The PCL significantly affects the functional outcome of total knee arthroplasty

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Abstract

This study tests the hypothesis that patients receiving a posterior cruciate ligament (PCL)—retaining prosthesis have no difference in functional outcome compared to those receiving a cruciate-sacrificing, posterior-stabilized (PS) design. Forty-nine patients underwent a total knee arthroplasty (TKA), performed by a single surgeon using the same implant design with either a PCL-retaining or a PS tibial insert. Each patient completed a self-administered, validated Total Knee Function Questionnaire as well as the SF-36. At 1-year follow-up, each patient’s range of motion and Knee Society knee score were measured. There were no statistically significant differences between the 2 groups using the traditional measures of function following total knee replacement, including overall satisfaction with surgery. However, the TKFQ revealed that patients with PS knees reported greater functional limitations in squatting, kneeling, and gardening. Our results suggest that with the specific implant used in this study, substitution for the PCL with a spine and cam mechanism may not fully restore the functional capacity of the intact PCL, particularly in high-demand activities that involve deep flexion.

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Materials and methods

We identified 49 patients of the senior author (BSP) who had undergone primary, unilateral knee replacement using a single design of knee prosthesis (AMK, DePuy, Warsaw, IN). In the first group, consisting of 28 patients, the knee prosthesis was implanted with retention of the posterior cruciate ligament at a time when this implant was not available with a cruciate substituting option. A second group, consisting of 21 patients receiving prostheses of the same design with a posterior stabilized

Results

The average age of the patients in the PCL-retaining group was 72.3 ± 3.1years (n = 28) compared to 69.2 ± 2.9 years in the PS group (n = 21). There was no significant differences between patients in the PCL-retaining and the PS groups in terms of age (P = .48) or sex (P = .78) (Table 1). The PCL-retaining group had average SF-36 and AKS scores of 57.7 ± 4.6 and 94.6 ± 2.4, respectively compared to the PS group with 61.4 ± 5.2 and 89.4 ± 3.7 (P = .60 and P = .29 respectively). From the ADL

Discussion

Our study design allows us to differentiate between 2 fundamentally different methods of achieving rollback with flexion without the compounding influences of differences in surgical technique, operating surgeon, or implant design that have been shortcomings of most, if not all, previous studies. Through the use of cohorts in which the same prosthesis was implanted by the same surgeon, we have demonstrated that there are few differences between PCL-retaining and PS knee replacements in terms of

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    Citation Excerpt :

    However, Misra et al [17] found results questioning the need for a competent PCL in the CR design all together when they found no difference in outcomes when retaining or resecting the PCL in CR designed knees. Despite those results, it is unlikely that the PCL plays no role in kinematic control of the knee as found from a large cohort of literature [8,17,18,34,35]. Failure of the PCL in a CR TKA is rarely clearly reported in the literature, but typically leads to a revision surgery with a more constrained design if symptomatic [32,36].

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Benefits or funds were received in partial or total support of the research material described in this article. These benefits and/or support were received from Centerpulse Orthopedics, Austin, Texas.

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