title: Dysfunction of the posterior cruciate ligament in total knee arthroplasty.
abstract: OBJECTIVE
  Total knee arthroplasty (TKA) is typically carried out either with retention (CR) of the posterior cruciate ligament (PCL) or with sacrifice of this ligament and implantation of a posterior stabilised (PS) prosthesis. This paper investigates a comparison of PCL function in knees treated for osteoarthritis with TKA where the PCL is preserved to those knees treated with TKA and posterior stabilisation.
  
  
  METHODS
  One hundred and sixty-eight patients (232 knees) who had undergone TKA with either a PS or CR implant were included in the study. Clinical assessment included antero-posterior (AP) laxity and posterior sag assessment with an arthrometer.
  
  
  RESULTS
  The mean AP laxity at 90° of flexion for CR TKAs was 6.5 mm (±3.1) and was the same [6.5 mm (±2.4)] as in the PS group. However, 56% of the PCL-preserved knees had a posterior sag of over 3 mm compared to 18% of the knees in the PS group. The American Knee Society Scores for either group showed that, although the mean function score was the same, the knee score was superior in the PS group (77 vs. 84). The range of motion was also superior in the PS group (111° vs. 105°).
  
  
  CONCLUSIONS
  The use of the PS prosthesis for TKA provides a more predictable outcome with regard to posterior sag and a better maximum flexion than a CR implant.
authors.affiliation: Good Hope and Solihull Hospitals, Heart of England NHS Foundation Trust, Birmingham, UK. jamie.arbuthnot@heartofengland.nhs.uk
authors.forename: James Edmund
authors.initials: JE
authors.lastname: Arbuthnot
authors.forename: Olwyn
authors.initials: O
authors.lastname: Wainwright
authors.forename: Gareth
authors.initials: G
authors.lastname: Stables
authors.forename: Manickam
authors.initials: M
authors.lastname: Rathinam
authors.forename: David I
authors.initials: DI
authors.lastname: Rowley
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McNicholas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000503:physiopathology* / Q000517:prevention & control; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D010147:Pain Measurement; D016119:Posterior Cruciate Ligament / Q000503:physiopathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D016059:Range of Motion, Articular / Q000502:physiology*; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
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