title: The risk of sacrificing the PCL in cruciate retaining total knee arthroplasty and the relationship to the sagittal inclination of the tibial plateau.
abstract: BACKGROUND
  In cruciate retaining total knee arthroplasty (TKA), a partial avulsion of PCL may occur when en-bloc tibial osteotomy is performed. We evaluated the effects of a tibial cut performed with different degrees of posterior slope on PCL insertion and whether the results are affected by the sagittal inclination of the patient's tibial plateau.
  
  
  METHODS
  We selected 83 MRIs of knees showing mild or no degenerative changes. The effects of a simulated tibial cut performed with a posterior slope of 0°, 3°, 5° and parallel to the patient's tibial plateau inclination on PCL insertion in the proximal tibia were investigated. The results were correlated with the degree of posterior inclination of the tibial plateau.
  
  
  RESULTS
  Every angle we used for the tibial cut caused a PCL avulsion greater than 50%. The percentage of PCL avulsion significantly increased with increasing the posterior slope of the tibial cut. Patients with sagittal tibial plateau inclination <5° showed greater PCL avulsion than those with sagittal inclination >8°.
  
  
  CONCLUSIONS
  Most of the PCL insertion is likely to be sacrificed when resection of the proximal tibia is performed en-block. The risk of PCL avulsion is reduced in patients showing a marked posterior inclination of the tibial plateau, but even in this group of patients a surgical technique aimed at sparing most of the PCL insertion is necessary.
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Italy. Electronic address: p.sessa@hotmail.it.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Sessa
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Fioravanti
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giannicola
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Cinotti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D016119:Posterior Cruciate Ligament / Q000601:surgery*; D016059:Range of Motion, Articular; D013977:Tibia / Q000601:surgery*; D055815:Young Adult
keywords: Cruciate retaining total knee arthroplasty; Femoral roll-back; Posterior cruciate ligament; Tibial cut; Total knee arthroplasty