Cruciate-retaining and cruciate-substituting total knee arthroplasty: An in vitro comparison of the kinematics under muscle loads

The kinematics of posterior cruciate ligament (PCL)-retaining (PCR) and PCL-substituting (PS) total knee arthroplasty (TKA) were compared directly in a robotic, in vitro study, and the forces in the PCL and cam-spine mechanism were measured from 0° to 120° of flexion. The forces in the PCL after PCR TKA and in cam-spine contact after PS TKA increased only at a flexion of ≥90°. Posterior translation of the lateral femoral condyle was significantly greater than translation of the medial femoral condyle in the intact knees, consistent with femoral rollback and internal tibial rotation. The PCR and PS TKAs partially restored these kinematics when the knee flexed >60° (ie, when the forces increased in the PCL and cam-spine mechanism), whereas the PCL-deficient TKA failed to do so. The results reflect the importance of the PCL and cam-spine mechanism after PCL retention and substitution in TKA and confirm the necessity for either one, if knee kinematics are to be restored even partially.