Proprioception following total knee arthroplasty with and without the posterior cruciate ligament

doi:10.1016/S0883-5403(96)80174-4

The Journal of Arthroplasty

Volume 11, Issue 7, October 1996, Pages 763-768

https://doi.org/10.1016/S0883-5403(96)80174-4 Get rights and content

Abstract

Proprioception was measured in two groups of patients following successful total knee arthroplasty (TKA). In one group, the posterior cruciate ligament was retained and an unconstrained cruciate-retaining total knee component was used; in the other group, the posterior cruciate ligament was excised and a cruciate-substituting design was implanted. Threshold to detection of passive motion was quantified as a measure of proprioception. The degree of preoperative arthritis was objectively classified according to Resnick and Niwoyama. There was no difference in threshold to detection of passive motion in cruciate-retaining versus cruciate-substituting TKA. In patients with a moderate grade of arthritis before surgery, the postoperative scores were virtually identical. When the grade of preoperative arthritis was severe, patients with cruciate-substituting TKAs performed significantly better than those with cruciate-retaining TKAs.

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Cited by (52)

Total Knee Arthroplasty in Patients With Knee Osteoarthritis: Effects on Proprioception. A Systematic Review and Best Evidence Synthesis
2019, Journal of Arthroplasty
Citation Excerpt :
Most of the studies of this systematic review focused on the effect of PCL retaining vs PCL sacrificing prosthesis, assuming that PCL retaining could provide better proprioceptive information. Despite a slight improvement in few cases (low grade knee OA and during passive 45° extension in TDPM [27,29]), PCL retaining did not positively influence proprioceptive abilities when compared to PCL sacrificing prosthesis design [16,18,21,22,26,27,30,33], especially when patients presented a more severe OA grade [26]. Although proprioceptive input from the cruciate ligaments is well established in the healthy population, their contribution may be limited in the aged population.
Impact of total knee arthroplasty (TKA) on proprioception remains to be determined. The aim of this systematic review is to analyze factors influencing proprioception in patients with knee osteoarthritis (OA) undergoing TKA.
A systematic literature search was conducted on 3 medical electronic databases: PubMed, PeDRO, and Cochrane Collaboration. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used. Risk of bias analysis and best evidence synthesis were performed. Three main aspects were investigated: the presence of preoperative, surgical, and postoperative factors influencing proprioception in OA patients undergoing TKA.
Search identified 1601 records. After screening, 19 papers were used for the analysis of 676 patients. Proprioception generally improved but often remained impaired after surgery. Strong evidence was found for no influence of prosthesis design on proprioception. Moderate evidence was found for patellar resurfacing not affecting proprioception, varus deformity negatively influencing proprioception, and time elapsed from surgery positively influencing proprioception. Limited evidence was found for valgus deformity, OA grade, intact anterior cruciate ligament, and anteroposterior joint laxity negatively affecting knee proprioception, and for muscle strength and sensorimotor training not affecting proprioception. Finally, conflicting evidence was found for better postoperative proprioception vs preoperative level.
Proprioception in OA patients undergoing TKA improves but remains impaired after surgery. The best evidence synthesis demonstrated no influence of prosthetic design, while the role of the treatment remains unclear. This warrants for further research efforts to study proprioceptive impairment to better manage OA patients undergoing TKA.
Is the posterior cruciate ligament destabilized after the tibial cut in a cruciate retaining total knee replacement?. An anatomical study
2013, Knee
Cruciate retaining total knee replacement has been shown to effectively improve pain and quality of life. Successful outcomes depend on many factors, including the maintenance of a competent posterior cruciate ligament. This study sought to anatomically analyze the percentage of PCL injured during a full transverse, tibial cut, thus altering normal function.
One hundred and thirty five consecutive knee MRIs taken from 2006 to 2011 were selected from a single surgeon's database for this study. Only subjects with non-arthritic knees were considered for this study; the lack of degenerative joint disease (DJD) was confirmed via a radiological report. The optimal view of the PCL's tibial attachment was observed using the sagittal view of the knee, with a T1 signal. One hundred and twenty two usable images were viewed electronically, and measurements were made using the standardized transverse cut implant guidelines. The percentage of PCL remaining following the cut was categorized into five different groups: 0% (no PCL undermined), 1–49%, 50–74%, 75–99% and 100% (PCL undermined entirely).
Overall only 9.0% (n = 11) would have not endured any damage to the PCL with a transverse tibial saw cut, while 79.6% (n = 98) would have had 50% or more of the PCL undermined. Of the 98 patients with more than 50% resected, 52.1% (n = 51 patients) presented complete destabilization of the PCL. The percentage of PCL destabilized was not significant across age groups (p = 0.280), gender (p = 0.586), or operative side (p = 0.460).
Independent of age, gender, and operative side, a majority of PCLs are more than 50% destabilized following the standard transverse tibial cut.
II
Should you save or Substitute the Posterior Cruciate Ligament in Total Knee Replacement?
2009, Evidence-Based Orthopaedics: The Best Answers to Clinical Questions
Should you save or substitute the posterior cruciate ligament in total knee replacement?
2008, Evidence-Based Orthopaedics: The Best Answers to Clinical Questions
Midterm comparison of posterior cruciate-retaining versus -substituting total knee arthroplasty using the Genesis II prosthesis. A multicenter prospective randomized clinical trial
2008, Knee
The purpose of the current study was to compare midterm outcomes of posterior cruciate-retaining (CR) versus posterior cruciate-substituting (PS) procedures using the Genesis II total knee arthroplasty (TKA) system (Smith and Nephew, Memphis, TN). Ninety-nine (99) CR and 93 PS TKA's were analyzed in this prospective, randomized clinical trial. Surgeries were performed at seven medical centers by participating surgeons. Clinical outcomes (Knee Society Score, Range of Motion, WOMAC, SF-12, and Radiographic Findings), in addition to postoperative complications, were evaluated with a minimum follow-up of 5 years. Following data analysis, there were no significant differences in patient demographics or preoperative clinical measures between the two groups. At the latest follow-up interval, no significant differences were found between the CR and PS groups with regards to functional assessment, patient satisfaction, or postoperative complication. However, the PS group did display statistically significant improvements in range of motion when compared with the CR group. The results of this investigation would suggest that, while comparable in regards to supporting good clinical outcomes, the PS Genesis II design does appear to support significantly improved postoperative range of motion when compared with the CR design.
Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty
2007, Knee
Citation Excerpt :
Warren et al. [14] concluded that PCL-retaining TKA had the greatest improvement in proprioception. In contrast, other authors have reported that proprioception in knees with PCL-retaining prosthesis is almost identical to that in knees with PCL-substituting prosthesis [19–24]. Furthermore, surgeons continue to debate the relative merits of UKA and TKA.
Proprioception was assessed after knee replacement to compare total (TKA) to unicompartmental (UKA) knee arthroplasty. Thirty-four patients were recruited; seventeen patients underwent TKA and seventeen patients underwent UKA. The patient's age was similar in both groups. Two measures of proprioception, joint position sense (JPS) and postural sway (PS) were measured. Function was assessed using the Oxford Knee Score (OKS). Measurements were taken pre-operatively and 6 months post-operatively on both the operated and contralateral leg. Pre-operatively, no differences in JPS or PS were found between groups or between limbs in either group. Post-operatively, both groups had significant improvement of JPS in the operated limb only (20% increase). The improvement in JPS was similar in both groups. PS also improved significantly in both groups although the improvement of PS in the UKA group was twice that for the TKA group. The OKS improved by a similar amount in both groups. Both UKA and TKA result in a significant improvement in proprioception. Dynamic aspects of proprioception improve more after UKA than TKA, which may explain, in part, why UKA patients have superior functional outcome to that of TKA patients.

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: Supported in part by a grant from Zimmer (Warsaw, IN) and University Orthopaedics Pittsburgh, Pennsylvania.

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Original articleProprioception following total knee arthroplasty with and without the posterior cruciate ligament

Abstract

J Electromyogr Kinesiol

Proprioception in the anterior cruciate deficient knee

Am J Sports Med

Proprioception following anterior cruciate ligament reconstruction

J Sports Rehabil

Pathophysiology of the medial ligament of the knee joint

Acta Chir Scand

Nerve supply of the human knee and its functional importance

Am J Sports Med

Neural anatomy of the human anterior cruciate ligament

J Bone Joint Surg

A histologic study of the posterior cruciate ligament in the arthritic knee

Am J Knee Surg

The mechanoreceptor innervation of the human fibular collateral ligament

J Anat

The sensory function of knee ligaments

A sensory role for the cruciate ligaments

Clin Orthop

Mechanoreceptors in the posterior cruciate ligament

Acta Orthop Scand

A histological comparison of posterior cruciate ligaments harvested from arthritic and age-controlled knee specimens

Quantitative evaluation of joint motion perception in aging population

J Gerontol

Age-related decline in proprioception

Clin Orthop

Joint proprioception in normal, osteoarthritic, and replaced knees

J Bone Joint Surg

Quantitative gait analysis after unilateral or bilateral total knee replacement

J Bone Joint Surg

Biomechanical gait analysis of the diseased knee joint

Clin Orthop

Original article
Proprioception following total knee arthroplasty with and without the posterior cruciate ligament