Oshima Yasushi, Fetto Joseph
Bull Hosp Jt Dis (2013). 2017 May;75(3):180-185.
The cruciate retaining (CR) design was developed to obtain knee stability with the natural posterior cruciate ligament (PCL) in total knee arthroplasty (TKA). However, the preservation of the PCL can limit knee exposure and increase the technical challenge during the procedure. Knee exposure is easily achieved under the released PCL, and we hypothesized that the PCL naturally repairs after release, thus re-establishing the posterior stability. Accordingly, the objective of this study was to evaluate the varying of the posterior stability after the PCL-released CR TKA over time.
Eight consecutive patients received the CR TKA in which the entire PCL was subperiostealy released at its femoral insertion. Thereafter, the patients were examined with the Knee Society Score, the posterior drawer examination, and the knee ligament arthrometer postoperatively.
Once the PCL was released, the tibia was easily subluxated, and the knee was clearly exposed intraoperatively. However, the posterior stability significantly improved with time postoperatively. We also had confirmed the reestablishment of the PCL directly at revision TKAs, one case of which is shown.
The reestablishment of the posterior stability after the PCL-released CR TKA was demonstrated. This procedure to release the entire PCL subperiostealy is recommended as a means of facilitating CR TKA.
在全膝关节置换术（TKA）中，十字韧带保留（CR）设计旨在利用自然的后交叉韧带（PCL）来获得膝关节稳定性。然而，保留PCL可能会限制膝关节暴露，并增加手术过程中的技术难度。在松解后的PCL下很容易实现膝关节暴露，我们推测PCL在松解后会自然修复，从而重新建立后方稳定性。因此，本研究的目的是评估PCL松解的CR TKA术后后方稳定性随时间的变化情况。
连续8例患者接受CR TKA，术中在股骨附着点处将整个PCL进行骨膜下松解。此后，术后对患者进行膝关节协会评分、后抽屉试验及膝关节韧带测压仪检查。
一旦PCL被松解，术中胫骨很容易出现半脱位，膝关节暴露清晰。然而，术后后方稳定性随时间显著改善。我们还在翻修TKA时直接证实了PCL的重新建立，其中1例情况如下所示。
证实了PCL松解的CR TKA术后后方稳定性得以重建。推荐骨膜下松解整个PCL这一术式作为促进CR TKA的一种方法。
