title: How much of the PCL is really preserved during the tibial cut?
abstract: OBJECTIVE
  There are two different techniques for retaining the posterior cruciate ligament (PCL) in total knee arthroplasty. The attachment of the PCL can be spared during resection of the tibial plateau, so that a small posterior bone block remains. In contrast to this, many surgeons resect the tibial plateau completely and detach a part of the tibial PCL attachment from the resected material. The objective of this study was to determine how big this part is in an anatomical resection of the tibial plateau with 0° and 7° slope and whether it is gender-dependent.
  
  
  METHODS
  Two hundred consecutive patients who had undergone MRI of a knee joint were included. Patients were excluded if they were younger than 18 years or had dysplasia of the knee joint or injuries of the posterior cruciate ligament. The MRIs of 182 knees that fulfilled the inclusion criteria were analysed. For each knee, an anatomical tibial resection with 0° and 7° posterior slope was simulated, and the parts of the tibial PCL attachment that were resected and retained were determined.
  
  
  RESULTS
  Given a measured tibial resection with 0° slope, 45 ± 28% of the tibial PCL attachment was removed in the men, compared with 46 ± 30% in the women (n.s.). Given a resection with 7° slope, 69 ± 24% of the tibial PCL attachment was removed in the men and 67 ± 25% in the women. This corresponded to a complete resection in 19 men (20%) and 16 women (24%).
  
  
  CONCLUSIONS
  Independently of gender, the anatomical resection of the tibia leads to the removal of a considerable part of the tibial PCL attachment, if this is not spared in the form of a bone block during resection. This becomes increasingly relevant with higher posterior slope of the resection plane. In the case of a cruciate-retaining surgical technique, the retention of the posterior tibial cortical bone in the area of attachment of the PCL is therefore strongly recommended.
  
  
  METHODS
  II.
authors: Orthopaedic Department, Center for Musculoskeletal Surgery, Charité, University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany. Georg.Matziolis@Charite.de
authors: Georg
authors: G
authors: Matziolis
authors: Saskia
authors: S
authors: Mehlhorn
authors: Nicole
authors: N
authors: Schattat
authors: Gerd
authors: G
authors: Diederichs
authors: Robert
authors: R
authors: Hube
authors: Carsten
authors: C
authors: Perka
authors: Doerte
authors: D
authors: Matziolis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D016119:Posterior Cruciate Ligament / Q000033:anatomy & histology / Q000601:surgery*; D012189:Retrospective Studies; D012737:Sex Factors; D013977:Tibia / Q000601:surgery*; D055815:Young Adult