Cruciate-retaining total knee arthroplasty: How much of the PCL is really retained?

Totlis, Trifon; Iosifidis, Michael; Melas, Ioannes; Apostolidis, Konstantinos; Agapidis, Alexios; Eftychiakos, Nikolaos; Alvanos, Dimitrios; Kyriakidis, Anastasios

doi:10.1007/s00167-016-4144-8

Cited by 9 publications

(19 citation statements)

References 26 publications

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“…Similar outcomes of CR-and PS implants for varus knees have been reported in terms of survivorship, range of movement, proprioception, and gait analysis and this is now well established. [18][19][20][21] However, the use of CR implants for valgus knees is less studied but gaining popularity.…”

Section: Discussionmentioning

confidence: 99%

High Medium-Term Survivorship of Cruciate-Retaining Total Knee Arthroplasties (110 Knees) for Valgus Deformity

Matar¹,

Thangaraj²,

Saraogi³

et al. 2019

J Knee Surg

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The main purpose of this article is to evaluate the clinical outcomes and survivorship of cruciate-retaining (CR) knee arthroplasties for valgus deformity. This article is retrospective consecutive series of 110 valgus knees using CR implants with a minimum 2-year follow-up. Deformity correction was achieved using stepwise sequential soft tissue releases (iliotibial band, popliteus tendon, lateral collateral release through sliver femoral condylar osteotomy). Demographic data, range of movement, and degrees of deformity were collected. The Oxford Knee Score (OKS) was used as patients' reported outcome measure at final follow-up. One-hundred and four patients (110 knees) were included (87 females/17 males) with mean age of 68.7 years. Primary diagnosis was osteoarthritis in 85 patients and rheumatoid arthritis in 19 patients. Mean follow-up was 5.5 years (median: 5 years; range: 2–14 years). Preoperative valgus deformity was measured radiographically using the mechanical tibiofemoral angle with a mean 18.6° (standard deviation [SD]: 7.5; range: 11–38°). At final follow-up, mechanical tibiofemoral angle was 3.8° (SD: 1.97; range: 2–8°). A p-value was <0.0001 and mean OKS was 42 (SD: 5.4; range: 36–48) suggesting satisfactory patients' reported outcomes with no implant revision for any cause. CR implants for valgus knees using staged soft tissue releases including sliver condylar osteotomy had excellent medium-term survivorship and satisfactory patient reported outcome measures. The Level of Evidence for this study is IV.

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Section: Discussionmentioning

confidence: 99%

High Medium-Term Survivorship of Cruciate-Retaining Total Knee Arthroplasties (110 Knees) for Valgus Deformity

Matar¹,

Thangaraj²,

Saraogi³

et al. 2019

J Knee Surg

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“…Soft-tissue injury to the medial or lateral collateral ligament (MCL or LCL), posterior cruciate ligament (PCL), or extensor mechanism may compromise postoperative clinical outcomes, through reduced stability and decreased implant survivorship. 1-5 Studies have shown that a full transverse tibial cut may lead to damage to the PCL 6-8 and even to the deep MCL. 9 PCL avulsion has been shown to be more likely with increased sagittal slope.…”

Section: Introductionmentioning

confidence: 99%

Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach

Hampp

Sodhi

Scholl

et al. 2019

Bone & Joint Research

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Objectives The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach. Methods A total of 12 fresh-frozen pelvis-to-toe cadaver specimens were included. Four surgeons each prepared three RATKA and three MTKA specimens for cruciate-retaining TKAs. A RATKA was performed on one knee and a MTKA on the other. Postoperatively, two additional surgeons assessed and graded damage to 14 key anatomical structures in a blinded manner. Kruskal–Wallis hypothesis tests were performed to assess statistical differences in soft-tissue damage between RATKA and MTKA cases. Results Significantly less damage occurred to the PCLs in the RATKA versus the MTKA specimens (p < 0.001). RATKA specimens had non-significantly less damage to the deep medial collateral ligaments (p = 0.149), iliotibial bands (p = 0.580), poplitei (p = 0.248), and patellar ligaments (p = 0.317). The remaining anatomical structures had minimal soft-tissue damage in all MTKA and RATKA specimens. Conclusion The results of this study indicate that less soft-tissue damage may occur when utilizing RATKA compared with MTKA. These findings are likely due to the enhanced preoperative planning with the robotic software, the real-time intraoperative feedback, and the haptically bounded saw blade, all of which may help protect the surrounding soft tissues and ligaments. Cite this article: Bone Joint Res 2019;8:495–501. DOI: 10.1302/2046-3758.810.BJR-2019-0129.R1.

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“…Bulk of the PCL is found in the distal part of PCL insertion [ 19 ]. Totlis et al studied tibial footprint of PCL in 30 female patients on MRI preoperatively and intraoperatively measured the length of footprint removed with the tibial cut [ 20 ]. They found that 65.1 ± 15.9 % of the footprint length may be lost in the tibial cut.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of posterior cruciate ligament retained in a posterior cruciate ligament retaining total knee replacement: a cadaveric study

Goyal

Singla

Paul

2018

SICOT-J

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Background: Recent evidence has highlighted a risk that the majority of posterior cruciate ligament (PCL) is removed while making bone cuts in tibia and femur during total knee replacement surgery. Aim of this cadaveric study is to calculate how much PCL footprint is retained in a PCL retaining prosthesis after routine tibial and femoral cuts are made. Methods: Twelve paired formalin-fixed Indian cadaveric knees were studied. Knees were disarticulated and all soft tissues were circumferentially removed from the tibia and femur. Footprints of antero-lateral and postero-medial bundles were marked on tibia and femur. Proximal tibial and distal femoral cuts were made using standard cutting jigs (Zimmer NexGen LPS). Digital photographs were taken with a magnification marker attached on the bone before and after making the cuts. Area of PCL insertion before and after the bone cuts was measured using software ImageJ (National Institute of Health).Results: Footprint on tibial side was reduced by 9.1%, and on femoral side by 21.8%. Footprint of AL bundle was reduced by 24.3% on the tibial side and by 15.3% on the femoral side. Footprint of PM bundle on tibia was not affected by the bone cut but was reduced by 18.5% on the femoral side.Conclusion: Tibial and femoral insertions of PCL are relatively well preserved after bone cuts are made in a posterior cruciate retaining TKR. There is differential sectioning of antero-lateral and postero-medial bundles of PCL on tibial and femoral sides.

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Cruciate-retaining total knee arthroplasty: How much of the PCL is really retained?

Abstract: IV.

Cited by 9 publications

References 26 publications

High Medium-Term Survivorship of Cruciate-Retaining Total Knee Arthroplasties (110 Knees) for Valgus Deformity

High Medium-Term Survivorship of Cruciate-Retaining Total Knee Arthroplasties (110 Knees) for Valgus Deformity

Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach

Anatomy of posterior cruciate ligament retained in a posterior cruciate ligament retaining total knee replacement: a cadaveric study

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