No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial



Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCL-sacrificing TKA.


Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no significant differences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups.


There were no significant differences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no significant differences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and flexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05).


The use of UC or PS inserts in TKA did not affect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential differences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacrificing the PCL in TKA.

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The authors received no specific funding for this work.

Author information




The study was conceived by D.C. D.C. performed all the surgeries. D.K. performed all the isokinetic tests. D.C., E.A.S. and S.A. performed the analyses and D.C. and E.A.S. wrote the initial draft. All authors contributed to the interpretation of the data and to revision of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Sefa Akti.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board (IRB) by the “Ankara Numune Training and Research Hospital Clinical Research Ethics Committee” ethical committee (1585/2017) and was performed in accordance to the 1964 Helsinki Declaration and its amendments.

Informed consent

Written informed consent was acquired for all participants prior to their participation.

Trial registration number and date of registration NCT04419311, 05 June 2020 (Retrospectively registered).

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Akti, S., Karakus, D., Sezgin, E.A. et al. No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc (2020).

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  • Ultra-congruent
  • Insert
  • Isokinetic
  • Total knee replacement
  • Posterior stabilized