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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 6,
766-771.
doi: 10.1302/0301-620X.89B6.18782 Copyright © 2007 by British Editorial Society of Bone and Joint Surgery The posterior cruciate ligament-preserving total knee replacement: do we preserve it?A RADIOLOGICAL STUDYF. J. Shannon, MCh, MSc, OrthEng FRCS(Trauma & Orth), Specialist Registrar1; J. J. Cronin, MRCS I, Orthopaedic Registrar1; M. S. Cleary, MCh, MRCS I, Specialist Registrar1; S. J. Eustace, FFR, RCS I, Consultant Musculoskeletal Radiologist1; and J. M. OByrne, FRCS(Trauma & Orth), Professor of Orthopaedic and Trauma Surgery11 Cappagh Orthopaedic Hospital, Finglas, Dublin 11, Republic of Ireland. Correspondence should be sent to Mr F. J. Shannon at Merlin Park Hospital, Galway, Ireland; e-mail: fjshannon{at}gmail.com
Our aims were to map the tibial footprint of the posterior cruciate ligament (PCL) using MRI in patients undergoing PCL-preserving total knee replacement, and to document the disruption of this footprint as a result of the tibial cut. In 26 consecutive patients plain radiography and MRI of the knee were performed pre-operatively, and plain radiography post-operatively. The lower margin of the PCL footprint was located a mean of 1 mm (10 to 8) above the upper aspect of the fibular head. The mean surface area was 83 mm2 (49 to 142). One-third of patients (8 of 22) had tibial cuts made below the lowest aspect of the PCL footprint (complete removal) and one-third (9 of 22) had cuts extending into the footprint (partial removal). The remaining patients (5 of 22) had footprints unaffected by the cuts, keeping them intact. Our study highlights the wide variation in the location of the tibial PCL footprint when referenced against the fibula. Proximal tibial cuts using conventional jigs resulted in the removal of a significant portion, if not all of the PCL footprint in most of the patients in our study. Our findings suggest that when performing PCL-retaining total knee replacement the tibial attachment of the PCL is often removed.
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