An algorithm for the posterior cruciate ligament in total knee arthroplasty

The fate of the posterior cruciate ligament in primary total knee arthropla sty is controversial. An algorithmic approach is presented that is based on pathologic criteria for evaluating and treating patients with primary tota l knee arthroplasty that will aid in the posterior cruciate ligament decisi on-making process, producing more predictable procedures and outcomes. A co nsecutive series of the first 120 patients (171 knees) who had primary post erior cruciate-retaining arthroplasty and the first 120 patients (180 knees ) who had primary posterior-stabilized arthroplasty with a minimum 5-year f ollowup in which the Maxim (R) Complete Total Knee System and the algorithm ic approach were used were compared. No statistically significant differenc es in outcome between the groups were observed. Among the patients who had posterior cruciate-retaining arthroplasty, no revisions attributable to ase ptic loosening have been reported at an average followup of 6.39 years. The average followup Knee Society total score was 162.16 points, with 91 (54.8 %) knees having excellent outcome ratings. No revisions attributable to ase ptic loosening have been reported among the patients who had posterior-stab ilized arthroplasty at an average followup of 5.98 years. The average follo wup Knee Society total score was 158.05 points, with excellent outcome rati ngs reported in 96 (54.9%) knees. The use of a standardized algorithm has s treamlined the treatment of patients having primary total knee arthroplasty , consistently providing excellent clinical results when either retaining o r sacrificing the posterior cruciate ligament.