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Partial resection of the PCL insertion site during tibial preparation in cruciate-retaining TKA
Hans Feyen1, Nick Van Opstal, Johan Bellemans
1Department of Orthopaedics, Catholic University Leuven, Leuven, Belgium, Hans_feyen@hotmail.com.
Purpose:
Based on the anatomy of the tibial PCL insertion site, we hypothesized that at least part of it is damaged while performing a standard tibial cut in a PCL-retaining total knee replacement. The purpose of this study was to determine and quantify the amount of resection of the tibial PCL attachment with a 9 mm tibial cut with 3 degrees of posterior slope.
Methods:
Twenty cadaver tibias were used. The borders of the PCL footprint were demarcated, and calibrated digital pictures were taken in order to determine the surface area. A standard tibial intramedullary guide was used to prepare and perform a tibial cut at a depth of 9 mm with 3 degrees posterior slope. After the tibial cut was made, a second digital picture was taken using the same methodology to measure the surface area of the remaining PCL insertion.
Results:
The mean surface area of the intact tibial PCL footprint before the cut was 148.9 ± 25.8 mm(2) and after the tibial cut 47.1 ± 28.0 mm(2). On average, 68.8 ± 15.3 % of the surface area of the PCL insertion was removed.
Conclusion:
The results of this study, therefore, indicate that the conventional technique for tibial preparation in cruciate-retaining total knee arthroplasty can result in damage or removal of a significant part of the tibial PCL insertion.