Is Posterior Cruciate Ligament Needle Pie-Crusting Safe and Effective in Balancing Cruciate-Retained Total Knee Arthroplasty?

Background: Preserving the anatomic structures of the knee during total knee arthroplasty might help achieve better kinematics and functional outcomes. Retaining the posterior cruciate ligament in CR-TKA results in better functional outcomes and a more natural knee compared to cruciate-substituting designs. However, balancing the PCL is a challenge with time-consuming steps. This study evaluates the outcomes of the needling technique as previously described for MCL, to balance the PCL in CR-TKA.Methods: 120 patients undergoing primary cruciate-retained TKA were enrolled in this study in 2020. During the operation, 66 patients with a tight PCL were balanced by multiple PCL needle pie-crusting and the results were compared to 54 patients that had appropriate PCL tension, hence an intact PCL. Oxford Knee Score and knee flexion range of motion and clinical PCL function in 1-year follow-up were evaluated as outcome measures.Results: All patients had acceptable outcomes without statistically significant differences between the two groups in terms of OKS and knee ROM. Furthermore, no confounding factors like age, height, weight, and BMI were found on the TKA outcomes. Both groups demonstrated normal PCL function on serial physical examinations.Conclusion: This technique seems to be simple and reliable for PCL balancing in CR-TKA based on favorable outcomes and few complications.