Posterior Cruciate Ligament Retaining Total Knee Arthroplasty

The posterior cruciate ligament (PCL) is a central stabilizer of the knee joint and it contributes to anteroposterior, valgus/varus and rotational stability. The PCL guides femoral rollback if it is preserved with proper tension during total knee arthroplasty. Maintenance of the joint line position, more conservation of bone and the possibility of reduced wear by absorption of shear forces are the potential advantages of posterior cruciate ligament retention. But an overly tensioned PCL increases polyethylene wear and on the other hand a lax PCL induces paradoxical femoral rollback and instability during knee flexion. So careful attention is needed in order to achieve the proper tension of the PCL during total knee arthroplasty, and sacrificing the PCL is considered in cases of severe deformity of the knee joint or progressive rheumatoid arthritis.