PCL Retaining vs Sacrificing TKR - Simon Coleridge 26/10/2001

Brief

Freeman and Railton, Journal of Arthroplasty 1988

Author

M.A.R Freeman and G.T. Railton ( London )

Title

Should the posterior cruciate ligament be retained or resected in condylar nonmeniscal knee arthroplasty

Reference

J Arthroplasty 1988;Oct Suppl S3-12

Summary

1. Earliest prosthesis were hinged and both cruciates were sacrificed.

2. 1968 Freeman proposed they be resected while replacing the articular surfaces with a femoral roller articulating in a tibial trough. Freeman-Swanson TKR inserted in1969.

3. The alternative was the Geomedic which aimed to retain both cruciates.

4. Advantages of resection; severe deformities more easily corrected; cement could be removed via the intercondylar notch; tibia could be subluxed forward allowing for easier insertion of tibial component; balancing of the collaterals became easier.

5. Today most TKR's sacrifice ACL (often absent), but there is a widespread preference for PCL retention.

6. Advantages of retaining; increased range of flexion as the PCL causes the femur to rollback across the top of the tibia; this rollback improves the quadriceps moment arm and therefore more powerful extension; improves stair climbing; ligament can transfer load thus decreasing interface stress.

7. Explains advantages of resection with regard to function and favours resection as surgically easier, easier to correct deformity and no loss from functional outcome.

Brief

Udomkiat Clin Orth and Related Research 2000

Author

Pacharapol Udomkiat et al ( Los Angeles )

Title

Functional Comparison of PCL retention and substitution knee replacement.

Reference

Clin Orth 2000;378:192-201

Summary

Prospective study looking at 38 matched patients who had either an Apollo knee with PCL retention or substitution. Results, no difference in Knee Society Score, functional scoring or ROM. Discussion “ study disproves theoretical and gait analyse and rollback studies suggesting PCL retention is superior to substitution.

Critique

Good paper but unclear as to who was selected to have substitution and retaining TKR.

Brief

Beuchel 1990 Clin Orth

Author

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