Introducing a New Technique for Improving Predictability in Cruciate-retaining Total Knee Arthroplasty: The Posterior Cruciate Referencing Technique

摘要

Abstract: Posterior cruciate ligament (PCL) retention in total knee arthroplasty has a number of theoretical and functional advantages, provided the procedure can be carried out predictably. Many knee designs and implantation techniques have been developed to address kinematics and wear performance of cruciate-retaining designs. However, these interventions base theoretical performance on proper tensioning of the PCL. Techniques used to insure proper PCL function include adjusting tibial resection slope, increased resection of the posterior femoral condyle, and selective release of the PCL (or recessing). We present an alternative approach: a technique and a series of implants to optimize PCL function in a predictable mannert-"the posterior cruciate referencing technique." Instrumentation has been designed to identify, use, and protect the PCL origins. Sloped tibial insert trials are then used to balance the flexion/extension gap; that is, balance PCL tension to achieve optimal range of motion and stability before final implant selection and insertion. In addition, a study has been conducted to examine intraoperative passive flexion, and illustrate the PCL referencing operative technique with the use of posterior cruciate-retaining tibial implants of varying slopes.