The Secret to Balancing a Deficient PCL Without Using a Posterior Stabilized Knee

How a highly conforming dished tibial component can eliminate the need for intercondylar notch resection and a post-and-cam mechanism.

Throughout decades of history in total knee arthroplasty (TKA), the role of the posterior cruciate ligament (PCL) has been controversial. Some reports have shown inconsistent results with cruciate-retaining (CR) TKA. Yet other studies have found CR TKA to be advantageous over posterior-stabilized (PS) designs with respect to maintaining proprioception and knee kinematics. In the final analysis, however, a combined review of the literature has failed to show the superiority of either CR or PS TKA.

A third method that may be used to enhance posterior stability is to increase the sagittal plane conformity of the tibial polyethylene. This additional conformity may be achieved by an anterior buildup of the tibial insert. The so-called anterior-stabilized (AS) insert helps stabilize the femur during flexion and stair-climbing, potentially eliminating the need for a more traditional cam and post design.