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

There is still debate over whether to sacrifice the posterior cruciate ligament (PCL) during total knee arthroplasty (TKA). Several studies reported the costs and benefits of each approach regarding technical difficulties in PCL balancing and post-operation complications. In this study, we aimed to evaluate PCL needling as a safe method for balancing the Cruciate-Retained TKA (CR-TKA). In this comparative study, 120 patients underwent CR-TKA and were divided into two groups. Fifty-four Patients with an acceptable PCL tightness were included in group A, and 66 cases with a tight PCL were included in group B. In group B, needle pie-crusting of the PCL was performed instead of releasing the PCL from its insertions as the standard procedure. The participants' functional outcomes, pain severity, knee range of motion (ROM), and PCL laxity were evaluated during multiple follow-ups in 3 years postoperatively. The participants' age, weight, and BMI did not differ between the two groups. The mean age of the patients was 69 ± 5.9 years. The functional outcomes and ROM of the patients in the two groups significantly improved after the operation compared to the preop status, but the postoperative score was not significantly different between groups (P> 0.05). Clinical examinations were normal in all patients in both groups in all follow-up stages. PCL balancing is a time-consuming yet essential step for the outcome of CR-TKA and patient satisfaction. PCL needling technique shows promising results and a few complications for PCL balancing in CR-TKA.