Effects of the posterior cruciate ligament and tibia insert thickness on tibiofemoral joint pressure in total knee arthroplasty: a cadaveric study

Background: Emerging knowledge has highlighted the significant role of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA). However, few studies have reported how the PCL affects tibiofemoral joint pressure (TFP), and differences in the effects of the PCL and the effects of tibial insert thickness on TFP remain unknown. Thus, this study used the sensor technique to analyze and compare the effects of PCL and tibial insert thickness on TFP during knee flexion. Methods: Cruciate-retaining total knee arthroplasty (CR-TKA) was performed in 8 cadaveric knees. The PCL was partially released and completely resected sequentially while the tibial insert thickness was increased from 10- to 12-mm at 1-mm intervals. With the optimal tibial insert in place, the effects of PCL release and resection on medial and lateral TFP during knee flexion were analyzed. Medial tibiofemoral joint pressure (MTFP) with PCL retention and a 12-mm tibial insert was set as the baseline. The effects of PCL resection without tibial insert thickness reduction on MTFP were compared to the effects of PCL retention with a 1- or 2-mm thinning of the tibial insert on MTFP during knee flexion. Results: PCL resection significantly reduced MTFP at 90 degrees and 120 degrees of knee flexion (P=0.01 and P=0.03, respectively). Partial release and complete resection of the PCL did not significantly reduce lateral tibiofemoral joint pressure (LTFP) at 10 degrees, 30 degrees, 60 degrees, 90 degrees and 120 degrees of knee flexion (P=0.68, P=0.60, P=0.62, P=0.21 and P=0.12, respectively). At 10 degrees, 30 degrees, and 60 degrees of knee flexion, a 1-mm reduction in the tibial insert had a greater effect on MTFP than did the resection of the PCL. In contrast, at 90 degrees of knee flexion, MTFP was more affected by PCL resection than by a 2-mm reduction of the tibial insert. Conclusions: The PCL predominantly affects MTFP at 90 degrees and 120 degrees of knee flexion. The impact of PCL resection on MTFP at 90 degrees flexion was higher than the impact of a 2-mm thinning of the tibial insert.