Comparable outcomes with a potential functional advantage of PCL preservation in medial-stabilized total knee arthroplasty: A systematic review and meta-analysis from the FP-UCBM Knee Study Group.

Purpose: The management of the posterior cruciate ligament (PCL) in medial-stabilized (MS) total knee arthroplasty (TKA) remains a topic of debate. This systematic review and meta-analysis investigate whether preserving or substituting the PCL in mechanical alignment (MA) MS-TKA impacts clinical, functional and radiographic outcomes. Methods: Systematic literature searches (PubMed-Medline, Scopus and Web of Science) followed PRISMA guidelines. Studies comparing PCL-retaining (PCL-r) and PCL-substituting (PCL-s) approaches in primary MS-TKA with MA were included. Outcomes analyzed included range of motion (ROM), implant survivorship, patient-reported outcome measures (PROMs), complication rates and radiological outcomes. Meta-analyses were performed using Review Manager (RevMan) software 5.4. Results: Overall, seven studies involving 1376 knees met the inclusion criteria. No significant differences were observed between PCL-r and PCL-s cohorts regarding ROM, radiographic outcome or PROMs such as the Forgotten Joint Score, Oxford Knee Score and Knee Society Score (KSS-Knee). A statistically significant difference was observed in KSS-Function favouring the PCL-r group (mean difference = -2.47, Conclusion: Both PCL-r and PCL-s strategies yield largely comparable outcomes in MS-TKA performed with MA. However, a significant difference in KSS-Function favours the PCL-r strategy, suggesting a potential advantage in functional recovery. The choice to retain or resect the PCL should be individualized based on patient characteristics, surgeon preference and implant design, but future studies are needed to explore the clinical implications of this functional benefit. Level of Evidence: Level III.