title: Effect of Varying Posterior Cruciate Ligament (PCL) Recessions on Kinematics and Ligament Strains with Cruciate Retaining Total Knee Prostheses.
abstract: BACKGROUND
  Proper ligament tension in flexion with posterior cruciate retaining (CR) total knee arthroplasty (TKA) has long been associated with clinical success. The purpose of this study was to determine the effect of varying levels of posterior cruciate ligament (PCL) release on the tibiofemoral kinematics and PCL strain.
  
  
  METHODS
  A computational analysis was performed and varying levels of PCL release were simulated. Tibiofemoral kinematics was evaluated. The maximum PCL strain was determined for each bundle to evaluate the risk of rupture based on the failure strain.
  
  
  RESULTS
  The femoral AP position shifted anteriorly as the PCL stiffness was reduced. PCL strain in both bundles increased as stiffness was reduced. The model predicts that the AL bundle should not rupture for a 75% release. Risk of PM bundle rupture is greater than AL bundle.
  
  
  CONCLUSIONS
  Our findings suggest that a partial PCL release impacts tibiofemoral kinematics and ligament tension and strain. The relationship is dynamic and care should be taken when seeking optimal balance intra-operatively.
authors.affiliation: Department of Orthopaedic Surgery, Division of Adult Reconstruction, NYU Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
authors.affiliation: Active Knee Business Leader, Smith & Nephew, Memphis, TN.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Laster
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Cross
authors.affiliation: Smith & Nephew, Memphis, TN.
authors.forename: Nathaniel M
authors.initials: NM
authors.lastname: Lenz
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods*; D003198:Computer Simulation; D055119:Elastic Modulus / Q000502:physiology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery*; D007720:Knee Prosthesis; D008954:Models, Biological; D059351:Organ Sparing Treatments / Q000379:methods; D016119:Posterior Cruciate Ligament / Q000503:physiopathology* / Q000601:surgery; D017755:Prosthesis Fitting / Q000379:methods; D016059:Range of Motion, Articular; D025321:Surgery, Computer-Assisted / Q000379:methods; D013718:Tensile Strength / Q000502:physiology; D016896:Treatment Outcome