Resident Total Knee Arthroplasty Training: The Protective Benefits of an Osteotome during Cruciate Retaining TKA

Resident Total Knee Arthroplasty Training: The Protective Benefits of an Osteotome during Cruciate Retaining TKA INTRODUCTION: The central objective of this study is to evaluate the effectiveness of a simple surgical technique to prevent PCL damage during performance of a posterior cruciate retaining (CR) total knee arthroplasty (TKA) surgery. This technique involves placement of an osteotome to prevent iatrogenic injury to the PCL by the sagittal saw blade during tibial resection. This simple technique can be useful to faculty members instructing novice residents or to senior surgeons looking to perform a low volume of CR TKA as an adjunct to their private practices. METHODS: We randomized 60 cadaveric specimens into two groups: Group I and Group II. Group I, 30 specimens, received standard tibial resections as performed during CR-TKA using a standard Y shaped PCL retractor. Group II, 30 specimens, received standard tibial resections as performed during CR-TKA using a standard Y shaped PCL retractor with the additional placement of a ½ inch osteotome. A board certified adult reconstructive orthopaedic surgeon, aligned the extramedullary tibial resection guide and positioned the osteotome. Posterior cruciate ligaments were assessed after completion of the procedures and removal of all instrumentation by 3 separate individuals to assess PCL damage. There were two states defined: PCL intact and PCL damaged. RESULTS: A difference in PCL damage was noted in 73% (22/30) of group I and in 23% (7/30) of group II. Group I was found to be twice more likely to have an injured PCL than Group II which used an osteotome for PCL protection. DISCUSSION AND CONCLUSION: Placement of an osteotome anterior to the PCL during CR-TKA provides a protective benefit to the patient. We speculate that the protective benefit could be increased by ensuring osteotome penetration is deeper than resection depth. This study simulated 60 tibial resections and may be applied to novice resident training.