Preserving the PCL during the tibial cut in total knee arthroplasty

Cinotti, Gianluca; Sessa, Pasquale; Amato, Mary G.; Ripani, Francesca Romana; Giannicola, Giuseppe

doi:10.1007/s00167-015-3842-y

Cited by 19 publications

(21 citation statements)

References 36 publications

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“…Several studies have drawn attention to how much of the PCL is actually preserved in a CR TKA, with several of them showing that most of the PCL insertion may be disrupted during the tibial cut, calling into question how much of the PCL is actually preserved. 24,[30][31][32][33][34] Liabaud et al used magnetic resonance imaging (MRI) to show that the majority (79.8%) of patients had more than 50% of the PCL destabilized following a standard transverse tibial cut. 30 Shannon et al also using MRI demonstrated that up to one-third of patients had complete removal of the PCL insertion.…”

Section: Discussionmentioning

confidence: 99%

“…32 Cinotti et al demonstrated that the PCL insertion could be spared in the majority of patients if the tibial cut is 4 mm or less with a slope of 3 to 5 degrees. 33 With the possibility that most CR TKAs have the majority of the PCL insertion damaged during the tibial cut, the actual role and the necessity of the PCL in a CR TKA are called into question. In the Cochrane Review, Jacobs et al showed that PCL resection without substituting the PCL with a PS TKA design showed no difference compared with PCL retention group (p ¼ 0.31).…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Risk Factors for Posterior Cruciate Ligament Avulsion during Cruciate Retaining Total Knee Arthroplasty

et al. 2018

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During cruciate retaining (CR) total knee arthroplasty (TKA), the posterior cruciate ligament (PCL) may avulse at its insertion. The incidence of PCL avulsion fracture has not been previously studied. The aim of this study is to report on the incidence and clinical significance of intraoperative PCL avulsion during primary CR TKA and to identify potential risk factors. Our institutional joint registry was retrospectively reviewed for PCL avulsion occurring during CR TKA implanted between April 2008 and April 2016. Patient demographics, preoperative range of motion (ROM), complications, and revision rate were examined. A control group of 132 patients was used for comparison to identify potential risk factors. Forty-four of 2,457 patients (1.7%) suffered a PCL avulsion fracture during primary CR TKA. No intraoperative repair was performed and no postoperative weight bearing or ROM restrictions were implemented. There was no significant difference in BMI (p = 0.258), mean preoperative ROM (p = 0.763), or femoral and tibial component sizes (p = 0.3069, p = 0.1306) between groups. Logistic regression found female gender (p = 0.0254) to be the only statistically significant risk factor for PCL avulsion. The incidence of intraoperative PCL avulsion fracture during CR TKA is low (1.7%) and does not appear to affect postoperative ROM, subjective stability, or incidence of revision. Female gender was identified as the only patient factor that increased the risk of PCL avulsion fracture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for Posterior Cruciate Ligament Avulsion during Cruciate Retaining Total Knee Arthroplasty

et al. 2018

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“…Several methods have been described to balance the ligaments and releasing the PCL completely may result worse outcomes [18,19,20,21]. Some studies have drawn attention that most PCL insertions may be destroyed during tibia cutting, and which raises questions about how much PCL actually saves in a CR TKA [18,[22][23][24][25][26]. Eric Kim et al [10] studied the incidence and risk factors of PCL avulsion during CR TKA, they found the incidence is 1.7% and female gender was the only risk factor.…”

Section: Discussionmentioning

confidence: 99%

Good Clinical Middle-term Outcomes of the Reduction of Posterior Cruciate Ligament Avulsion Fracture in Cruciate Retaining Total Knee Arthroplasty

Lin

Niu

Dai

et al. 2020

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Background Intraoperative posterior cruciate ligament (PCL) avulsion fracture of tibial is an uncommon but serious complication during primary cruciate retaining (CR) total knee arthroplasty (TKA). However, the clinical outcomes and patient-reported outcome (PRO) of the reduction of PCL avulsion fracture of tibial have rarely been informed. The objective of this research was to investigate the prevalence and middle-term clinical outcomes of this kind of fracture during primary CR TKA and to identify the potential risk factors. Methods A retrospective cohort study from January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of tibial and intraoperative reduction during primary CR TKA as PCL avulsion group, matched in a 4:1 ratio of 224 patients who underwent primary CR TKA as control group for comparison. All patients were followed up at least 4 years. Patients’ demographics, before surgery and last follow-up after surgery including range of motion (ROM), Knee Society Score (KSS), Forgotten joint score (FJS) were assessed in the two groups, Logistic regression to identify the potential risk factors. Results In our series of 1216 patients who underwent CR TKA during the retrospective period, 56 patients (4.6%) experienced PCL avulsion fracture of tibial. There were no noteworthy differences in demographic, ROM, KSS, FJS scores of the patients between the two groups. In PCL avulsion fracture group, no patients experienced revision due to the knee instability. Logistic regression analysis showed that older age (P = 0.032) and female gender (P = 0.041) were the risk factors of PCL avulsion fracture of tibial. Conclusions The incidence of PCL avulsion fracture of tibial is 4.6%, older patients and female gender may be the two risk factors of PCL avulsion fracture. The reduction of PCL avulsion fracture during CR TKA can achieve an excellent middle-term clinical and PRO outcomes compared with the control group, and without increased the risk of complications.

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“…Excessive release of the ligaments may result in worse outcomes [17][18][19][20]. In many cases, the PCL insertion may be damaged during the tibial cut, which raises a question about how much the PCL is actually preserved [17,[21][22][23][24][25]. Some surgeons argued that a posterior-stabilized TKA with a spine-cam mechanism is an alternative when the PCL is sacri ced.…”

Section: Discussionmentioning

confidence: 99%

A Surgical Reduction Technique for Posterior Cruciate Ligament Avulsion Fracture in Total Knee Arthroplasty: A Comparison Study

Lin

Niu

Dai

et al. 2020

Preprint

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Background: Posterior cruciate ligament (PCL) avulsion fracture of tibia is an uncommon but serious complication during primary cruciate retaining total knee arthroplasty (TKA). The first objective of this report was to conduct a retrospective cohort study to investigate the incidence and potential risk factors of PCL avulsion fracture in primary cruciate-retaining TKA. The second objective was to assess the functional outcomes of the knee after reduction of PCL avulsion fracture.Methods: From January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of tibia in primary cruciate-retaining TKA were included in study group. Patients in this group underwent reduction of avulsion fracture. In this period, we selected 224 patients (control group) for comparison. Patients in this group also underwent the same TKA but no PCL avulsion fracture occurred. Range of motion of the knee and Knee Society Scores were assessed. The forgotten joint score was used to analyze the ability to forget the joint. Differences were considered statistically significant at p < 0.05.Results: In our series, the incidence of PCL avulsion fracture was 4.6%. There was no significant differences (p > 0.05) with regard to preoperative or postoperative range of motion of the knee, final 4 year mean clinical score in study and control groups 92.4 ± 2.7 and 93.6 ± 1.9, respectively, and mean functional scores of 85.1 ± 1.8 and 87.1 ± 1.2, respectively.Conclusions: The incidence of PCL avulsion fracture of tibia is relatively high. Older age and female gender were two risk factors of fracture in primary cruciate-retaining TKA. Reduction of PCL avulsion fracture with high-strength line can achieve good stability and function of the knee.

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Preserving the PCL during the tibial cut in total knee arthroplasty

Abstract: II.

Cited by 19 publications

References 36 publications

Incidence and Risk Factors for Posterior Cruciate Ligament Avulsion during Cruciate Retaining Total Knee Arthroplasty

Incidence and Risk Factors for Posterior Cruciate Ligament Avulsion during Cruciate Retaining Total Knee Arthroplasty

Good Clinical Middle-term Outcomes of the Reduction of Posterior Cruciate Ligament Avulsion Fracture in Cruciate Retaining Total Knee Arthroplasty

A Surgical Reduction Technique for Posterior Cruciate Ligament Avulsion Fracture in Total Knee Arthroplasty: A Comparison Study

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