Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4208-4217
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4208
Intact, pie-crusting and repairing the posterior cruciate ligament in posterior cruciate ligament-retaining total knee arthroplasty: A 5-year follow-up
De-Si Ma, Liang Wen, Zhi-Wei Wang, Bo Zhang, Shi-Xiang Ren, Yuan Lin
De-Si Ma, Liang Wen, Zhi-Wei Wang, Bo Zhang, Shi-Xiang Ren, Yuan Lin, Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Author contributions: Ma DS analyzed the data and wrote the first draft of the manuscript; Wen L designed the research and provided guidance for the study; Wang ZW, Ren SX and Zhang B contributed to the acquisition of data and interpretation of data. Yuan Lin performed the surgeries.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University (No. 12-70).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Liang Wen, MD, PhD, Associate Chief Physician, Doctor, Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, No 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, China. wenliang@ccmu.edu.cn
Telephone: +86-10-85231228
Received: September 29, 2019
Peer-review started: September 29, 2019
First decision: November 21, 2019
Revised: November 25, 2019
Accepted: November 30, 2019
Article in press: November 30, 2019
Published online: December 26, 2019
ARTICLE HIGHLIGHTS
Research background

One of the most persistent issues discussed in total knee arthroplasty (TKA) is the role of retention or substitution of the posterior cruciate ligament (PCL). Whether the entire PCL should be retained during cruciate-retaining (CR)-TKA is controversial. Maintaining the function of the PCL is the goal of CR-TKA.

Research motivation

The PCL is composed of anterolateral and posteromedial bundles. The anterolateral bundle is the main functional part of the PCL and plays an important role in the stability of knee flexion. The anterolateral bundle of the PCL should not be sacrificed in CR-TKA, although it would be easier to balance the flexion gap by releasing or excising the anterolateral bundle.

Research objectives

The aim of the study was to evaluate the clinical outcomes of PCL preservation in CR-TKA and the methods used to deal with the PCL during surgery.

Research methods

A total of 176 patients (205 knees) were involved in this study. A PCL protector was used to preserve the intact PCL bone block during the CR-TKA. The status of the PCL was recorded during surgery. Intact PCL preserved, pie-crusting and repairing were used to balance the tension of the PCL according to the strategy used for a tight PCL in CR-TKA. Range of motion (ROM) and the Knee Society Clinical Rating system (KSS) scores were evaluated as the clinical outcomes.

Research results

The intact PCL could be preserved in most CR-TKAs (63.0%). 23.7% of CR-TKAs required pie-crusting and 13.3% required PCL repair to balance the tension of the PCL. The ROM and KSS scores were significantly improved after surgery in all cases and there were no differences in the three groups.

Research conclusions

The PCL protector can effectively protect the PCL bone block and does not increase the difficulty of TKA. PCL pie-crusting and PCL repair have no impact on the clinical outcomes in CR-TKA and can be included during surgery to balance the tension of the PCL.

Research perspectives

Preservation of the intact PCL can be achieved by the PCL protector and the surgical technique used. Sometimes it can be difficult to balance the tension of the intact PCL. In future research, more attention should be paid to investigating the relationship between the intact PCL and balance of the PCL during CR-TKA.