Orthopaedic department, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Thessaloniki, Greece
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The ways of treating the posterior cruciate ligament have been a matter of excessive debate during the past years. Between retaining, sacrificing and substituting, studies have been mainly focused among posterior cruciate ligament retaining and posterior cruciate ligament substituting designs and techniques. Most studies report mostly these critical outcomes of a successful total knee arthroplasty: survivability and range of motion/flexion, along with other scores that demonstrate the quality of life and mobility of the patient. Also, there have been studies that analyse the histology of posterior cruciate ligament s in arthritic knees, and ones that study the biomechanical behaviour of posterior cruciate ligament retaining and posterior cruciate ligament substituting arthroplasties. The aim of this review is to discover the advances that have been made during the past years in terms of establishing the differences between cruciate retaining and substituting designs. Also, the review explores these differences and their true impact on patients and implant survival rate.
In terms of survival, both types of implants so far have shown almost excellent durability even on long-term follow-ups of 10 and more years. The difference between these two implants that has been revealed by recent meta-analyses is in the range of motion where, paradoxically for some researchers, the posterior cruciate ligament substituting designs provide more flexion and range of motion. Histological analyses reveal that most posterior cruciate ligaments in arthritic knees are under a degenerative process. Future comparing properly randomized trials could possibly reveal how these small differences in flexion and the degeneration of posterior cruciate ligament affect the lives of patients who have undergone a posterior cruciate ligament retaining or posterior cruciate ligament substituting knee arthroplasties.