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
Knee

Abstract

Purpose

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.

Methods

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.

Results

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°).

Conclusion

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.

Keywords

Total knee replacement Total knee arthroplasty Posterior cruciate ligament AP laxity 

Notes

Acknowledgments

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.

References

  1. 1.
    Albert A, Forthomme JP, Vandenhooft A, Van Eeckhout P, Feoli F (2008) Are lesions of the posterior cruciate ligament predictable before knee arthroplasty? A histological study of 434 ligaments in osteoarthritic knees. Acta Orthop Belg 74:652–658PubMedGoogle Scholar
  2. 2.
    Banks S, Bellemans J, Nozaki H, Whiteside LA, Harman M, Hodge WA (2003) Knee motions during maximum flexion in fixed and mobile-bearing arthroplasties. Clin Orthop Relat Res 410:131–138PubMedCrossRefGoogle Scholar
  3. 3.
    Cates HE, Komistek RD, Mahfouz MR, Schmidt MA, Anderle M (2008) In vivo comparison of knee kinematics for subjects having either a posterior stabilized or cruciate retaining high-flexion total knee arthroplasty. J Arthroplasty 23:1057–1067PubMedCrossRefGoogle Scholar
  4. 4.
    Christen B, Heesterbeek PV, Wymenga A, Wehrli U (2007) Posterior cruciate ligament balancing in total knee replacement: the quantitative relationship between tightness of the flexion gap and tibial translation. J Bone Joint Surg Br 89:1046–1050PubMedCrossRefGoogle Scholar
  5. 5.
    Dejour D, Deschamps G, Garotta L, Dejour H (1999) Laxity in posterior cruciate sparing and posterior stabilized total knee prostheses. Clin Orthop Relat Res 364:182–193PubMedCrossRefGoogle Scholar
  6. 6.
    Dennis DA, Komistek RD, Mahfouz MR, Haas BD, Stiehl JB (2003) Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res 416:37–57PubMedCrossRefGoogle Scholar
  7. 7.
    Freeman MA, Pinskerova V (2003) The movement of the knee studied by magnetic resonance imaging. Clin Orthop Relat Res 410:35–43PubMedCrossRefGoogle Scholar
  8. 8.
    Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee: a biomechanical study. J Bone Joint Surg Am 69:233–242PubMedGoogle Scholar
  9. 9.
    Han HS, Kang SB, Yoon KS (2007) High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement. J Bone Joint Surg Br 89:1457–1461PubMedCrossRefGoogle Scholar
  10. 10.
    Hatcher J, Hatcher A, Arbuthnot J, McNicholas M (2005) An investigation to examine the inter-tester and intra-tester reliability of the Rolimeter knee tester, and its sensitivity in identifying knee joint laxity. J Orthop Res 23:1399–1403PubMedGoogle Scholar
  11. 11.
    Jacobs WC, Clement DJ, Wymenga AB (2005) Retention versus sacrifice of the posterior cruciate ligament in total knee replacement for treatment of osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev 19:CD004803Google Scholar
  12. 12.
    Kim YH, Choi Y, Kwon OR, Kim JS (2009) Functional outcome and range of motion of high-flexion posterior cruciate-retaining and high-flexion posterior cruciate-substituting total knee prostheses. A prospective, randomized study. J Bone Joint Surg Am 91:753–760PubMedCrossRefGoogle Scholar
  13. 13.
    Komistek RD, Dennis DA, Mahfouz M (2003) In vivo fluoroscopic analysis of the normal human knee. Clin Orthop Relat Res 410:69–81PubMedCrossRefGoogle Scholar
  14. 14.
    Li G, Most E, Otterberg E, Sabbag K, Zayontz S, Johnson T, Rubash H (2002) Biomechanics of posterior-substituting total knee arthroplasty: an in vitro study. Clin Orthop Relat Res 404:214–225PubMedCrossRefGoogle Scholar
  15. 15.
    Mahoney OM, Noble PC, Rhoads DD, Alexander JW, Tullos HS (1994) Posterior cruciate function following total knee arthroplasty: a biomechanical study. J Arthroplasty 9:569–578PubMedCrossRefGoogle Scholar
  16. 16.
    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 Relat Res 366:169–173PubMedCrossRefGoogle Scholar
  17. 17.
    Morberg P, Chapman-Sheath P, Morris P, Cain S, Walsh WR (2002) The function of the posterior cruciate ligament in an anteroposterior-gliding rotating platform total knee arthroplasty. J Arthroplasty 17:484–489PubMedCrossRefGoogle Scholar
  18. 18.
    Nakagawa S, Johal P, Pinskerova V, Komatsu T, Sosna A, Williams A, Freeman MA (2004) The posterior cruciate ligament during flexion of the normal knee. J Bone Joint Surg Br 86:450–456PubMedCrossRefGoogle Scholar
  19. 19.
    Nelissen RG, Hogendoorn PC (2001) Retain or sacrifice the posterior cruciate ligament in total knee arthroplasty? A histopathological study of the cruciate ligament in osteoarthritic and rheumatoid disease. J Clin Pathol 54:381–384PubMedCrossRefGoogle Scholar
  20. 20.
    Pagnano MW, Cushner FD, Scott WN (1998) Role of the posterior cruciate ligament in total knee arthroplasty. J Am Acad Orthop Surg 6:176–187PubMedGoogle Scholar
  21. 21.
    Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ (1998) Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop Relat Res 356:39–46PubMedCrossRefGoogle Scholar
  22. 22.
    Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS (2003) Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 85:259–265PubMedGoogle Scholar
  23. 23.
    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 89:766–771PubMedCrossRefGoogle Scholar
  24. 24.
    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 85:671–674PubMedGoogle Scholar
  25. 25.
    Victor J, Banks S, Bellemans J (2005) Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg Br 87:646–655PubMedCrossRefGoogle Scholar
  26. 26.
    Waslewski GL, Marson BM, Benjamin JB (1998) Early, incapacitating instability of posterior cruciate ligament-retaining total knee arthroplasty. J Arthroplasty 13:763–767PubMedCrossRefGoogle Scholar

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

Personalised recommendations