Retention versus removal of the posterior cruciate ligament in total knee replacement: A systematic literature review within the Cochrane framework

Background There is no consensus as to whether to use a posterior cruciate ligament (PCL) retaining design or a posterior-stabilized design for total knee arthroplasty. The objective of this study was to establish the difference in functional, clinical, and radiological outcome between retention and removal of the PCL.

Methods We conducted a search in Medline, EMBASE, the Cochrane database, and Current Contents, along with reference checks and citation tracking. Randomized controlled trials were selected and methodological quality was assessed with the van Tulder and Jadad checklists by 2 independent reviewers.

Results We found 8 randomized controlled trials. 2 treatment options were compared against PCL retention: PCL removal without post and cam mechanism (2 studies), and posterior-stabilized design (5 studies). 1 study included all 3 options. Range of motion was found to be 8° higher (105° vs. 113°) in the posterior-stabilized group compared to the PCL retention group (p = 0.01, 95% CI (1.7, 15)).

Interpretation These results should be interpreted with caution, as the methodological quality of the studies was highly variable. Suggestions are given to improve future research on this specific aspect of knee arthroplasty.