The role of the posterior cruciate ligament in total knee replacement.
We randomised 129 knees which were to be replaced using a standard posterior-cruciate-ligament (PCL)-retaining cemented total knee replacement into two groups. In one the PCL was retained in the normal way and in the other it was resected. They were well matched, with a predominance of women, and a mean age of 67 years. There was no statistically significant difference in the Hospital for Special Surgery scores at a mean of 57 months (56 to 60) between the two groups although 21 patients (24 knees) were lost to follow-up. Relief from pain, correction of deformity, range of movement, stability and strength were comparable in both. Radiological assessment showed femoral rollback in approximately 20% of knees with a slightly higher incidence in the PCL-resected group. There was no significant loosening detected in either group at review at two years. At five years, one knee in the PCL-retained group had been revised because of infection and one patient in each group was awaiting revision for loosening. Our findings have shown no significant difference in the five-year results for a PCL-retaining total knee replacement if the PCL is excised or preserved. This suggests two important points. First, the PCL is not functional in most patients with a total knee replacement even when retained. Secondly, patients with an excised PCL show a good result with a PCL-retaining implant, thereby questioning the need for a posterior stabilised design in such a situation.
Royal Bournemouth Hospital, England, UK.
A N
AN
Misra
M R A
MR
Hussain
N J
NJ
Fiddian
G
G
Newton
D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001843:Bone Cements; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D016119:Posterior Cruciate Ligament; D011446:Prospective Studies; D016896:Treatment Outcome
D001843:Bone Cements