Department of Orthopaedic Surgery, Japan Community Health Care Organization Gunma Central Hospital, Maebashi, Gunma, Japan.
Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
J Arthroplasty. 2018 May;33(5):1389-1393. doi: 10.1016/j.arth.2017.12.026. Epub 2017 Dec 28.
The purpose of our study was to identify factors affecting posterior cruciate ligament (PCL) tightness during cruciate-retaining total knee arthroplasty.
A total of 225 varus osteoarthritic knees that underwent cruciate-retaining total knee arthroplasty were included in this study. When the flexion gap was tighter than the extension gap after all bone resection and the lift-off sign was positive during surgery, the PCL was released. The association between PCL release and potential risk factors, such as age, gender, body mass index, preoperative range of motion, anterior cruciate ligament status, preoperative hip-knee-ankle angle (HKA), decrease in posterior condylar offset, and also change in tibial posterior slope angle (TPSA) from preoperative to postoperative measurement, was evaluated by univariate and multivariate logistic regression analyses.
The PCL was released in 68 of 225 knees (30.2%). According to the univariate logistic regression analysis, preoperative knee flexion angle (odds ratio [OR], 0.98), anterior cruciate ligament status (OR, 3.94), the decrease in medial (OR, 0.73) and lateral posterior condylar offset (OR, 0.76), preoperative HKA (OR, 1.1), preoperative (OR, 1.15) and postoperative TPSA (OR, 0.77), and the decrease in TPSA (OR, 1.23) were associated with PCL release. Multivariable stepwise logistic regression analysis demonstrated that preoperative HKA (P < .001), postoperative TPSA (P = .02), and the decrease in TPSA (P < .001) were independently associated with PCL release.
Many factors are associated with PCL tightness. The change in TPSA between preoperative and postoperative measurements was a higher risk factor than postoperative TPSA.
本研究旨在确定影响保留后交叉韧带（PCL）的全膝关节置换术中的后交叉韧带紧张度的因素。
本研究共纳入 225 例接受保留后交叉韧带的全膝关节置换术的内翻性骨关节炎膝关节。当所有骨切除后，膝关节屈曲间隙比伸展间隙紧，且术中出现“抬起征”阳性时，释放 PCL。通过单变量和多变量逻辑回归分析评估 PCL 释放与可能的危险因素（如年龄、性别、体重指数、术前活动范围、前交叉韧带状态、术前髋膝踝角（HKA）、后髁间距离减少、以及胫骨后倾角角度（TPSA）从术前到术后测量的变化）之间的关联。
225 例膝关节中，68 例（30.2%）释放了 PCL。根据单变量逻辑回归分析，术前膝关节屈曲角度（比值比 [OR]，0.98）、前交叉韧带状态（OR，3.94）、内侧（OR，0.73）和外侧后髁间距离减少（OR，0.76）、术前 HKA（OR，1.1）、术前（OR，1.15）和术后 TPSA（OR，0.77）以及 TPSA 减少（OR，1.23）与 PCL 释放有关。多变量逐步逻辑回归分析表明，术前 HKA（P<.001）、术后 TPSA（P=0.02）和 TPSA 减少（P<.001）与 PCL 释放独立相关。
许多因素与 PCL 紧张有关。术前和术后 TPSA 之间的变化是比术后 TPSA 更高的危险因素。
