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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2023

Open Access 18-12-2021 | KNEE

More passive internal tibial rotation with posterior cruciate ligament retention than with excision in a medial pivot TKA implanted with unrestricted caliper verified kinematic alignment

Authors: Alexander J. Nedopil, Stephen M. Howell, Maury L. Hull

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2023

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Abstract

Purpose

Excision of the posterior cruciate ligament (PCL) is recommended when implanting a medial pivot (MP) total knee arthroplasty (TKA) to reduce the risk of limiting flexion by over-tensioning the flexion space. The present study determined whether PCL retention (1) limits internal tibial rotation and (2) causes anterior lift-off of the insert in 90° flexion after implantation of an MP design with unrestricted caliper verified kinematic alignment (KA).

Methods

Four surgeons implanted an MP TKA design with medial ball-in-socket and lateral flat tibial insert in ten fresh-frozen cadaveric knees. Before and after PCL excision, trial inserts with medial goniometric markings measured the angular I–E tibial orientation relative to the trial femoral component's medial condyle in extension and at 90° flexion, and the surgeon recorded the occurrence of anterior lift-off of the insert at 90° flexion.

Results

PCL retention resulted in greater internal tibial rotation than PCL excision, with mean values of 15° vs 7° degrees from maximum extension to 90° flexion, respectively (p < 0.0007). At 90° flexion, no TKAs with PCL retention and one TKA with PCL excision had anterior lift-off of the insert (N.S.).

Conclusions

This preliminary study of ten cadaveric knees showed that PCL retention restored more passive internal tibial rotation than PCL excision with a negligible risk of anterior lift-off. However, in vivo analysis from multiple authors with a larger sample size is required to recommend PCL retention with an MP TKA design implanted with unrestricted caliper verified KA.
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Metadata
Title
More passive internal tibial rotation with posterior cruciate ligament retention than with excision in a medial pivot TKA implanted with unrestricted caliper verified kinematic alignment
Authors
Alexander J. Nedopil
Stephen M. Howell
Maury L. Hull
Publication date
18-12-2021
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-021-06840-0

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