Hs. Hirsch et al., THE POSTERIOR CRUCIATE LIGAMENT IN TOTAL KNEE SURGERY - SAVE, SACRIFICE, OR SUBSTITUTE, Clinical orthopaedics and related research, (309), 1994, pp. 64-68
To determine the role of the posterior cruciate ligament in total knee
arthroplasty, 242 consecutive primary total knee arthroplasties were
included in 1 of 3 sequential groups. Group I included 77 Press Fit Co
ndylar total knee replacements in which the posterior cruciate ligamen
t was completely released from its tibial attachment. In Group II, the
re were 80 Press Fit Condylar total knee replacements in which the pos
terior cruciate ligament was retained. Group III consisted of 85 total
knee replacements with a posterior cruciate-substituting device (Insa
ll-Burstein II). All patients were observed at least 2 Sears and evalu
ated by the Knee Society's Clinical and Functional Scoring System, inc
luding a radiographic evaluation. No differences were found between th
e posterior cruciate ligament sacrificed group and the posterior cruci
ate ligament preserved group. The 1 significant difference among the 3
groups was in range of motion (ROM). Groups I and II averaged 103 deg
rees and 104 degrees motion respectively, whereas Group III, the poste
rior cruciate-substituting group, averaged 112 degrees (p = 0.001). In
addition, only in Group III was the lower 95% confidence limit of the
mean ROM >90 degrees. These findings suggest that preserving the post
erior cruciate ligament does not consistently lead to improved functio
nal ROM. The posterior cruciate ligament-substituting device historica
lly has demonstrated excellent survivorship and appears to offer great
er ROM.