Progressive Tibial Bearing Sagittal Plane Conformity in Cruciate-Retaining Total Knee Arthroplasty

John B. Meding, Lindsey K. Meding, R. Michael Meneghini, Robert A. Malinzak

Research output: Contribution to journalArticlepeer-review


Background: We hypothesized that when the posterior cruciate ligament (PCL) is found deficient at total knee arthroplasty (TKA), using an anterior-stabilized (AS) tibial insert would provide similar function and survivorship when compared to using a more traditional cruciate-retaining (CR) bearing when the (PCL) is balanced. Methods: A total of 1731 TKAs were performed using the same TKA design. Of them, 868 TKAs had a standard CR insert implanted (CR-S), 480 TKAs used a lipped CR insert (CR-L), and 383 TKAs used an AS insert. If the PCL was considered nonfunctional or absent, an AS bearing was placed. When the PCL was balanced, a CR-S or CR-L bearing was used. Follow-up was performed using the Knee Society scoring system. Kaplan-Meier survivorship was used with failure defined as aseptic loosening. Results: At final follow-up, there were no significant differences in knee flexion, pain, function, or stair scores. Walking scores were significantly lower in the AS group. Posterior instability was higher in the CR-S group, whereas the manipulation rate was highest in the CR-L group (1.7%, 1.3%, and 0% for CR-L, CR-S, and AS groups, respectively). Kaplan-Meier survivorship at 5 years demonstrated no significant difference between the 3 groups (99% 100%, and 99% for CR-S, CR-L, and AS groups, respectively). Conclusion: Using an AS insert provided similar function and 5-year survivorship as compared to using a CR-S and CR-L tibial insert when the PCL was balanced. Using an ultracongruent AS dished tibial component appears to be a reasonable option when the PCL is completely released or found deficient at operation.

Original languageEnglish (US)
JournalJournal of Arthroplasty
StateAccepted/In press - 2020


  • conformity
  • cruciate-retaining
  • knee arthroplasty
  • sagittal plane
  • ultra-congruent

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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