No clinically meaningful differences between PCL preservation and sacrifice in medial pivot total knee arthroplasty: A systematic review and meta‐analysis
Bibliographic record
Abstract
Abstract Purpose The decision to preserve or sacrifice the posterior cruciate ligament (PCL) during medial pivot total knee arthroplasty (TKA) remains controversial. This systematic review and meta‐analysis evaluated postoperative functional outcomes and complications in patients undergoing medial pivot TKA with and without PCL preservation. Methods Eight databases were systematically searched eight databases through July 2025 following PRISMA guidelines. Studies comparing PCL preservation (cruciate‐retaining [CR]) versus sacrifice (cruciate‐sacrificing [CS]) in medial pivot TKA with minimum 2‐year follow‐up were included. Primary outcomes were functional scores and complication rates. Due to substantial heterogeneity ( I 2 > 75%) in key outcomes, we emphasized qualitative synthesis over pooled estimates for affected outcomes. Statistical analysis employed random‐effects models with prediction intervals for highly heterogeneous outcomes. Results Seven cohort studies (957 patients) were included. For outcomes with acceptable heterogeneity, quantitative pooling showed no statistically significant differences: Knee Society Score (KSS) (mean difference: 0.39, 95% confidence interval [CI]: −0.5, 1.27, I 2 = 60.4%) and Forgotten Joint Score (FJS) (mean difference: 0.77, 95% CI: −0.25, 1.79, I 2 = 23%). However, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score and range of motion demonstrated extremely high heterogeneity ( I 2 = 89.6%–99.4%), precluding reliable pooled estimates. Qualitative synthesis of individual studies consistently showed no clinically meaningful differences between approaches, it is important to note that the extremely high heterogeneity for most functional outcomes severely limits the reliability of these conclusions and prevents definitive recommendations. Complication rates were similar between groups (9% CS vs. 6% CR, p = 0.57, I 2 = 21%). Conclusions Based on low to moderate certainty evidence with significant study heterogeneity, PCL management strategy does not result in clinically meaningful differences in functional outcomes or complication rates in medial pivot TKA. Level of Evidence Level III.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.041 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.021 | 0.033 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".