gap. Clin Orthop 391:210–217PubMedCrossRef
7.
go back to reference Insall J, Hood R, Flawn L, Sullivan D (1983) The total condylar knee prosthesis in gonarthrosis. A five to nine-year follow-up of the first one hundred consecutive replacements. J Bone Joint Surg [Am] 65:619–628 Insall J, Hood R, Flawn L, Sullivan D (1983) The total condylar knee prosthesis in gonarthrosis. A five to nine-year follow-up of the first one hundred consecutive replacements. J Bone Joint Surg [Am] 65:619–628
8.
go back to reference Straw R, Kulkarni S, Attfield S, Wilton TJ (2003) Posterior cruciate ligament at total knee replacement. Essential, beneficial or a hindrance? J Bone Joint Surg [Br] 85:671–674 Straw R, Kulkarni S, Attfield S, Wilton TJ (2003) Posterior cruciate ligament at total knee replacement. Essential, beneficial or a hindrance? J Bone Joint Surg [Br] 85:671–674
9.
go back to reference Misra A, Hussain M, Fiddian N, Newton G (2003) The role of the posterior cruciate ligament in total knee replacement. J Bone Joint Surg [Br] 85:389–392CrossRef Misra A, Hussain M, Fiddian N, Newton G (2003) The role of the posterior cruciate ligament in total knee replacement. J Bone Joint Surg [Br] 85:389–392CrossRef
10.
go back to reference Mizu-uchi H, Matsuda S, Miura H, Nabeyama R, Okazaki K, Iwamoto Y (2006) Anteroposterior stability in posterior cruciate ligament-retaining total knee arthroplasty. J Arthroplasty 21:592–598PubMedCrossRef Mizu-uchi H, Matsuda S, Miura H, Nabeyama R, Okazaki K, Iwamoto Y (2006) Anteroposterior stability in posterior cruciate ligament-retaining total knee arthroplasty. J Arthroplasty 21:592–598PubMedCrossRef
11.
go back to reference Sorger JI, Federle D, Kirk PG, Grood E, Cochran J, Levy M (1997) The posterior cruciate ligament in total knee arthroplasty. J Arthroplasty 12:869–879PubMedCrossRef Sorger JI, Federle D, Kirk PG, Grood E, Cochran J, Levy M (1997) The posterior cruciate ligament in total knee arthroplasty. J Arthroplasty 12:869–879PubMedCrossRef
12.
go back to reference Edwards A, Bull AM, Amis AA (2007) The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy 23:284–290PubMedCrossRef Edwards A, Bull AM, Amis AA (2007) The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy 23:284–290PubMedCrossRef
13.
go back to reference Ritter MA, Faris PM, Keating EM (1988) Posterior cruciate ligament balancing during total knee arthroplasty. J Arthroplasty 3:323–326PubMedCrossRef Ritter MA, Faris PM, Keating EM (1988) Posterior cruciate ligament balancing during total knee arthroplasty. J Arthroplasty 3:323–326PubMedCrossRef
14.
go back to reference Arima J, Whiteside LA, Martin JW, Miura H, White SE, McCarthy DS (1998) Effect of partial release of the posterior cruciate ligament in total knee arthroplasty. Clin Orthop 353:194–202PubMedCrossRef Arima J, Whiteside LA, Martin JW, Miura H, White SE, McCarthy DS (1998) Effect of partial release of the posterior cruciate ligament in total knee arthroplasty. Clin Orthop 353:194–202PubMedCrossRef
15.
go back to reference Lew WD, Lewis J (1982) The effect of knee-prosthesis geometry on cruciate ligament mechanics during flexion. J Bone Joint Surg [Am] 64:734 Lew WD, Lewis J (1982) The effect of knee-prosthesis geometry on cruciate ligament mechanics during flexion. J Bone Joint Surg [Am] 64:734
16.
go back to reference Worland RL, Jessup DE, Johnson J (1997) Posterior cruciate recession in total knee arthroplasty. J Arthroplasty 12:70–73PubMedCrossRef Worland RL, Jessup DE, Johnson J (1997) Posterior cruciate recession in total knee arthroplasty. J Arthroplasty 12:70–73PubMedCrossRef
17.
go back to reference Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ (1998) Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop 356:39–46PubMedCrossRef Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ (1998) Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop 356:39–46PubMedCrossRef
18.
go back to reference Mihalko WM, Krackow KA (1999) Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop 360:243–250PubMedCrossRef Mihalko WM, Krackow KA (1999) Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop 360:243–250PubMedCrossRef
19.
go back to reference Shannon FJ, Cronin JJ, Cleary MS, Eustace SJ, O’Byrne JM (2007) The posterior cruciate ligament-preserving total knee replacement: do we ‘preserve’ it? A radiological study. J Bone Joint Surg Br 89:766–771PubMedCrossRef Shannon FJ, Cronin JJ, Cleary MS, Eustace SJ, O’Byrne JM (2007) The posterior cruciate ligament-preserving total knee replacement: do we ‘preserve’ it? A radiological study. J Bone Joint Surg Br 89:766–771PubMedCrossRef
20.
go back to reference Andriacchi TP, Stanwyck TS, Galante JO (1986) Knee biomechanics and total knee replacement. J Arthroplasty 1:211–219PubMedCrossRef Andriacchi TP, Stanwyck TS, Galante JO (1986) Knee biomechanics and total knee replacement. J Arthroplasty 1:211–219PubMedCrossRef
21.
go back to reference Ryu J (2000) Posterior cruciate ligament preserving with total knee replacement. Kansetsugeka (Joint Surg) 19:34–41 (in Japanese) Ryu J (2000) Posterior cruciate ligament preserving with total knee replacement. Kansetsugeka (Joint Surg) 19:34–41 (in Japanese)
22.
go back to reference Scott RD, Volatile TB (1986) Twelve years’ experience with posterior cruciate-retaining total knee arthroplasty. Clin Orthop Relat Res 205:100–107PubMed Scott RD, Volatile TB (1986) Twelve years’ experience with posterior cruciate-retaining total knee arthroplasty. Clin Orthop Relat Res 205:100–107PubMed
23.
go back to reference Warren PJ, Olanlokun TK, Cobb AG, Bentley G (1993) Proprioception after knee arthroplasty: the influence of prosthetic design. Clin Orthop 297:182–187PubMed Warren PJ, Olanlokun TK, Cobb AG, Bentley G (1993) Proprioception after knee arthroplasty: the influence of prosthetic design. Clin Orthop 297:182–187PubMed
24.
go back to reference Simmons S, Lephart S, Rubash H, Borsa P, Barrack RL (1996) Proprioception following total knee arthroplasty with and without the posterior cruciate ligament. J Arthroplasty 11:763–768PubMedCrossRef Simmons S, Lephart S, Rubash H, Borsa P, Barrack RL (1996) Proprioception following total knee arthroplasty with and without the posterior cruciate ligament. J Arthroplasty 11:763–768PubMedCrossRef
25.
go back to reference 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 86:328–334PubMed 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 86:328–334PubMed
26.
go back to reference Cash RM, Gonzalez MH, Garst J, Barmada R, Stern SH (1996) Proprioception after arthroplasty: role of the posterior cruciate ligament. Clin Orthop 331:172–178PubMedCrossRef Cash RM, Gonzalez MH, Garst J, Barmada R, Stern SH (1996) Proprioception after arthroplasty: role of the posterior cruciate ligament. Clin Orthop 331:172–178PubMedCrossRef
27.
go back to reference Ishii Y, Terajima K, Terashima S, Bechtold JE, Laskin RS (1997) Comparison of joint position sense after total knee arthroplasty. J Arthroplasty 12:541–545PubMedCrossRef Ishii Y, Terajima K, Terashima S, Bechtold JE, Laskin RS (1997) Comparison of joint position sense after total knee arthroplasty. J Arthroplasty 12:541–545PubMedCrossRef
Metadata
Title
Functional evaluation in cruciate-retaining-type TKA: anatomical relationship between tibial osteotomy level and PCL attachment
Authors
Masaya Aoki
Takaaki Shishido
Yasuhito Takahashi
Yoichi Katori
Kosuke Kubo
Taichiro Takamatsu
Kengo Yamamoto
Publication date
01-12-2014
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 8/2014
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-014-1414-3

Other articles of this Issue 8/2014

European Journal of Orthopaedic Surgery & Traumatology 8/2014 Go to the issue