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Is the posterior cruciate ligament necessary for medial pivot knee prostheses with regard to postoperative kinematics?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Excellent clinical and kinematical performance is commonly reported after medial pivot knee arthroplasty. However, there is conflicting evidence as to whether the posterior cruciate ligament should be retained. This study simulated how the posterior cruciate ligament, post-cam mechanism and medial tibial insert morphology may affect postoperative kinematics.

Methods

After the computational intact knee model was validated according to the motion of a normal knee, four TKA models were built based on a medial pivot prosthesis; PS type, modified PS type, CR type with PCL retained and CR type with PCL sacrificed. Anteroposterior translation and axial rotation of femoral condyles on the tibia during 0°–135° knee flexion were analyzed.

Results

There was no significant difference in kinematics between the intact knee model and reported data for a normal knee. In all TKA models, normal motion was almost fully restored, except for the CR type with PCL sacrificed. Sacrificing the PCL produced paradoxical anterior femoral translation and tibial external rotation during full flexion.

Conclusion

Either the posterior cruciate ligament or post-cam mechanism is necessary for medial pivot prostheses to regain normal kinematics after total knee arthroplasty. The morphology of medial tibial insert was also shown to produce a small but noticeable effect on knee kinematics.

Level of evidence

V.

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Correspondence to Tie-Bing Qu or Cheng-Kung Cheng.

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Fang, CH., Chang, CM., Lai, YS. et al. Is the posterior cruciate ligament necessary for medial pivot knee prostheses with regard to postoperative kinematics?. Knee Surg Sports Traumatol Arthrosc 23, 3375–3382 (2015). https://doi.org/10.1007/s00167-014-3249-1

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  • DOI: https://doi.org/10.1007/s00167-014-3249-1

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