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Retained versus resected posterior cruciate ligament in mobile-bearing total knee replacement: a retrospective, clinical and functional assessment

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Abstract

Purpose

Fully conforming, mobile-bearing total knee replacement (TKR) was initially designed using a posterior cruciate-sacrificing (CS) technique. Rotating-platform TKR that could also be performed retaining the posterior cruciate developed afterwards. The purpose of this study was to compare the clinical and functional outcomes of patients who had either cruciate-retaining (CR) or cruciate-sacrificing (CS) TKR at a minimum follow-up of 2 years with the same prosthetic design.

Methods

One hundred and two consecutive TKR (88 patients) were performed at the same institution either with CS (56 TKR—49 patients) or with CR (46 TKR—39 patients) technique. Patients were followed at a minimum of 2 years. Patients were evaluated for articular range of motion, complication rate (infection, loosening) and clinical outcome measures included the pain and functional components of the Knee Society Score.

Results

The two groups (CS, CR) were homogeneous. At final follow-up, no significant difference was seen between the two surgical techniques in terms of ROM, pain and functional level, and revision rate.

Conclusions

This study showed that for this given mobile-bearing, fully conforming prosthetic design, sacrificing or resecting the PCL does not influence the clinical and functional outcomes at a minimum of 2-year follow-up. Surgeons may indifferently choose one of the two options (CS, CR) according to their preferences.

Level of evidence

Case series, level IV.

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References

  1. Verra WC, van den Boom LG, Jacobs W, Clement DJ, Wymenga AA, Nelissen RG (2013) Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis. Cochrane Database Syst Rev 10:CD004803

    PubMed  Google Scholar 

  2. Roh YW, Jang J, Choi WC, Lee JK, Chun SH, Lee S, Seong SC, Lee MC (2012) Preservation of the posterior cruciate ligament is not helpful in highly conforming mobile-bearing total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 21:2850–2859

    Article  PubMed  Google Scholar 

  3. McIlwraith CW, Frisbie DD, Rodkey WG, Kisiday JD, Werpy NM, Kawcak CE, Steadman JR (2011) Evaluation of intra-articular mesenchymal stem cells to augment healing of microfractured chondral defects. Arthroscopy 27:1552–1561

    Article  PubMed  Google Scholar 

  4. Ishii Y, Noguchi H, Takeda M, Sato J, Toyabe S (2011) Prediction of range of motion 2 years after mobile-bearing total knee arthroplasty: PCL-retaining versus PCL-sacrificing. Knee Surg Sports Traumatol Arthrosc 19:2002–2008

    Article  PubMed  Google Scholar 

  5. Hanratty BM, Thompson NW, Wilson RK, Beverland DE (2007) The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant. J Bone Joint Surg Br 89:915–918

    Article  CAS  PubMed  Google Scholar 

  6. Hirsch HS, Lotke PA, Morrison LD (1994) The posterior cruciate ligament in total knee surgery. Save, sacrifice, or substitute? Clin Orthop Relat Res 309:64–68

    PubMed  Google Scholar 

  7. Evans MC, Parsons EM, Scott RD, Thornhill TS, Zurakowski D (2006) Comparative flexion after rotating-platform vs fixed-bearing total knee arthroplasty. J Arthroplasty 21:985–991

    Article  PubMed  Google Scholar 

  8. 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 Arthroplasty 21:127–131

    Article  PubMed  Google Scholar 

  9. Kim YH, Kim JS, Park JW, Joo JH (2011) Comparison of the low contact stress and press fit condylar rotating-platform mobile-bearing prostheses in total knee arthroplasty: a prospective randomized study. J Bone Joint Surg Am 93:1001–1007

    PubMed  Google Scholar 

  10. Conditt MA, Noble PC, Bertolusso R, Woody J, Parsley BS (2004) The PCL significantly affects the functional outcome of total knee arthroplasty. J Arthroplasty 19:107–112

    Article  PubMed  Google Scholar 

  11. Misra AN, Hussain MR, Fiddian NJ, Newton G (2003) The role of the posterior cruciate ligament in total knee replacement. J Bone Joint Surg Br 85:389–392

    Article  CAS  PubMed  Google Scholar 

  12. Andriacchi TP, Galante JO (1988) Retention of the posterior cruciate in total knee arthroplasty. J Arthroplasty 3(Suppl):S13–S19

    Article  PubMed  Google Scholar 

  13. Dejour D, Deschamps G, Garotta L, Dejour H (1999) Laxity in posterior cruciate sparing and posterior stabilized total knee prostheses. Clin Orthop Relat Res 364:182–193

    Article  PubMed  Google Scholar 

  14. Chouteau J, Lerat JL, Testa R, Moyen B, Banks SA (2009) Sagittal laxity after posterior cruciate ligament-retaining mobile-bearing total knee arthroplasty. J Arthroplasty 24:710–715

    Article  PubMed  Google Scholar 

  15. Bae DK, Song SJ, Cho SD (2011) Clinical outcome of total knee arthroplasty with medial pivot prosthesis a comparative study between the cruciate retaining and sacrificing. J Arthroplasty 26:693–698

    Article  PubMed  Google Scholar 

  16. Kwak JY, Jeong JH, Lee SH, Jung HJ, Jung YB (2012) Comparison of the clinical outcomes after total knee arthroplasty with the LCS rotating platform mobile bearing knee system and the PFC Sigma RP-F mobile bearing knee system. Clin Orthop Surg 4:256–262

    Article  PubMed Central  PubMed  Google Scholar 

  17. Stiehl JB, Voorhorst PE (1999) Total knee arthroplasty with a mobile-bearing prosthesis: comparison of retention and sacrifice of the posterior cruciate ligament in cementless implants. Am J Orthop (Belle Mead NJ) 28:223–228

    CAS  Google Scholar 

  18. Zaki SH, Rafiq I, Kapoor A, Raut V, Gambhir AK, Porter ML (2007) Medium-term results with the Press Fit Condylar (PFC) Sigma knee prosthesis the Wrightington experience. Acta Orthop Belg 73:55–59

    PubMed  Google Scholar 

  19. Arthur CH, Wood AM, Keenan AC, Clayton RA, Walmsley P, Brenkel I (2013) Ten-year results of the press fit condylar sigma total knee replacement. Bone Joint J 95-B:177–180

    Article  CAS  PubMed  Google Scholar 

  20. Linder R, Muller H, Grenz-Farenholtz B, Wagner C, Stockheim M, Verheyen F (2012) Replacement of endoprosthetic implants within a two years follow-up period: a statutory health insurance routine data analysis. BMC Musculoskelet Disord 13:223–227

    Article  PubMed Central  PubMed  Google Scholar 

  21. Pedersen AB, Mehnert F, Odgaard A, Schroder HM (2012) Existing data sources for clinical epidemiology: the Danish Knee Arthroplasty Register. Clin Epidemiol 4:125–135

    Article  PubMed Central  PubMed  Google Scholar 

  22. Asaid R, Williams I, Hyde D, Tiang T (2013) Infection rates following hip and knee joint arthroplasty: large referral centre versus a small elective-only hospital. Eur J Orthop Surg Traumatol 23:165–168

    Article  CAS  PubMed  Google Scholar 

  23. Nakama GY, Peccin MS, Almeida GJ, Lira Neto Ode A, Queiroz AA, Navarro RD (2012) Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases. Cochrane Database Syst Rev 10:6193

    Google Scholar 

  24. Pilling RW, Moulder E, Allgar V, Messner J, Sun Z, Mohsen A (2012) Patellar resurfacing in primary total knee replacement: a meta-analysis. J Bone Joint Surg Am 94:2270–2278

    Article  CAS  PubMed  Google Scholar 

  25. Signorelli JJ, Bernini PM, Shirreffs TG (2011) Uncemented total knee arthroplasty: 2-year follow-up of 100 knees with a rotating platform, cruciate-retaining design. J Arthroplasty 26:427–431

    Article  PubMed  Google Scholar 

  26. Stiehl JB, Dennis DA, Komistek RD, Keblish PA (2000) In vivo kinematic comparison of posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg 13:13–18

    CAS  PubMed  Google Scholar 

  27. Stiehl JB, Voorhorst PE, Keblish P, Sorrells RB (1997) Comparison of range of motion after posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg 10:216–220

    CAS  PubMed  Google Scholar 

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Conflict of interest

Davide Enea received a Grant (No. 012102) cofinanced by Permedica s.p.a. and the Polytechnic University of Marche. The other authors declare no conflicts of interest.

Ethical standard

This work was performed in keeping with the ethical standards of the 1964 Declaration of Helsinki as revised in 2000. All the patients gave their informed consent prior to being included into the study, and the study was authorized by the local ethical committee.

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Authors and Affiliations

  1. Department of Orthopaedics, Polytechnic University of Marche, Ancona, Italy

    D. Enea, V. Cigna, C. Sgolacchia, L. Tozzi, A. Verdenelli & A. Gigante

  2. Department of Clinical and Molecular Science, Polytechnic University of Marche, Via Conca 10/a, Ancona, Italy

    D. Enea

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  1. D. Enea
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  2. V. Cigna
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  3. C. Sgolacchia
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  4. L. Tozzi
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  5. A. Verdenelli
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  6. A. Gigante
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Correspondence to D. Enea.

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Enea, D., Cigna, V., Sgolacchia, C. et al. Retained versus resected posterior cruciate ligament in mobile-bearing total knee replacement: a retrospective, clinical and functional assessment. Musculoskelet Surg 99, 149–154 (2015). https://doi.org/10.1007/s12306-014-0345-9

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  • DOI: https://doi.org/10.1007/s12306-014-0345-9

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