Cruciate-Retaining Total Knee Arthroplasty

Abstract

The debate over the relative merits of substituting or retaining the posterior cruciate ligament (PCL) in total knee arthroplasty is still ongoing. The potential advantages of PCL preservation are a more natural femoral rollback, the presence of a structure critical for the proprioception, the maintenance of a native central stabilizer of the joint, and low shear stress on the bone-cement interface of the tibial component. Numerous retrospective studies of cruciate-retaining (CR) total knee arthroplasties have demonstrated consistently good clinical results and excellent intermediate and long-term survival. The main criticisms of the surgical technique are that the distal attachment of the PCL is vulnerable to injury and that balancing the PCL can be difficult; based on our experience, surgical tricks will be described to avoid the avulsion of the ligament and they will be discussed the main points to consider when you can find a discrepancy between flexion and extension stability. Based on the current evidence, we conclude that with a standardized technique, this type of implant should be preferred even in those cases where the sacrifice of the cruciate ligament seems to be the easiest way.

PCL retention demonstrates better functional scores and gait patterns in total knee arthroplasty using a medial congruent insert—a prospective study

“…PCL preservation is best utilized by the slightly lattened design of the tibia in the sagittal plane. The congruence in the frontal plane helps reduce stress on the polyethylene, thus reducing long-term wear [5,19]. The MC insert has a longer femoral trochlear groove and a smoother patellar trajectory [11].…”

Range of Motion Outcomes Post Cruciate-Retaining vs Posterior Stabilized Total Knee Arthroplasty: A Retrospective Multi-Centre Cohort Study

“…Performing a CR TKR is relatively more difficult compared to its PS counterpart, however aside from functional outcomes (ROM), it has its advantages in that it involves reduced bone cuts, preserves ligamentous structures (and hence physiological function), and maintains proprioception. 26 Proprioception is important for balance and postural stability, which are relevant functional outcomes. 27 Evidence from studies that compared prosthetic designs have shown that CR implants tend to produce superior improvement in proprioception than PS prostheses and could hence be a factor for clinicians to consider when choosing different types of prostheses.…”