The PCL-Sparing Total Knee Arthroplasty

A consistently debated topic within the field of joint reconstruction is posterior cruciate ligament (PCL) sparing versus PCL substituting total knee arthroplasty. The use of cruciate retaining (CR) versus posterior stabilized (PS) implants in primary total knee arthroplasty (TKA) is often surgeon, institution, or region specific. The United States continues to hold a strong preference for PS-TKA designs, while globally, CR-TKA dominates the landscape. The PCL acts to resist posterior translation of the tibia on the femur and facilitates femoral rollback during knee flexion. Several advantages have been proposed including improved gait mechanics and longer survival, avoidance of cam-post impingement, and decreased rates of aseptic loosening and lower fracture risk, though the data remains inconsistent. Nevertheless, PCL-sparing TKA remains a successful implant design with numerous studies demonstrating good survivorship and patient-reported outcomes. As implant design continues to evolve to restore native biomechanics and to circumvent some concerns with the cam-post mechanism, designs such as medial-pivot (MP) and ultra-congruent (UC) TKA are becoming more popular. The goal of this chapter is to explore the role of the PCL-sparing TKA and its implant design, surgical technique, and outcomes.