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.
Similar content being viewed by others
References
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 74:652–658
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 410:131–138
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 23:1057–1067
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 89:1046–1050
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
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 416:37–57
Freeman MA, Pinskerova V (2003) The movement of the knee studied by magnetic resonance imaging. Clin Orthop Relat Res 410:35–43
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 69:233–242
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 89:1457–1461
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 23:1399–1403
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:CD004803
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 91:753–760
Komistek RD, Dennis DA, Mahfouz M (2003) In vivo fluoroscopic analysis of the normal human knee. Clin Orthop Relat Res 410:69–81
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 404:214–225
Mahoney OM, Noble PC, Rhoads DD, Alexander JW, Tullos HS (1994) Posterior cruciate function following total knee arthroplasty: a biomechanical study. J Arthroplasty 9:569–578
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 366:169–173
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 17:484–489
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 86:450–456
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 54:381–384
Pagnano MW, Cushner FD, Scott WN (1998) Role of the posterior cruciate ligament in total knee arthroplasty. J Am Acad Orthop Surg 6:176–187
Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ (1998) Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop Relat Res 356:39–46
Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS (2003) Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 85:259–265
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 89:766–771
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 85:671–674
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 87:646–655
Waslewski GL, Marson BM, Benjamin JB (1998) Early, incapacitating instability of posterior cruciate ligament-retaining total knee arthroplasty. J Arthroplasty 13:763–767
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Arbuthnot, J.E., Wainwright, O., Stables, G. et al. Dysfunction of the posterior cruciate ligament in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19, 893–898 (2011). https://doi.org/10.1007/s00167-010-1234-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-010-1234-x