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Does Recession of the Posterior Cruciate Ligament Influence Outcome in Total Knee Arthroplasty?

Abstract

BACKGROUND

For a PCL-retaining (posterior cruciate ligament) total knee arthroplasty (TKA) to function suitably, proper soft tissue balancing, including PCL recession, is required. Yet, when the recession of the PCL is needed, there is still a debate as to whether a cruciate-retaining (CR) TKA should be converted to a posterior-stabilized TKA due to the concern of instability and poorer clinical outcomes. The purpose of this study is to determine whether recession of the PCL adversely affects clinical outcomes in patients who undergo CR TKA.

METHODS

CR TKAs of the same design performed by the senior author (J.M.) were identified between December 2006 and July 2015. Clinical outcome measurements were collected and included the Western Ontario and McMaster Universities Osteoarthritis Index score, the Knee Society Clinical Rating System, Short Form-12 Physical Composite Score/Mental Health Composite Score, and revision rates.

RESULTS

There were no significant differences in clinical outcome when the PCL was retained, partially recessed, or completely released during PCL-retaining TKA (Western Ontario and McMaster Universities Osteoarthritis Index: P = .54, Knee Society Clinical Rating System: P = .42, Short Form-12 Mental Health Composite Score: P = .89, Short Form-12 Physical Composite Score: P = .527).

CONCLUSION

This study presents evidence of similar clinical outcomes when the PCL is retained or released during PCL-retaining TKA, provided attention is paid to appropriate soft tissue balancing. CR TKA undergoing partial or complete release of the PCL should not routinely be converted to a posterior-stabilized knee design.

LEVEL OF EVIDENCE

Level II, Prognostic study.

Authors+Show Affiliations

Division of Orthopaedic Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada.Division of Orthopaedic Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada.Division of Orthopaedic Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada.Division of Orthopaedic Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31326243

Citation

Dion, Charles-Antoine B., et al. "Does Recession of the Posterior Cruciate Ligament Influence Outcome in Total Knee Arthroplasty?" The Journal of Arthroplasty, 2019.
Dion CB, Howard JL, Lanting BA, et al. Does Recession of the Posterior Cruciate Ligament Influence Outcome in Total Knee Arthroplasty? J Arthroplasty. 2019.
Dion, C. B., Howard, J. L., Lanting, B. A., & McAuley, J. P. (2019). Does Recession of the Posterior Cruciate Ligament Influence Outcome in Total Knee Arthroplasty? The Journal of Arthroplasty, doi:10.1016/j.arth.2019.05.052.
Dion CB, et al. Does Recession of the Posterior Cruciate Ligament Influence Outcome in Total Knee Arthroplasty. J Arthroplasty. 2019 Jun 5; PubMed PMID: 31326243.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does Recession of the Posterior Cruciate Ligament Influence Outcome in Total Knee Arthroplasty? AU - Dion,Charles-Antoine B, AU - Howard,James L, AU - Lanting,Brent A, AU - McAuley,James P, Y1 - 2019/06/05/ PY - 2019/03/04/received PY - 2019/05/19/revised PY - 2019/05/29/accepted PY - 2019/7/22/entrez PY - 2019/7/22/pubmed PY - 2019/7/22/medline KW - arthroplasty KW - posterior cruciate ligament KW - recession KW - release KW - total knee replacement JF - The Journal of arthroplasty JO - J Arthroplasty N2 - BACKGROUND: For a PCL-retaining (posterior cruciate ligament) total knee arthroplasty (TKA) to function suitably, proper soft tissue balancing, including PCL recession, is required. Yet, when the recession of the PCL is needed, there is still a debate as to whether a cruciate-retaining (CR) TKA should be converted to a posterior-stabilized TKA due to the concern of instability and poorer clinical outcomes. The purpose of this study is to determine whether recession of the PCL adversely affects clinical outcomes in patients who undergo CR TKA. METHODS: CR TKAs of the same design performed by the senior author (J.M.) were identified between December 2006 and July 2015. Clinical outcome measurements were collected and included the Western Ontario and McMaster Universities Osteoarthritis Index score, the Knee Society Clinical Rating System, Short Form-12 Physical Composite Score/Mental Health Composite Score, and revision rates. RESULTS: There were no significant differences in clinical outcome when the PCL was retained, partially recessed, or completely released during PCL-retaining TKA (Western Ontario and McMaster Universities Osteoarthritis Index: P = .54, Knee Society Clinical Rating System: P = .42, Short Form-12 Mental Health Composite Score: P = .89, Short Form-12 Physical Composite Score: P = .527). CONCLUSION: This study presents evidence of similar clinical outcomes when the PCL is retained or released during PCL-retaining TKA, provided attention is paid to appropriate soft tissue balancing. CR TKA undergoing partial or complete release of the PCL should not routinely be converted to a posterior-stabilized knee design. LEVEL OF EVIDENCE: Level II, Prognostic study. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/31326243/Does_Recession_of_the_Posterior_Cruciate_Ligament_Influence_Outcome_in_Total_Knee_Arthroplasty L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(19)30535-2 DB - PRIME DP - Unbound Medicine ER -