How much of the PCL is really preserved during the tibial cut?

Matziolis, Georg; Mehlhorn, Saskia; Schattat, Nicole; Diederichs, Gerd; Hube, Robert; Perka, Carsten; Matziolis, Doerte

doi:10.1007/s00167-011-1696-5

Cited by 56 publications

(56 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several studies have drawn attention to how much of the PCL is actually preserved in a CR TKA, with several of them showing that most of the PCL insertion may be disrupted during the tibial cut, calling into question how much of the PCL is actually preserved. 24,[30][31][32][33][34] Liabaud et al used magnetic resonance imaging (MRI) to show that the majority (79.8%) of patients had more than 50% of the PCL destabilized following a standard transverse tibial cut. 30 Shannon et al also using MRI demonstrated that up to one-third of patients had complete removal of the PCL insertion.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for Posterior Cruciate Ligament Avulsion during Cruciate Retaining Total Knee Arthroplasty

et al. 2018

View full text Add to dashboard Cite

During cruciate retaining (CR) total knee arthroplasty (TKA), the posterior cruciate ligament (PCL) may avulse at its insertion. The incidence of PCL avulsion fracture has not been previously studied. The aim of this study is to report on the incidence and clinical significance of intraoperative PCL avulsion during primary CR TKA and to identify potential risk factors. Our institutional joint registry was retrospectively reviewed for PCL avulsion occurring during CR TKA implanted between April 2008 and April 2016. Patient demographics, preoperative range of motion (ROM), complications, and revision rate were examined. A control group of 132 patients was used for comparison to identify potential risk factors. Forty-four of 2,457 patients (1.7%) suffered a PCL avulsion fracture during primary CR TKA. No intraoperative repair was performed and no postoperative weight bearing or ROM restrictions were implemented. There was no significant difference in BMI (p = 0.258), mean preoperative ROM (p = 0.763), or femoral and tibial component sizes (p = 0.3069, p = 0.1306) between groups. Logistic regression found female gender (p = 0.0254) to be the only statistically significant risk factor for PCL avulsion. The incidence of intraoperative PCL avulsion fracture during CR TKA is low (1.7%) and does not appear to affect postoperative ROM, subjective stability, or incidence of revision. Female gender was identified as the only patient factor that increased the risk of PCL avulsion fracture.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for Posterior Cruciate Ligament Avulsion during Cruciate Retaining Total Knee Arthroplasty

et al. 2018

View full text Add to dashboard Cite

show abstract

“…This suggests that the sMCL may be a more important restraint than the PCL at low flexion angles in CR‐TKA, and thus why the knees in this study did not meet the hypothesis stated, which was based on studies with native, non‐injured PCL knees . A study showing that between 45% and 69% of the tibial PCL attachments were found to have been resected during standard CR‐TKA tibial cuts, which may reduce the amount of load that the PCL can carry and therefore its usefulness in a clinical setting, although in this study there was no visible damage to the PCL. It is clear however that if the PCL is completely ruptured there would be instability in posterior drawer especially at higher flexion angles, and a posterior–stabilized (PS) TKA with a post‐cam mechanism would be needed to restore stability.…”

Section: Discussionmentioning

confidence: 72%

Lateral soft-tissue structures contribute to cruciate-retaining total knee arthroplasty stability

et al. 2016

View full text Add to dashboard Cite

Little information is available to surgeons regarding how the lateral structures prevent instability in the replaced knee. The aim of this study was to quantify the lateral soft-tissue contributions to stability following cruciate-retaining total knee arthroplasty (CR TKA). Nine cadaveric knees were tested in a robotic system at full extension, 30°, 60°, and 90° flexion angles. In both native and CR implanted states, ±90 N anterior-posterior force, ±8 Nm varus-valgus, and ±5 Nm internal-external torque were applied. The anterolateral structures (ALS, including the iliotibial band), the lateral collateral ligament (LCL), the popliteus tendon complex (Pop T), and the posterior cruciate ligament (PCL) were transected and their relative contributions to stabilizing the applied loads were quantified. The LCL was found to be the primary restraint to varus laxity (an average 56% across all flexion angles), and was significant in internal-external rotational stability (28% and 26%, respectively) and anterior drawer (16%). The ALS restrained 25% of internal rotation, while the PCL was significant in posterior drawer only at 60° and 90° flexion. The Pop T was not found to be significant in any tests. Therefore, the LCL was confirmed as the major lateral structure in CR TKA stability throughout the arc of flexion and deficiency could present a complex rotational laxity that cannot be overcome by the other passive lateral structures or the PCL. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1902-1909, 2017.

show abstract

“…Several methods have been described to balance the ligaments and releasing the PCL completely may result worse outcomes [18,19,20,21]. Some studies have drawn attention that most PCL insertions may be destroyed during tibia cutting, and which raises questions about how much PCL actually saves in a CR TKA [18,[22][23][24][25][26]. Eric Kim et al [10] studied the incidence and risk factors of PCL avulsion during CR TKA, they found the incidence is 1.7% and female gender was the only risk factor.…”

Section: Discussionmentioning

confidence: 99%

Good Clinical Middle-term Outcomes of the Reduction of Posterior Cruciate Ligament Avulsion Fracture in Cruciate Retaining Total Knee Arthroplasty

Lin

Niu

Dai

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Intraoperative posterior cruciate ligament (PCL) avulsion fracture of tibial is an uncommon but serious complication during primary cruciate retaining (CR) total knee arthroplasty (TKA). However, the clinical outcomes and patient-reported outcome (PRO) of the reduction of PCL avulsion fracture of tibial have rarely been informed. The objective of this research was to investigate the prevalence and middle-term clinical outcomes of this kind of fracture during primary CR TKA and to identify the potential risk factors. Methods A retrospective cohort study from January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of tibial and intraoperative reduction during primary CR TKA as PCL avulsion group, matched in a 4:1 ratio of 224 patients who underwent primary CR TKA as control group for comparison. All patients were followed up at least 4 years. Patients’ demographics, before surgery and last follow-up after surgery including range of motion (ROM), Knee Society Score (KSS), Forgotten joint score (FJS) were assessed in the two groups, Logistic regression to identify the potential risk factors. Results In our series of 1216 patients who underwent CR TKA during the retrospective period, 56 patients (4.6%) experienced PCL avulsion fracture of tibial. There were no noteworthy differences in demographic, ROM, KSS, FJS scores of the patients between the two groups. In PCL avulsion fracture group, no patients experienced revision due to the knee instability. Logistic regression analysis showed that older age (P = 0.032) and female gender (P = 0.041) were the risk factors of PCL avulsion fracture of tibial. Conclusions The incidence of PCL avulsion fracture of tibial is 4.6%, older patients and female gender may be the two risk factors of PCL avulsion fracture. The reduction of PCL avulsion fracture during CR TKA can achieve an excellent middle-term clinical and PRO outcomes compared with the control group, and without increased the risk of complications.

show abstract

How much of the PCL is really preserved during the tibial cut?

Abstract: II.

Cited by 56 publications

References 16 publications

Incidence and Risk Factors for Posterior Cruciate Ligament Avulsion during Cruciate Retaining Total Knee Arthroplasty

Incidence and Risk Factors for Posterior Cruciate Ligament Avulsion during Cruciate Retaining Total Knee Arthroplasty

Lateral soft-tissue structures contribute to cruciate-retaining total knee arthroplasty stability

Good Clinical Middle-term Outcomes of the Reduction of Posterior Cruciate Ligament Avulsion Fracture in Cruciate Retaining Total Knee Arthroplasty

Contact Info

Product

Resources

About