Research Article Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament Melinda K. Harman, 1 Stephanie J. Bonin, 2 Chris J. Leslie, 3 Scott A. Banks, 4 and W. Andrew Hodge 5 1 Department of Bioengineering, 301 Rhodes Engineering Research Center, Clemson University, Clemson, SC 29634-0905, USA 2 MEA Forensic Engineers & Scientists, 23281 Vista Grande Drive, Laguna Hills, CA 92653, USA 3 Leslie Orthopaedics & Sports Medicine, 226 East U.S. Highway 54, Camdenton, MO 65020, USA 4 Department Mechanical & Aerospace Engineering, MAEA 318, University of Florida, P.O. Box 116250, Gainesville, FL 32611, USA 5 Department of Orthopaedics, Eastern Maine Medical Center, 489 State Street, Bangor, ME 04401, USA Correspondence should be addressed to Melinda K. Harman; harman2@clemson.edu Received 2 March 2014; Revised 26 August 2014; Accepted 31 August 2014; Published 8 October 2014 Academic Editor: Rene C. Verdonk Copyright © 2014 Melinda K. Harman et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. his study reports prospective midterm clinical, radiographic, and functional outcomes of a ixed- bearing design implanted using two diferent surgical techniques. he PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee (96±7) and function (92±13) scores and radiographic outcomes were good to excellent for 84% of patients ater 5–10 years in vivo. Range of motion averaged 124 ∘ ±9 ∘ , with 126 knees exhibiting ≥ 120 ∘ lexion. Small diferences in average knee lexion and function scores were noted, with the PCL-resected group exhibiting an average of 5 ∘ more lexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. his study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal lexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. his TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacriicing the PCL. 1. Introduction Contemporary total knee arthroplasty (TKA) provides reli- able pain relief and restoration of moderate function for patients sufering from severe joint degeneration. Outcomes are typically very good [1, 2], but many times patients do not regain a normal range of motion and strength. In particular, TKA designs that allow excessive anterior-posterior (AP) translation of the femur with respect to the tibia (knee insta- bility) exhibit reduced knee lexion, diminished functional strength, and unfavorable conditions for bearing surface wear [3–13]. Excessive AP motion in well-aligned prostheses occurs with the femur sliding anterior on the tibia in lexion and posterior in extension, resulting in limited femoral rollback and the potential of bony impingement between the femur bone and posterior rim of the tibial insert [5, 14–16]. his instability appears to result from the loss of the knee’s natural intrinsic stabilizing structures ater TKA, including one or both of the cruciate ligaments and the menisci [17]. herefore, controlling AP translation of the femur, in the presence or absence of the posterior cruciate ligament (PCL), is oten cited as a means for achieving optimal function in modern TKA designs [5, 16, 18–26]. Traditionally, orthopaedic surgeons have been trained to execute surgical techniques that depend on the integrity of the posterior cruciate ligament by utilizing one of two basic TKA designs, the cruciate-retaining type (CR) or the posterior-stabilized type (PS). However, joint laxity can vary Hindawi Publishing Corporation Advances in Orthopedics Volume 2014, Article ID 178156, 8 pages http://dx.doi.org/10.1155/2014/178156