POSTERIOR CRUCIATE LIGAMENT RETENTION DOES NOT INFLUENCE CLINICAL OUTCOMES IN MEDIAL PIVOT TOTAL KNEE ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background The optimal management of the posterior cruciate ligament (PCL) in medial pivot (MP) total knee arthroplasty (TKA) remains unclear, with limited evidence on whether retention or sacrifice offers superior outcomes. We therefore asked: (1) does PCL retention in MP TKA provide superior functional outcomes compared to PCL sacrifice, after at least 2 years of follow-up? and (2) does PCL retention in MP TKA provide fewer complications and a lower revision rate compared to PCL sacrifice? Methods A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. PubMed/MEDLINE and Embase were searched from inception to December 11, 2024, for studies comparing MP TKA with PCL retention versus sacrifice with at least 2 years of follow-up. Outcomes analyzed included functional scores, complication rates, and revision rates. Data were pooled using a random-effects model, and heterogeneity was assessed using the I 2 -statistic. Results The included studies consisted of one randomized controlled trial and five case-control studies, published between 2011 and 2023. The total sample size across all studies was 663 patients who had an MP TKA with PCL retention and 754 patients who had an MP TKA with PCL sacrifice. There were no differences regarding functional scores (Knee Society Score, Forgotten Joint Score, Oxford Knee Score), range of motion, or complication and revision rates between the two groups. Conclusions This meta-analysis found no meaningful differences in functional outcomes, complication rates, or revision rates between MP TKA with PCL retention versus sacrifice. Further biomechanical studies may provide additional insights, but sacrificing the PCL appears to offer a practical approach for intraoperative joint balancing without compromising clinical outcomes.