{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T03:00:50Z","timestamp":1784430050014,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,10,12]],"date-time":"2014-10-12T00:00:00Z","timestamp":1413072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2014,10,12]],"date-time":"2014-10-12T00:00:00Z","timestamp":1413072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The tibial insertion of the posterior cruciate ligament (PCL) frequently becomes damaged when performing a tibial cut in a PCL\u2010retaining total knee replacement (TKA). The aim of this study was to quantify the functional effect of this structural damage on the tensile strength and failure load.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Six paired knees from fresh\u2010frozen cadaver specimens were used. All soft tissues but the PCL were removed. In the left\u2010sided specimens, a classic tibial cut at a depth of 9\u00a0mm with 3\u00b0 of posterior slope was made, while in the right\u2010sided specimens, a bone block was left in front of the tibial PCL insertion. After cementing a tibial tray, the specimens were mounted in a loading frame in 60\u00b0 of flexion. The femur was translated anteriorly at a constant velocity rate of 0.5\u00a0mm\/s. Tensions in the PCL were measured continuously until failure occurred.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In one specimen, the tibial PCL insertion was completely removed by the tibial cut. In the other five paired specimens, the mean tensile strength of the PCL was 380.6 \u00b1 154.7\u00a0N in the left\u2010sided knees. In the right\u2010sided knees, the mean tensile strength was 738.4 \u00b1 166.7. The average right\u2010to\u2010left ratio was 2.2 \u00b1 0.7 (<jats:italic>p<\/jats:italic> = 0.006).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results of this study indicate that the conventional technique for tibial preparation in cruciate\u2010retaining total knee arthroplasty can result in a significant decrease in tensile strength of the PCL, rendering it susceptible to failure and subsequent midflexion instability. Therefore, we recommend leaving the posterior tibial cortex anterior to the PCL insertion intact when performing a cruciate\u2010retaining TKA.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-014-3377-7","type":"journal-article","created":{"date-parts":[[2014,10,13]],"date-time":"2014-10-13T00:59:39Z","timestamp":1413161979000},"page":"273-278","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Mean tensile strength of the PCL in TKA depends on the preservation of the tibial insertion site"],"prefix":"10.1002","volume":"24","author":[{"given":"N.","family":"Van Opstal","sequence":"first","affiliation":[{"name":"Heilig Hart Lier Mechelsestraat 24 2500 Lier Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Feyen","sequence":"additional","affiliation":[{"name":"Heilig Hart Lier Mechelsestraat 24 2500 Lier Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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L\u00fctznerC DexelJ KirschnerS(2014) Similar stability and range of motion between cruciate\u2010retaining and cruciate\u2010substituting ultracongruent insert total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc. doi:10.1007\/s00167\u2010014\u20102892\u2010x","DOI":"10.1007\/s00167-014-2892-x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010199909000\u201000021"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010011\u20101696\u20105"},{"key":"e_1_2_7_13_1","first-page":"167","article-title":"Late rupture of the posterior cruciate ligament after total knee replacement","volume":"13","author":"Montgomery RL","year":"1993","journal-title":"Iowa Orthop J"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2002.31071"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00776\u2010003\u20100654\u20106"},{"key":"e_1_2_7_16_1","first-page":"1121","article-title":"Posterior 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