Effectiveness comparison of partial versus intact posterior cruciate ligament-retaining in total knee arthroplasty with cruciate-retaining prosthesis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Bo ,  LIN Yuan , REN Shixiang , CHEN Tong , ZHAO Xiaoxiong , YU Yang

Department of Orthopedics, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, P.R.China;

Corresponding author：

LIN Yuan, Email: 13801187991@163.com

Keywords：

Total knee arthroplasty; posterior cruciate ligament; cruciate-retaining prosthesis; joint stability

DOI：

10.7507/1002-1892.202007021

Video：

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Objective To compare the effectiveness of partial versus intact posterior cruciate ligament (PCL)-retaining in total knee arthroplasty (TKA) with cruciate-retaining (CR) prosthesis.Methods A total of 200 patients with osteoarthritis, who met the selection criteria and proposed unilateral TKA with CR prosthesis, were included in the study and randomly assigned into two groups (n=100). The patients were treated with intact retention of the double bundles of PCL in intact group and with partial resection of the anterior lateral bundle of PCL and the anterior bone island at the time of intraoperative tibial osteotomy in partial group. Patients with lost follow-up and re-fracture were excluded, and 84 cases in partial group and 88 cases in intact group were included in the final study. There was no significant difference between the two groups (P>0.05) in terms of gender, age, body mass index, course and grade of osteoarthritis, preoperative varus deformity of knee joint, flexion contracture, range of motion, clinical and functional scores of Knee Society Score (KSS). The operation time, wound drainage volume during 24 hours after operation, visual analogue scale (VAS) score at 24 hours after operation, range of motion of knee joint, clinical and functional scores of KSS, and the anteroposterior displacement of knee joint at 30° and 90° flexion positions were compared between the two groups.Results There was no significant difference between the two groups in operation time, wound drainage volume during 24 hours after operation, and VAS score at 24 hours after operation (P>0.05). Patients in both groups were followed up after operation. The follow-up time was 25-40 months (mean, 30.2 months) in intact group and 24-40 months (mean, 31.8 months) in partial group. There was no significant difference in the range of motion and clinical scores of KSS between the two groups at 6, 12, and 24 months after operation (P>0.05). The functional scores of KSS were significantly higher in intact group than in partial group (P<0.05). There was no significant difference between the two groups in the anteroposterior displacement of knee joints at 30° flexion position at 6, 12, and 24 months after operation (P>0.05). When the knee was at 90° flexion position, there was no significant difference between the two groups at 6 and 12 months after operation (P>0.05), but the intact group was significantly smaller than partial group at 24 months after operation (P<0.05). Postoperative incision continued exudation in 4 patients (2 cases of partial group and 2 cases of intact group), and incision debridement in 2 patients (1 case of partial group and 1 case of intact group). No prosthesis loosening, excessive wear, or dislocation of gasket was found during follow-up.Conclusion The double bundle of PCL plays an equally important role in maintaining the stability of the knee joint, and the integrity of PCL should be kept as much as possible when TKA is performed with CR prosthesis.

Citation： ZHANG Bo, LIN Yuan, REN Shixiang, CHEN Tong, ZHAO Xiaoxiong, YU Yang. Effectiveness comparison of partial versus intact posterior cruciate ligament-retaining in total knee arthroplasty with cruciate-retaining prosthesis. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 51-57. doi: 10.7507/1002-1892.202007021 Copy

1.	Nha KW, Shon OJ, Kong BS, et al. Gait comparison of unicompartmental knee arthroplasty and total knee arthroplasty during level walking. PLoS One, 2018, 13(8): e0203310.
2.	Ishii Y, Noguchi H, Sato J, et al. Anteroposterior translation and range of motion after total knee arthroplasty using posterior cruciate ligament-retaining versus posterior cruciate ligament-substituting prostheses. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3536-3542.
3.	Koh YG, Park KM, Lee HY, et al. Prediction of wear performance in femoral and tibial conformity in patient-specific cruciate-retaining total knee arthroplasty. J Orthop Surg Res, 2020, 15(1): 1-10.
4.	Koh YG, Lee JA, Chung PK, et al. Computational analysis of customized cruciate retaining total knee arthroplasty restoration of native knee joint biomechanics. Artif Organs, 2019, 43(5): 504-514.
5.	Yue B, Varadarajan KM, Rubash HE, et al. In vivo function of posterior cruciate ligament before and after posterior cruciate ligament-retaining total knee arthroplasty. Int Orthop, 2012, 36(7): 1387-1392.
6.	Scott CEH, Bell KR, Ng RT, et al. Excellent 10-year patient-reported outcomes and survival in a single-radius, cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1106-1115.
7.	Karaduman ZO. Comparison of the clinical results of patients who underwent PCL-retaining and PCL-substituting total knee arthroplasty. J Clin Exp Invest, 2020, 11(1): 734-740.
8.	Nasab SHH, Smith C, Schütz P, et al. Elongation patterns of the posterior cruciate ligament after total knee arthroplasty. J Clin Med, 2020, 9(7): 2078-2089.
9.	Kato T, Śmigielski R, Ge Y, et al. Posterior cruciate ligament is twisted and flat structure: new prospective on anatomical morphology. Knee Surg Sports Traumatol Arthrosc, 2018, 26(1): 31-39.
10.	Komistek RD, Mahfouz MR, Bertin KC, et al. In vivo determination of total knee arthroplasty kinematics: a multicenter analysis of an asymmetrical posterior cruciate retaining total knee arthroplasty. J Arthroplasty, 2008, 23(1): 41-50.
11.	Papannagari R, DeFrate LE, Nha KW, et al. Function of posterior cruciate ligament bundles during in vivo knee flexion. Am J Sports Med, 2007, 35(9): 1507-1512.
12.	Wünschel M, Leasure JM, Dalheimer P, et al. Differences in knee joint kinematics and forces after posterior cruciate retaining and stabilized total knee arthroplasty. Knee, 2013, 20(6): 416-421.
13.	Jiang C, Liu ZL, Wang Y, et al. Posterior cruciate ligament retention versus posterior stabilization for total knee arthroplasty: a meta-analysis. PLoS One, 2016, 11(1): e0147865.
14.	Murakami K, Hamai S, Okazaki K, et al. Knee kinematics in bi-cruciate stabilized total knee arthroplasty during squatting and stair-climbing activities. J Orthop, 2018, 15(2): 650-654.
15.	Kennedy NI, Wijdicks CA, Goldsmith MT, et al. Kinematic analysis of the posterior cruciate ligament, part 1: the individual and collective function of the anterolateral and posteromedial bundles. Am J Sports Med, 2013, 41(12): 2828-2838.
16.	Lombardi AV, Berend KR. Soft tissue balancing of the knee-flexion contractures. Techniques in Knee Surgery, 2005, 4(3): 193-206.
17.	Van Opstal N, Feyen H, Luyckx JP, et al. Mean tensile strength of the PCL in TKA depends on the preservation of the tibial insertion site. Knee Surg Sports Traumatol Arthrosc, 2016, 24(1): 273-278.
18.	Lützner J, Beyer F, Dexel J, et al. No difference in range of motion between ultracongruent and posterior stabilized design in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3515-3521.
19.	Luo SX, Su W, Zhao JM, et al. High-flexion vs conventional prostheses total knee arthroplasty: a meta-analysis. J Arthroplasty, 2011, 26(6): 847-854.
20.	Fritzsche H, Beyer F, Postler A, et al. Different intraoperative kinematics, stability, and range of motion between cruciate-substituting ultracongruent and posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1465-1470.
21.	Kirschberg J, Goralski S, Layher F, et al. Normalized gait analysis parameters are closely related to patient-reported outcome measures after total knee arthroplasty. Arch Orthop Trauma Surg, 2018, 138(5): 711-717.
22.	Manning WA, Blain A, Longstaff L, et al. A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2238-2250.

1. Nha KW, Shon OJ, Kong BS, et al. Gait comparison of unicompartmental knee arthroplasty and total knee arthroplasty during level walking. PLoS One, 2018, 13(8): e0203310.
2. Ishii Y, Noguchi H, Sato J, et al. Anteroposterior translation and range of motion after total knee arthroplasty using posterior cruciate ligament-retaining versus posterior cruciate ligament-substituting prostheses. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3536-3542.
3. Koh YG, Park KM, Lee HY, et al. Prediction of wear performance in femoral and tibial conformity in patient-specific cruciate-retaining total knee arthroplasty. J Orthop Surg Res, 2020, 15(1): 1-10.
4. Koh YG, Lee JA, Chung PK, et al. Computational analysis of customized cruciate retaining total knee arthroplasty restoration of native knee joint biomechanics. Artif Organs, 2019, 43(5): 504-514.
5. Yue B, Varadarajan KM, Rubash HE, et al. In vivo function of posterior cruciate ligament before and after posterior cruciate ligament-retaining total knee arthroplasty. Int Orthop, 2012, 36(7): 1387-1392.
6. Scott CEH, Bell KR, Ng RT, et al. Excellent 10-year patient-reported outcomes and survival in a single-radius, cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1106-1115.
7. Karaduman ZO. Comparison of the clinical results of patients who underwent PCL-retaining and PCL-substituting total knee arthroplasty. J Clin Exp Invest, 2020, 11(1): 734-740.
8. Nasab SHH, Smith C, Schütz P, et al. Elongation patterns of the posterior cruciate ligament after total knee arthroplasty. J Clin Med, 2020, 9(7): 2078-2089.
9. Kato T, Śmigielski R, Ge Y, et al. Posterior cruciate ligament is twisted and flat structure: new prospective on anatomical morphology. Knee Surg Sports Traumatol Arthrosc, 2018, 26(1): 31-39.
10. Komistek RD, Mahfouz MR, Bertin KC, et al. In vivo determination of total knee arthroplasty kinematics: a multicenter analysis of an asymmetrical posterior cruciate retaining total knee arthroplasty. J Arthroplasty, 2008, 23(1): 41-50.
11. Papannagari R, DeFrate LE, Nha KW, et al. Function of posterior cruciate ligament bundles during in vivo knee flexion. Am J Sports Med, 2007, 35(9): 1507-1512.
12. Wünschel M, Leasure JM, Dalheimer P, et al. Differences in knee joint kinematics and forces after posterior cruciate retaining and stabilized total knee arthroplasty. Knee, 2013, 20(6): 416-421.
13. Jiang C, Liu ZL, Wang Y, et al. Posterior cruciate ligament retention versus posterior stabilization for total knee arthroplasty: a meta-analysis. PLoS One, 2016, 11(1): e0147865.
14. Murakami K, Hamai S, Okazaki K, et al. Knee kinematics in bi-cruciate stabilized total knee arthroplasty during squatting and stair-climbing activities. J Orthop, 2018, 15(2): 650-654.
15. Kennedy NI, Wijdicks CA, Goldsmith MT, et al. Kinematic analysis of the posterior cruciate ligament, part 1: the individual and collective function of the anterolateral and posteromedial bundles. Am J Sports Med, 2013, 41(12): 2828-2838.
16. Lombardi AV, Berend KR. Soft tissue balancing of the knee-flexion contractures. Techniques in Knee Surgery, 2005, 4(3): 193-206.
17. Van Opstal N, Feyen H, Luyckx JP, et al. Mean tensile strength of the PCL in TKA depends on the preservation of the tibial insertion site. Knee Surg Sports Traumatol Arthrosc, 2016, 24(1): 273-278.
18. Lützner J, Beyer F, Dexel J, et al. No difference in range of motion between ultracongruent and posterior stabilized design in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3515-3521.
19. Luo SX, Su W, Zhao JM, et al. High-flexion vs conventional prostheses total knee arthroplasty: a meta-analysis. J Arthroplasty, 2011, 26(6): 847-854.
20. Fritzsche H, Beyer F, Postler A, et al. Different intraoperative kinematics, stability, and range of motion between cruciate-substituting ultracongruent and posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1465-1470.
21. Kirschberg J, Goralski S, Layher F, et al. Normalized gait analysis parameters are closely related to patient-reported outcome measures after total knee arthroplasty. Arch Orthop Trauma Surg, 2018, 138(5): 711-717.
22. Manning WA, Blain A, Longstaff L, et al. A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2238-2250.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison of partial versus intact posterior cruciate ligament-retaining in total knee arthroplasty with cruciate-retaining prosthesis

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