Impact of posterior cruciate ligament resection on the elasticity of the periarticular soft tissue sleeve in the knee joint.
10.12200/j.issn.1003-0034.20250516
- Author:
Yun-Feng ZHANG
1
;
De-Jin YANG
2
;
Zhao-Lun WANG
2
;
Yi-Xin ZHOU
2
;
Hao TANG
2
;
Xiang-Dong WU
2
;
Han-Long ZHENG
2
Author Information
1. Peking University Fourth School of Clinical Medicine, Beijing 100035, China.
2. Peking University Fourth School of Clinical Medicine, Beijing 100035, China; Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
- Publication Type:Journal Article
- Keywords:
Biomechanics;
Cadaveric study;
Posterior cruciate ligament;
Soft tissue balance;
Total knee arthroplasty
- MeSH:
Humans;
Posterior Cruciate Ligament/physiopathology*;
Knee Joint/physiopathology*;
Arthroplasty, Replacement, Knee;
Elasticity;
Male;
Female;
Middle Aged;
Aged;
Biomechanical Phenomena;
Adult
- From:
China Journal of Orthopaedics and Traumatology
2025;38(10):1055-1060
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To evaluate the effects of posterior cruciate ligament(PCL) resection on soft tissue elasticity and knee stability in total knee arthroplasty(TKA).
METHODS:Six adult cadaveric knee specimens (involving 10 knees) were included in the study. With the assistance of the robotic system(TiRobot Recon, TINAVI, Beijing), total knee arthroplasty (TKA) was performed sequentially using cruciate retaining (CR) prostheses and posterior stabilizing (PS) prostheses. Between the two surgical procedures, the femoral and tibial osteotomy surfaces were not altered;only the posterior cruciate ligament (PCL) was resected and the intercondylar fossa was treated. After installing the femoral trial component, a soft tissue balance solver was used to apply tension ranging from 30 N to 90 N in 5 N increments at 0°, 10°, and 90° of knee flexion. Meanwhile, the medial and lateral joint gaps were measured synchronously. Based on the tension-gap coupling data, the equivalent elastic coefficients of the medial and lateral soft tissue sleeves at different knee flexion angles, as well as the range of the joint line convergence angle (JLCA) under fixed varus-valgus stress, were calculated. Additionally, the gap balance status under 80 N of tension was analyzed. Self-control comparisons of each indicator were conducted before and after PCL resection to analyze the change patterns.
RESULTS:After PCL resection, in the fully extended position (knee flexion 0°). The medial equivalent elastic coefficient was 32.2 (25.7, 63.3) N·mm-1 for the CR prosthesis and 27.7 (22.0, 51.9) N·mm-1 for the PS prosthesis, and the statistically significant difference (P=0.013). The range of JLCA was 0.41°(0.26, 0.55)° for the CR prosthesis, which was smaller than 0.75° (0.40, 0.98)° for the PS prosthesis, and the difference was statistically significant(P=0.041). At 90° of knee flexion, the medial joint gap was 10.7(10.1, 11.7) mm for the CR prosthesis, which was smaller than 12.1(10.9, 15.1) mm for the PS prosthesis, with a statistically significant difference(P=0.011). No statistically significant differences were observed in other joint gaps.
CONCLUSION:PCL resection reduces the rigidity of the medial soft tissues in the fully extended knee and increases the medial joint gap in the flexed position, thereby affecting knee stability and balance. This finding suggests that PS and CR prostheses may require different morphological designs, and there should be differences in indications and osteotomy strategies between CR-TKA and PS-TKA. CR-TKA is more suitable for patients with preoperative medial soft tissue laxity.
