Protecting the PCL During Total Knee Arthroplasty Using a Bone Island Technique

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Surgical Technique

Background:

• Posterior cruciate ligament (PCL) preservation is vital in cruciate retaining total knee arthroplasty (CR TKA).
• Standard CR TKA techniques risk partial PCL resection, even with experienced surgeons.
• Optimizing surgical methods to maintain PCL integrity during CR TKA is a key objective.

Purpose of the Study:

• To assess a straightforward surgical technique for preventing PCL damage during CR TKA.
• To compare the efficacy of an osteotome-assisted method versus standard technique in PCL protection.

Main Methods:

• Sixty cadaver specimens were divided into experimental and control groups.
• The experimental group used an osteotome to preserve a bone island at the PCL tibial attachment.
• The control group underwent standard tibial resection without an osteotome.

Main Results:

• PCL damage occurred in 73% of the control group specimens.
• PCL damage was significantly lower, occurring in 23% of the experimental group specimens.
• The osteotome technique demonstrated a 50% absolute risk reduction in PCL damage.

Conclusions:

• Employing an osteotome to create a bone island effectively protects the PCL during CR TKA, particularly with limited surgical experience.
• Standard techniques, even with PCL retractors, may offer insufficient protection.
• This technique enhances PCL preservation in CR TKA surgery.