Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4208
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
Processing time: 87 Days and 1.9 Hours
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.
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.
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.
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.
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.
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.
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.