Dysfunction of the posterior cruciate ligament in total knee arthroplasty

  • James Edmund Arbuthnot
  • Olwyn Wainwright
  • Gareth Stables
  • Manickam Rathinam
  • David I. Rowley
  • Michael J. McNicholas



Total knee arthroplasty (TKA) is typically carried out either with retention (CR) of the posterior cruciate ligament (PCL) or with sacrifice of this ligament and implantation of a posterior stabilised (PS) prosthesis. This paper investigates a comparison of PCL function in knees treated for osteoarthritis with TKA where the PCL is preserved to those knees treated with TKA and posterior stabilisation.


One hundred and sixty-eight patients (232 knees) who had undergone TKA with either a PS or CR implant were included in the study. Clinical assessment included antero-posterior (AP) laxity and posterior sag assessment with an arthrometer.


The mean AP laxity at 90° of flexion for CR TKAs was 6.5 mm (±3.1) and was the same [6.5 mm (±2.4)] as in the PS group. However, 56% of the PCL-preserved knees had a posterior sag of over 3 mm compared to 18% of the knees in the PS group. The American Knee Society Scores for either group showed that, although the mean function score was the same, the knee score was superior in the PS group (77 vs. 84). The range of motion was also superior in the PS group (111° vs. 105°).


The use of the PS prosthesis for TKA provides a more predictable outcome with regard to posterior sag and a better maximum flexion than a CR implant.


Total knee replacement Total knee arthroplasty Posterior cruciate ligament AP laxity 



The authors would like to express their appreciation to the surgeons of Warrington Hospital, North Cheshire, who allowed their patients to be included in this study, and Aircast® who helped fund this study.

Conflict of interest

One or more of the authors have received or will receive benefits from a commercial party related directly or indirectly to the subject of this article.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • James Edmund Arbuthnot
    • 1
    • 5
  • Olwyn Wainwright
    • 2
  • Gareth Stables
    • 3
  • Manickam Rathinam
    • 2
  • David I. Rowley
    • 4
  • Michael J. McNicholas
    • 2
  1. 1.Good Hope and Solihull HospitalsHeart of England NHS Foundation TrustBirminghamUK
  2. 2.Warrington HospitalNorth Cheshire Hospitals NHS TrustWarringtonUK
  3. 3.Mersey Deanery Specialist Registrar RotationLiverpoolUK
  4. 4.Ninewells Hospital and Medical SchoolUniversity Department of Orthopaedic and Trauma SurgeryDundeeUK
  5. 5.Department of Orthopaedics and TraumaGood Hope HospitalBirminghamUK

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