Is Posterior Cruciate Ligament Needle Pie-Crusting Safe and Effective in Balancing Cruciate-Retained Total Knee Arthroplasty? A Comparative Study

Mohammad Mahdi Sarzaeem; Farzad Amouzadeh Omrani; Alireza Manafi Rasi; Seyed Morteza Kazemi; Alireza Mirahmadi; Mohammad Movahedinia

doi:10.1016/j.artd.2023.101277

Is Posterior Cruciate Ligament Needle Pie-Crusting Safe and Effective in Balancing Cruciate-Retained Total Knee Arthroplasty? A Comparative Study

Arthroplast Today. 2023 Nov 20:24:101277. doi: 10.1016/j.artd.2023.101277. eCollection 2023 Dec.

Authors

Mohammad Mahdi Sarzaeem¹, Farzad Amouzadeh Omrani¹, Alireza Manafi Rasi¹, Seyed Morteza Kazemi^{1

2}, Alireza Mirahmadi^{1

2}, Mohammad Movahedinia¹

Affiliations

¹ Department of Orthopedic Surgery and Traumatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Bone, Joint and Related Tissue Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background: There is still debate over whether to sacrifice the posterior cruciate ligament (PCL) during total knee arthroplasty (TKA). Several studies reported the costs and benefits of each approach regarding technical difficulties in PCL balancing and postoperation complications. In this study, we aimed to evaluate PCL needling as a safe method for balancing the cruciate-retained TKA (CR-TKA).

Methods: In this comparative study, 120 patients underwent CR-TKA and were divided into 2 groups. Fifty-four patients with an acceptable PCL tightness were included in group A, and 66 cases with a tight PCL were included in group B. In group B, needle pie-crusting of the PCL was performed instead of releasing the PCL from its insertions as the standard procedure. The participants' functional outcomes, pain severity, knee range of motion, and PCL laxity were evaluated during multiple follow-ups in 3 years postoperatively.

Results: The participants' age, weight, and body mass index did not differ between the 2 groups. The mean age of the patients was 69 ± 5.9 years. The functional outcomes and range of motion of the patients in the 2 groups significantly improved after the operation compared to the preoperative status, but the postoperative score was not significantly different between groups (P > .05). Clinical examinations were normal in all patients in both groups in all follow-up stages.

Conclusions: PCL balancing is a time-consuming yet essential step for the outcome of CR-TKA and patient satisfaction. PCL needling technique shows promising results and a few complications for PCL balancing in CR-TKA.

Keywords: Arthroplasty; Knee; Posterior cruciate ligament; Range of motion; Replacement.