Protecting the PCL During Total Knee Arthroplasty Using a Bone Island Technique.

Background: Prior studies have shown that the posterior cruciate ligament (PCL) may be partially resected during cruciate retaining (CR) total knee arthroplasty (TKA) using highly experienced hands and standard surgical technique; therefore, proper surgical technique is aimed at preservation and balance of the PCL during CR TKA. The central objective of this study is to evaluate the effectiveness of a simple surgical technique to prevent PCL damage during performance of a CR TKA.

Methods: Sixty embalmed cadaver specimens were randomized into 2 groups, experimental and control. The control group consisted of standard tibial resection without the use of an osteotome. The experimental group utilized an osteotome in addition to standard technique to preserve a bone island anterior to the tibial attachment of the PCL.

Results: In the control group, PCL damage was noted in 73% (22/30) of specimens. In the experimental group, where an osteotome was used, PCL damage was found in 23% (7/30) of specimens. The use of an osteotome was found to have an absolute risk reduction of 50% when compared to the control group which did not use an osteotome to protect the PCL.

Conclusion: In the setting of minimal surgical experience, the use of an osteotome to preserve the PCL during CR TKA by forming a bone island was found to be an effective means of protecting the PCL over standard technique. In addition, standard technique with the use of a Y-shaped PCL retractor was found to provide questionable protection to the PCL.