Forgotten but fundamental - Classic papers revisited

Featured Paper: Thomas P. Andriacchi, Jorge O. Galante. Retention of the posterior cruciate in total knee arthroplasty, The Journal of Arthroplasty, Volume 3, Supplement, 1988, Pages S13-S19, ISSN 0883-5403, https://doi.org/10.1016/S0883-5403(88)80003-2. (https://www.sciencedirect.com/science/article/pii/S0883540388800032). The role of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) has been a subject of extensive biomechanical and clinical investigation. This article explored how PCL retention influences implant design, joint kinematics, functional performance, and long-term durability of the prosthesis. The key factors such as passive knee motion, femoral rollback mechanics, load distribution across the implant-bone-cement interface, and wear characteristics are analyzed. Evidence suggests that preserving the PCL enhances passive range of motion, optimizes muscular efficiency – particularly during activities such as stair climbing – and reduces interface stresses, while exerting minimal influence on polyethylene wear rates. WHY IT MATTERED THEN? This was one of the earliest systematic evaluations of whether to retain or sacrifice the PCL in TKA It set the stage for two dominant design philosophies – PCL-retaining (CR) versus PCL-substituting (PS) The work emphasized the balance between stability, kinematics, and ease of surgery. WHY IT STILL MATTERS TODAY? Despite advances in implant design, navigation, and robotics, the CR versus PS debate continues in every operating room Registry data and randomized controlled trials remain inconclusive; patient factors, surgeon preference, and implant evolution still influence decisions The paper reminds us that fundamental biomechanics questions transcend the generations of technology. TAKE-HOME REFLECTION “Every new technology stands on the shoulders of unresolved old debates. Revisiting them ensures we don’t repeat cycles of fashion over science.” Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.