Does Posterior Cruciate Ligament Retention or Sacrifice in Total Knee Replacement Affect Proprioception? A Systematic Review

Abstract

Background: Proprioception is an important part of the somatosensory system involved in human motion control, which is fundamental for activities of daily living, exercise, and sport-specific gestures. When total knee arthroplasty (TKA) is performed, the posterior cruciate ligament (PCL) can be retained, replaced, or discarded. The PCL seems to be responsible for maintaining the integrity of the joint position sense (JPS) and joint kinesthesia. The aim of this review was to assess the effect of PCL on knee joint proprioception in total knee replacement. Methods: This systematic review was conducted within five electronic databases: PubMed, Scopus, Web of Science, Cochrane, and PEDro with no data limit from inception to May 2021. Results: In total 10 publications were evaluated. The analysis was divided by proprioception assessment method: direct assessment (JPS, kinesthesia) and indirect assessment (balance). Conclusions: The current evidence suggest that the retention of the PCL does not substantially improve the joint proprioception after TKA. Due to the high heterogeneity of the studies in terms of design, proprioception outcomes, evaluation methods, further studies are needed to confirm the conclusions. In addition, future research should focus on the possible correlation between joint proprioception and walking function.

No Significant Differences in Clinical and Radiographic Outcomes between PCL Retained or Sacrificed Kinematic Aligned Medial Pivot Total Knee Arthroplasty in Varus Knee

“…Several studies have compared patients’ outcomes with PCL-preserved or sacrificed TKA; generally, no significant differences were described between the two groups of patients [ 34 , 43 , 44 , 45 ]. Thippanne et al [ 43 ] reported no statistically significant differences for FJS between 169 PCL-retained TKAs and 178 PCL-sacrificed TKAs.…”

“…Until August 2019, the PCL was always sacrificed in all treated patients. Starting in September 2019, considering the theoretical advantages of PCL preservation based on recent scientific evidence [ 34 , 35 , 36 , 37 ], such as increased anteroposterior stability and improved proprioception, we decided to retain the PCL in every case. In patients with tight flexion, space was evident after bone resections and gap balancing based on tibial recut was performed ( Figure 1 ).…”

Relationship Between Mechanoreceptors in the Posterior Cruciate Ligament and Patient Age or Osteoarthritis Severity

“…Yet, they did not analyze in detail the number of mechanoreceptors of the PCL in patients with different degrees of OA, and they did not know whether the value of retaining PCLs in patients with OA at all levels was the same. The clinical results of Vandekerckhove et al, 22 Götz et al, 12 and Bravi et al 3 show that preservation of PCLs cannot significantly improve the proprioception or postural stability of the joint after TKA. Nevertheless, their study did not indicate the degree of OA in the experimental group and the control group, which does not reflect the true preservation value of the PCL.…”

“…2 Proprioception includes perception of the static position, displacement, velocity, acceleration, and muscle force of body parts. 3 Proprioception depends on mechanoreceptors, which are distributed in many tissues of the knee joint. C xabuk et al 5 found that there are mechanoreceptors at the PCL, the anterior articular capsule, and the medial meniscus, which attaches to the articular capsule.…”

Anterior and Posterior Cruciate Ligaments Mechanoreceptors: A Review of Basic Science

“…One of the main issues in total knee arthroplasty is the retention or the sacrifice of PCL, as it seems to affect the proprioception of the knee. Bravi et al concluded that the retention of the PCL does not substantially improve the joint proprioception after TKR [ 39 ].…”