Common controversies in total knee replacement surgery: Current evidence

Table 1 Studies comparing posterior cruciate retaining vs posterior cruciate sacrificing total knee replacement methods

Ref.	Type of study	Outcome
Verra et al[15]	Meta-analysis of randomized and quasi-randomized controlled trials, comparing retention with sacrifice of the PCL in primary TKR	No clinically relevant differences found. Range of motion was 2.4° higher in the PCL sacrificing group
Li et al[14]	Meta-analysis of randomized controlled trials comparing posterior cruciate-retaining with posterior stabilized TKA	No differences between the 2 designs
Yagishita et al[13]	Prospective, randomized study comparing high-flexion CR design implanted in one knee and high-flexion PS design implanted in the other knee in simultaneous bilateral TKA	PS prosthesis better in postoperative knee motion, posterior knee pain at passive flexion and patient satisfaction
Seon et al[12]	Prospective randomized trial, comparing in vivo kinematics, range of motion, and functional outcomes in patients who received either a high-flexion cruciate retaining or a high-flexion cruciate substituting TKR	No differences in clinical outcomes. PS TKR superior to CR TKR in weight-bearing maximum flexion and posterior femoral roll-back
Kim et al[11]	Prospective randomized trial, comparing ROM and functional outcome in knees receiving either a high-flexion posterior cruciate-retaining or a high-flexion posterior cruciate-substituting TKR	No differences among groups
Chaudhary et al[10]	Prospective randomized study comparing range of motion of posterior CR vs posterior cruciate-substituting (PS) (TKA)	No differences among groups
Harato et al[9]	Prospective, randomized clinical trial comparing midterm outcomes of posterior CR vs posterior cruciate-substituting (PS) procedures using the Genesis II (TKA)	No significant difference in knee function, postoperative complications and patient satisfaction. Superior ROM in the PS group
Jacobs et al[8]	Systematic review and meta-analysis of prospective randomized trials	Range of motion 8° higher in the posterior-stabilized group compared to the PCL retention group

TKR: Total knee replacement; TKA: Total knee arthroplasty; PCL: Posterior cruciate ligament; PS: Posterior stabilized; CR: Cruciate retaining; ROM: Range of motion.