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Comparison of Routine Posterior Cruciate Ligament Resection vs Selective PCL Balancing Using a Medial Congruent
Jacob Goldstein1, Sara Strecker2, Donald Allen2,3
1University of Connecticut School of Medicine, Farmington, CT, USA.
Background:
Total knee arthroplasty (TKA) techniques and implant designs vary significantly regarding management of the posterior cruciate ligament (PCL). The clinical implications of routinely resecting or selectively balancing the PCL in modern congruent or pivot designs remain debated. This study compares clinical outcomes between routine PCL resection and selective PCL balancing using a medial congruent polyethylene.
Methods:
A retrospective matched-cohort study was conducted with 304 patients undergoing primary unilateral TKA between September 2020 and April 2024. Patients were matched based on demographics (age, gender, body mass index, Charlson Comorbidity Index, and the Risk Assessment and Prediction Tool score) and based on preoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) scores. Postoperative outcomes were analyzed, including patient-reported outcome measures, physical therapy parameters, readmission rate, overall complication rate, and 90-day return to operating room.
Results:
The PCL resection group had significantly longer operative times (86.5 vs 73.9 minutes, P < .001) but lower all-cause 90-day readmission rates (1.3% vs 5.9%, P = .032). No significant differences were observed in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, PROMIS (Patient-Reported Outcomes Measurement Information System) scores, Forgotten Joint Score, postoperative pain levels, physical therapy parameters, or discharge disposition.
Conclusions:
Routine PCL resection in TKA utilizing a medial congruent polyethylene design did not influence patient-reported outcomes compared to selective balancing and should be left up to surgeon preference.
