Preservation of the posterior cruciate ligament is not helpful in highly conforming mobile-bearing total knee arthroplasty: a randomized controlled study

Roh, Yoon Whan; Jang, Ji Yun; Choi, Won Chul; Lee, Joon Kyu; Chun, Sae Hyung; Lee, Sahnghoon; Seong, Sang Cheol; Lee, Myung Chul

doi:10.1007/s00167-012-2265-2

Cited by 23 publications

(19 citation statements)

References 44 publications

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“…5 articles described how the randomization sequence for the study was generated ( Misra et al 2003 , Chaudhary et al 2008 , Harato et al 2008 , Roh et al 2013 , Thomsen et al 2013 ). The method of concealment of allocation was reported in 6 studies ( Chaudhary et al 2008 , Harato et al 2008 , Kim et al 2009 , Seon et al 2011 , Matsumoto et al 2012 , Thomsen et al 2013 ).…”

Section: Resultsmentioning

confidence: 99%

Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty

Verra¹,

Boom²,

Jacobs³

et al. 2014

Acta Orthopaedica

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Background and purpose To retain or to sacrifice the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) remains a matter of discussion. In this systematic review, we wanted to find differences in functional and clinical outcome between the 2 methods.Methods We conducted a systematic review and meta-analysis including all randomized controlled trials (RCTs) and quasi-RCTs that have compared PCL retention with PCL sacrifice in TKA with a minimum of 1-year follow-up. Primary outcome was range of motion. Secondary outcomes were knee pain and clinical scoring systems that were preferably validated. Quality of evidence was graded using the GRADE approach. All outcomes available for data pooling were used for meta-analysis.Results 20 studies involving 1,877 patients and 2,347 knees were included. In meta-analysis, the postoperative flexion angle had a mean difference of 2 degrees (95% CI: 0.23–4.0; p = 0.03) and the KSS functional score was 2.4 points higher in favor of PCL sacrifice (95% CI: 0.41–4.3; p = 0.02). There were no statistically significant differences regarding other measured clinical outcomes such as WOMAC, KSS pain, clinical and overall score, HSS score, SF-12, radiolucencies, femoro-tibial angle, and tibial slope. The quality of the studies varied considerably. Risk of bias in most studies was unclear; 5 were judged to have a low risk of bias and 5 to have a high risk of bias.Interpretation We found no clinically relevant differences between retention and sacrifice of the PCL in TKA, in terms of functional and clinical outcomes. The quality of the studies ranged from moderate to low. Based on the current evidence, no recommendation can be made as to whether to retain or to sacrifice the PCL.

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Section: Resultsmentioning

confidence: 99%

Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty

Verra¹,

Boom²,

Jacobs³

et al. 2014

Acta Orthopaedica

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“…In a study by Roh et al [ 31 ] comparing highly conforming PCL-retaining vs. PCL-sacrificing MB knees, there were kinematic differences between both procedures, however, with no consequences in terms of significant differences in ROM, functional scores or radiographic results. In the present study, all patients received a PCL-retaining TKA, with no outcome differences when comparing both groups across the time.…”

Section: Discussionmentioning

confidence: 99%

No differences in clinical outcomes between fixed- and mobile-bearing computer-assisted total knee arthroplasties and no correlations between navigation data and clinical scores

Marques

Daniel

Sufi-Siavach

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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PurposeThe theoretical advantages of mobile-bearing (MB) designs over the conventional fixed bearings (FBs) for total knee arthroplasty (TKA) have not been proved yet through clinical studies. The aim of the study was to test whether the MB design has advantages in terms of better clinical outcomes when compared to FB. Furthermore, the relationships between intra-operative obtained implant positioning data and the clinical scores were analysed.MethodsA total of 99 patients were randomized into the FB or the MB group. All patients received the same posterior cruciate retaining implants and were operated with the use of a computer-assisted navigation system. The clinical outcomes of both groups were compared pre-operatively, at 1 year, and at a mean follow-up time of 4 years after surgery.ResultsThe MB implants showed no advantages over the FB when comparing the Knee Society Scores, the Oxford Score, the range of movement (ROM) and pain intensity of the patients in both groups at 1 and 4 years after surgery. There were no relationships between the computer navigation data and the clinical scores.ConclusionsIn view of the 4-year results, there is no evidence to support the recommendation of one design over the other in terms of better clinical outcome scores, higher ROM or lower pain rates. Long-term follow-up results may be necessary, including survival rates. Further research comparing different TKA designs should also include standardized performance-based tests.Level of evidenceProspective study (Randomized controlled trial with adequate statistical power to detect differences), Level I.

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“…Knee flexion range is a useful measure and accurate indicator of TKA outcomes. Previous clinical studies have reported mean final knee flexions ranging from 100° to 130°, regardless of the surgical technique or prosthetic design [32,40,42].…”

Section: Introductionmentioning

confidence: 99%

Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis

Liao

Huang

et al. 2015

Knee Surg Sports Traumatol Arthrosc

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Preservation of the posterior cruciate ligament is not helpful in highly conforming mobile-bearing total knee arthroplasty: a randomized controlled study

Abstract: The preservation of the PCL was not helpful for improving kinematics and clinical outcome in highly conforming mobile-bearing TKA.

Cited by 23 publications

References 44 publications

Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty

Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty

No differences in clinical outcomes between fixed- and mobile-bearing computer-assisted total knee arthroplasties and no correlations between navigation data and clinical scores

Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis

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