Effect of preservation versus sacrifice of the posterior cruciate ligament on clinical outcomes after medial congruent total knee arthroplasty using mechanical alignment: A systematic review and meta-analysis.

PURPOSE: The debate on whether to preserve or sacrifice the posterior cruciate ligament (PCL) during medial congruent (MC) total knee arthroplasty (TKA) is still ongoing. Currently, there is no comprehensive consensus due to the limited evidence on which approach yields better outcomes. This systematic review and meta-analysis aimed to compared the functional outcomes of PCL retaining (PR) versus PCL sacrificing (PS) in MC TKA.

METHODS

Two independent researchers to find relevant articles, with no time limit until 4 August 2025, searched PubMed/Medline, Scopus, Web of Science and Embase databases. Postoperative functional outcomes were compared between the PR and PS groups, in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. The Cochran Q and I 2 tests were employed to assess heterogeneity between studies.

RESULTS

Six cohort studies, including 903 patients, were included. The pooled estimate of the four studies demonstrated that at 3 months after surgery, the mean difference in postoperative KSS score between the PR and PS groups was 1.15, which was not statistically significant (95% CI: -1.11, 3.31). At 12 months after surgery, the mean Knee Society Score (KSS) reached statistical significance in favour of the PR group (MD: 1.97, p < 0.05); however, this difference did not exceed the minimal clinically important difference (MCID) of 5.3 points, indicating a lack of clinical significance There was no significant difference in the mean Oxford Knee Score (OKS) score at 3 and 12 months after surgery between the PR and PS groups.

CONCLUSIONS

There appears to be no clinically meaningful difference in PR or PS during MC TKA in improving short-term clinical outcomes based on moderate-certainty evidence (Level IV). In the long term, preserving the PCL may lead to greater improvements in physical function compared to losing the PCL. However, no significant differences were noted in other clinical or functional outcomes, nor in complication rates, between the two groups.

LEVEL OF EVIDENCE: Level III.