Can We Predict Posterior Cruciate Ligament Degeneration with Functional Tests?

Area of Science:

• Orthopedic Surgery
• Histopathology
• Biomedical Engineering

Background:

• The posterior cruciate ligament (PCL) is crucial for knee stability, preventing posterior translation and enabling femoral rollback.
• Limited literature exists on PCL pathology, necessitating further investigation into its microscopic changes.
• Understanding PCL degeneration is vital for optimizing treatment outcomes in knee osteoarthritis.

Purpose of the Study:

• To histopathologically examine PCL samples from patients undergoing total knee arthroplasty for gonarthrosis.
• To investigate the correlation between PCL histopathology and preoperative functional scores.
• To evaluate the precision of current functional scores in assessing PCL degeneration.

Main Methods:

• Seventy-six PCL samples were obtained from patients (50-75 years) with primary knee osteoarthritis undergoing total knee arthroplasty.
• Exclusion criteria included prior intra-articular knee surgery and rheumatic diseases.
• PCL samples were histopathologically graded (0-4) using light microscopy, and correlated with SF-36, PQAS, Lysholm, and WOMAC scores.

Main Results:

• Significant correlations were found between PCL histopathologic stage and SF-36 (activity limitations, physical health), PQAS (pain intensity, radiation, throbbing, aching, heaviness), Lysholm (total score), and WOMAC (total score).
• Moderate correlations were observed between PCL stage and Lysholm's cane/crutch use and PQAS radiating pain.
• These findings indicate a link between microscopic PCL changes and patient-reported functional outcomes.

Conclusions:

• While significant correlations exist, current functional scores may not precisely capture microscopic PCL degeneration.
• The study highlights the need for developing PCL-specific scoring systems for more granular preoperative assessment.
• Improved assessment tools could lead to more tailored treatment strategies for knee osteoarthritis patients with PCL involvement.