title: Preserving the PCL during the tibial cut in total knee arthroplasty.
abstract: OBJECTIVE
  Previous studies have shown that the PCL insertion may be damaged during the tibial cut performed in total knee arthroplasty. We investigated the maximum thickness of a tibial cut that preserves the PCL insertion and to what extent the posterior slope of the tibial cut and that of the patient's tibial plateaus affect the outcome.
  
  
  METHODS
  MR images of 83 knees were analysed. The maximum thickness of a tibial cut that preserves the PCL using a posterior slope of 0°, 3°, 5° and parallel to the patient's slope of the tibial plateau, was evaluated. Correlations between the results and the degrees of the posterior slope of the patient's tibial plateaus were also investigated.
  
  
  RESULTS
  The maximum thickness of a tibial cut that preserves the entire PCL insertion was, on average, 5.5, 4.7, 4.2 and 3.1 mm when a posterior slope of 0°, 3°, 5° and parallel to the patients' tibial plateaus was used, respectively. When the 25th percentile was considered, the maximum thickness of a tibial cut that preserved the PCL was 4 and 3 mm with a tibial cut of 0° and 5° of posterior slope, respectively. The maximum thickness of a tibial cut that preserved the PCL was significantly greater in patients with a sagittal slope of the tibial plateaus more than 8° than in those with a sagittal slope less than 8°.
  
  
  CONCLUSIONS
  In cruciate retaining implants, the PCL insertion may be spared in the majority of patients by performing a tibial cut of 4 mm, or even less when a posterior slope of 3°-5° is used. The clinical relevance of our study is that the execution of a conservative tibial cut, followed by a second tibial resection to achieve the thickness required for the tibial component to be implanted, may be an alternative technique to spare the PCL in CR TKA.
  
  
  METHODS
  II.
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Rome, Italy. md3581@mclink.it.
authors.forename: G
authors.initials: G
authors.lastname: Cinotti
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Sessa
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Amato
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Rome, Italy.
authors.forename: F R
authors.initials: FR
authors.lastname: Ripani
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Giannicola
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D002102:Cadaver; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000033:anatomy & histology / Q000601:surgery; D013977:Tibia / Q000000981:diagnostic imaging* / Q000601:surgery*; D055815:Young Adult
keywords: Cruciate retaining; Femoral rollback; Knee kinematics; Knee replacement; Posterior cruciate ligament; Total knee arthroplasty