Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty

Figures & data

Table 1. Characteristics of the 20 studies

Authors	Sample size			TKA type		Mean [SD] age		% Females		Outcome	Follow-up
	Patients	Knees	OA (%)	CR	CS	CR	CS	CR	CS		(years)
Aglietti et al. 2005	197	210	100	103	107	71	70	86	81	ROM, VAS pain, KS score, radiographic evaluation, mechanical axis, radiolucencies	–4
Catani et al. 2004	40	40	100	20	20	70 [6]	71 [7]	65	75	ROM, RSA, KS score, HSS score	2
Chaudhary et al. 2008	100	100	ND	51	49	69 [9]	70 [8]	53	45	ROM, RAND-36, WOMAC	2
Clark et al. 2001	128	128	97	59	69	72 [12]	71 [14]	ND	ND	ROM, KS score, SF-12, WOMAC	–3
de Andrade et al. 2009	85	85	89	36	49	66 (41–78)		74		KS score (overall)	1.3
Harato et al. 2008	192	222	100	111	111	68	66	34	34	KS score, WOMAC, SF-12, radiolucencies, kinematics (Victor et al. 2005)	5.0–7.3
Kim et al. 2009	250	500	100	250	250	72 [6]		96		ROM, KS score, HSS score, WOMAC pain, radiological	2.3
Maruyama et al. 2004	20	40	100	20	20	74 (65–84)		60		ROM, KS score, joint line	–2.7
Matsumoto et al. 2012	41	41	100	19	22	74 [1]	74 [1]	100	100	ROM, KS score, laxity	5
Misra et al. 2012	103	105	92	51	54	67	67	67	59	ROM, HSS score, satisfaction score, radiological (rollback, loosening)	4.8
Roh et al. 2012	86	86	100	42	44	70 [5]	71 [5]	95	93	ROM, tibio-femoral angle KS score, HSS score, WOMAC	–3.1
Seon et al. 2011	95	95	100	48	47	68 [7]	69 [7]	91		ROM, HSS score, WOMAC, tibio-femoral angle, kinematics	2
Shoji et al. 1994	28	56	54	28	28	60 (48–85)		71		ROM, HSS score	–4.5
Straw et al. 2003	167	167	ND	66	101	73	73/74 ^a	44	45	ROM, KS score, pain score, stability	–6.5
Tanzer et al. 2002	37	40	97	20	20	68	66	75	80	Flexion angle, KS score	2
Thomsen et al. 2013	36	72	97	36	36	67 (49–84)		58		ROM, knee pain, satisfaction, ability to perform ADL, SF-36	1
Wang et al. 2004	185	224	91	128	96	55	55	80	80	ROM, KS score, tibio-femoral angle, radiolucencies, SF-12 functional score, ligament laxity	–5.5
Yagishita et al. 2012	29	58	100	29	29	74 [7]		86		ROM, KS score, pain score, radiolucencies	5
Yansheng et al. 2013	38	38	100	19	19	66	64	68	63	ROM, WOMAC, proprioception	–1.4
Yoshiya et al. 2005	20	40	100	20	20	74 (62–84)		66		ROM, KS score, fluoroscopic motion analysis	–4.4

CR: (posterior) cruciate-retaining; CS: (posterior) cruciate sacrificing; ND: no data or unclear; ADL: activities of daily living; HSS: Hospital for Special Surgery; KS: Knee Society; ROM: range of motion; RSA: radiostereometric analysis; SF: short form; VAS: visual analog scale; WOMAC: Western Ontario and McMasters osteoarthritis index.

^a PS/resection

Figure 1. Flow chart of study selection showing the process of article selection and the reasons for articles being excluded.

Figure 2. Forest plots from meta-analysis. A. Knee flexion from all PCL-sacrificing and PCL-retaining TKAs. Shows homogeneous results favoring PCL sacrifice with 2.1 degrees better flexion angle. B. Knee flexion from PCL-retaining TKA design versus posterior-stabilized TKA design. Shows homogeneous results favoring PCL sacrifice, with 2.8-degrees better flexion angle. C. Knee Society functional score from all PCL-sacrificing and PCL retaining TKAs. Shows homogeneous results favoring PCL sacrifice, with 2.4 more points in mean difference. D. WOMAC score from all PCL-sacrificing and PCL-retaining TKAs. Shows homogeneous results without any significant differences (0.78 points favoring PCL retention).

Table 3. Complications reported in the studies selected

Study	PCL retention	PCL sacrifice
Aglietti 2005	None	Septic loosening: 1
Catani 2004	Anterior knee pain: 1 Limited ROM: 1	Anterior knee pain: 2
Chaudhary 2008	Deep infection: 1	Limited ROM: 1
Harato 2008	Stiff knee (< 90° flexion): 7	Stiff knee: 1
	Knee pain: 5	Knee pain: 2
Infection: 1	Infection: 3
Kim 2009	Femoral notching: 2	Femoral notching: 3
	Superficial infection: 1	Superficial infection: 1
Maruyama 2004	None	None
Matsumoto 2012	None	DVT: 1
Misra 2003	Stiff knee (< 30° flexion): 2	Stiff knee: 2
	Infection: 1	Dystrophy: 1
	Aseptic loosening: 2	Aseptic loosening: 3
	Instability: 3	Instability: 3
Roh 2012	PCL laxity: 2	None
	PCL tightness: 1
Thomsen 2013	Infection: 1	None
Yagishita 2012	None	DVT: 1
Yansheng 2013	None	None

DVT: deep venous thrombosis; PCL: posterior cruciate ligament; ROM: range of motion.

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