Preoperative Factors Predicting the Preservation of the Posterior Cruciate Ligament in Total Knee Arthroplasty

Wang, Yi; Zhang, Liyi; Lin, Jianhua; Xing, Dan; Liu, Qiang; Zhou, Diange

doi:10.1111/os.13439

Cited by 3 publications

(6 citation statements)

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“…According to the investigation conducted by Wang et al ., it was discovered that an increased patellar position corresponded to a decreased patellar tendon strain. This decrease in strain facilitates achieving an appropriate joint separation 10 . As the knee flexes to a 90° angle, the PCL and patellar tendon align closely with the longitudinal axis of the tibia.…”

Section: Discussionmentioning

confidence: 98%

“… 18 Patients with a higher position of the patella tend to retain the PCL compared to individuals with a lower patellar position. 10 According to the investigation conducted by Wang et al ., it was discovered that an increased patellar position corresponded to a decreased patellar tendon strain. This decrease in strain facilitates achieving an appropriate joint separation.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown that ISI, most commonly used to determine patellar height, is an essential predictor of sacrificing PCL 18 . Patients with a higher position of the patella tend to retain the PCL compared to individuals with a lower patellar position 10 . According to the investigation conducted by Wang et al ., it was discovered that an increased patellar position corresponded to a decreased patellar tendon strain.…”

Section: Discussionmentioning

confidence: 99%

“…Radiographic data was obtained through preoperative X‐ray films (Figure 2). The MLW was measured using the anterior view of the knees 10 . The measurement of MMH and LMH was conducted by employing the lateral view of the knees, while a full limb radiograph was utilized to measure the mechanical axis.…”

Section: Methodsmentioning

confidence: 99%

“…This decrease in strain facilitates achieving an appropriate joint separation. 10 As the knee flexes to a 90 angle, the PCL and patellar tendon align closely with the longitudinal axis of the tibia. Hence, the patellar tendon plays a crucial role in preserving the joint gap during knee flexion.…”

Section: Several Important Predictorsmentioning

confidence: 98%

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Developing a Machine‐Learning Predictive Model for Retention of Posterior Cruciate Ligament in Patients Undergoing Total Knee Arthroplasty

Chen,

Zhang,

Zhou

et al. 2024

Orthopaedic Surgery

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ObjectivePredicting whether the posterior cruciate ligament (PCL) should be preserved during total knee arthroplasty (TKA) procedures is a complex task in the preoperative phase. The choice to either retain or excise the PCL has a substantial effect on the surgical outcomes and biomechanical integrity of the knee joint after the operation. To enhance surgeons' ability to predict the removal and retention of the PCL in patients before TKA, we developed machine learning models. We also identified significant feature factors that contribute to accurate predictions during this process.MethodsPatients' data on TKA continuously performed by a single surgeon who had intended initially to undergo implantation of cruciate‐retaining (CR) prostheses was collected. During the sacrifice of PCL, we utilized anterior‐stabilized (AS) tibial bearings. The dataset was split into CR and AS categories to form distinct groups. Relevant information regarding age, gender, body mass index (BMI), the affected side, and preoperative diagnosis was extracted by reviewing the medical records of the patients. To ensure the authenticity of the research, an initial step involved capturing X‐ray images before the surgery. These images were then analyzed to determine the height of the medial condyle (MMH) and lateral condyle (LMH), as well as the ratios between MLW and MMH and MLW and LMH. Additionally, the insall‐salvati index (ISI) was calculated, and the severity of any varus or valgus deformities was assessed. Eight machine‐learning methods were developed to predict the retention of PCL in TKA. Risk factor analysis was performed using the SHApley Additive exPlanations method.ResultsA total of 307 knee joints from 266 patients were included, among which there were 254 females and 53 males. A stratified random sampling technique was used to split patients in a 70:30 ratio into a training dataset and a testing dataset. Eight machine‐learning models were trained using data feeding. Except for the AUC of the LGBM Classifier, which is 0.70, the AUCs of other machine learning models are all lower than 0.70. In importance‐based analysis, ISI, MMH, LMH, deformity, and age were confirmed as important predictive factors for PCL retention in operations.ConclusionThe LGBM Classifier model achieved the best performance in predicting PCL retention in TKA. Among the potential risk factors, ISI, MMH, LMH, and deformity played essential roles in the prediction of PCL retention.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Several Important Predictorsmentioning

confidence: 98%

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Developing a Machine‐Learning Predictive Model for Retention of Posterior Cruciate Ligament in Patients Undergoing Total Knee Arthroplasty

Chen,

Zhang,

Zhou

et al. 2024

Orthopaedic Surgery

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Radiological measurement of posterior tibial subluxation as a preoperative factor in choosing the type of implant in primary total knee arthroplasty

Jegierski,

Maciąg,

Żarnovsky

et al. 2024

Reumatologia

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IntroductionTotal knee arthroplasty (TKA) is the most effective treatment of late osteoarthritis (OA) and is considered among the most successful surgical procedures in general. However, about 20% of patients remain dissatisfied. An important aspect of TKA is the proper choice of implant type – posterior stabilized (PS) or cruciate retaining (CR). Both have their indications for use based on intraoperative functional examination, but no objective radiological criteria have yet been developed. The aim of this study was to investigate the relationship between the posterior subluxation of the tibia on preoperative radiograms and implant type used.Material and methodsA series of 52 patients undergoing TKA were included in the study. All patients were over 50 years old, had clinically and radiologically confirmed primary OA of grade IV on the Kellgren-Lawrence scale and were undergoing a primary total knee replacement (TKR) with a PS or CR design. Preoperative lateral radiographs were analysed retrospectively. The tibial translation ratio was calculated as a percentage of subluxation in the length of the tibial plateau.ResultsThere were no significant differences between implant types in regard to investigated parameters. However, there was a significant difference between the groups CR and PS in regard to age (68.5 [60.0–72.0] vs. 72.5 [68.0–75.0], <i>p</i> = 0.006).ConclusionsThis study revealed that preoperative tibial translation does not significantly correlate with the choice of implant type and so probably not with posterior cruciate ligament (PCL) function and efficiency either. Additionally, this study showed that PCL insufficiency is related to the age of the patients, because of the more frequent choice of the PS implant type for the surgery in older patients than in the case of the CR implant type.

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Cruciate-Retaining Total Knee Arthroplasty: Current Concepts Review

Yang,

Sohn,

Sambandam

2023

Cureus

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Posterior cruciate-retaining (CR) total knee arthroplasty for osteoarthritis of the knee is a popular implant choice. At present, there is no consensus on whether sacrifice or retention of the posterior cruciate ligament (PCL) offers superior outcomes. This review explores the current literature available on CR total knee arthroplasty (TKA). PubMed was searched by keyword to find relevant articles for inclusion. Additional sources came from article references and joint registry reports. CR design knees have distinct kinematic gait patterns from posterior-stabilizing (PS) knees and exhibit paradoxical anterior femoral movement with less femoral rollback. While CR implants offer less flexion than PS designs, the difference is not clinically detectable as clinical scores are similar in the short and long term. CR implants have better long-term survival compared to PS knees, likely due to lower risk of aseptic loosening. CR total knee arthroplasties also have shorter operating times and lower risk of peri-prosthetic fractures. Because the CR implant is unconstrained, there may be an increased risk of instability compared to PS designs, but the literature is mixed. Overall, the current literature supports the continued use of CR TKAs due to their lower risk of complications, durability, and demonstrated equivalence in function to posterior-substituting models.

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Preoperative Factors Predicting the Preservation of the Posterior Cruciate Ligament in Total Knee Arthroplasty

Cited by 3 publications

References 32 publications

Developing a Machine‐Learning Predictive Model for Retention of Posterior Cruciate Ligament in Patients Undergoing Total Knee Arthroplasty

Developing a Machine‐Learning Predictive Model for Retention of Posterior Cruciate Ligament in Patients Undergoing Total Knee Arthroplasty

Radiological measurement of posterior tibial subluxation as a preoperative factor in choosing the type of implant in primary total knee arthroplasty

Cruciate-Retaining Total Knee Arthroplasty: Current Concepts Review

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