ASSESSMENT OF PCL STATUS IN PATIENTS UNDERGOING

TKR AND ITS IMPLICATIONS ON PCL RESECTION –

PROSPECTIVE OBSERVATIONAL STUDY

Thesis
Submitted to
All India Institute of Medical Sciences, Jodhpur
In partial fulfilment of the requirement for the degree of
Master of Surgery (MS)
(Orthopaedics)

Session July 2022

Submitted (December 2024)
AIIMS, Jodhpur DR. MANVEER SINGH
 ACKNOWLEDGEMENT

‘Teach me and I remember, involve me and I learn -Benjamin Franklin’

First and foremost, I would like to thank my greatest teacher of all: God. I
know that I am here and can write all of this for a reason. I will do my best never to
forget what a great fortune I have had in just being here, and that it comes with a
lesson and a responsibility. I hope I am doing the work you have planned for me to do.

I would like to gratefully acknowledge the contribution of all the people who
provided valuable support to me during this thesis. I would not be at this landmark
moment without the trust and patient patronage of my guide and mentor Dr.
SUMIT BANERJEE, Professor, Department of Orthopaedics, All India Institute of
Medical Sciences, Jodhpur, whose inspiring vision and dedication to orthopaedics
stimulated me to work in this field. Whilst the sensation of doing something that would
impress everybody was short-lived, those first few days of uncertainty that you pulled
with me are ones that I will not ever forget. Without your guidance and support, I
would have given up long ago. Thank you for believing in me. Every piece of this
work bears the reflection of your trust in my efforts.

I also owe a deep sense of gratitude to my co-guide Dr. ABHAY ELHENCE,

Professor and Head, Department of Orthopaedics, All India Institute of Medical
Sciences, Jodhpur, who was always by my side through thick and thin and made me
smile in difficult situations and found time for making inspiring suggestions in
producing this work.

I am deeply grateful to Dr. NITESH GAHLOT, Additional Professor,

Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, who
has been unwavering in his support throughout this journey. During my under-
graduation after finishing my daily college routine, I would spend time in the
dissection hall with my esteemed teacher, Dr. Nayeem. Similarly, in orthopaedics,
Nitesh Sir played a comparable role, offering a platform to discuss ideas beyond the
conventional. He shared my profound appreciation for anatomy and viewed surgery
as an art form. His encouragement, unwavering presence during challenging times,
and insightful suggestions have significantly contributed to the completion of this
work.
 I extend my profound appreciation to Dr. SAURABH GUPTA, Associate
Professor, Department of Orthopaedics, All India Institute of Medical Sciences,
Jodhpur, whose unwavering support and invaluable counsel have been pivotal
throughout this project. His steadfast encouragement, unwavering presence during
challenges, and insightful recommendations have greatly enriched the outcomes of
this study.

I will always be in debt to DR. PUSHPENDER SINGH KHERA, Professor

and Head, Department of Radiology, All India Institute of Medical Sciences, Jodhpur,
Dr. Sandeep Kumar Yadav, Associate Professor, Department of Orthopaedics, All
India Institute of Medical Sciences, Jodhpur, and Dr. Prabodh Kantiwal, Associate
Professor, Department of Orthopaedics, All India Institute of Medical Sciences,
Jodhpur, Dr. Rajesh Kumar Rajnish, Assistant Professor, Department of Orthopaedics,
All India Institute of Medical Sciences, Jodhpur and Dr. Laxman Choudhary,
Assistant Professor, Department of Orthopaedics, All India Institute of Medical
Sciences, Jodhpur for being selfless and supportive throughout my research.

I would also like to appreciate the significant role played by my seniors,

notably, Dr. Sanchit Roy, Dr. Dhirendra Kumar, Dr. Ashraf Jamal, Dr. Binod Kumar,
Dr. Sheikh Azharuddin, Dr. Garnepally Lakshmiprasad, Dr. Abbas Bhatia, Dr. Akhil
Mathew Jacob, and Dr. Devdutta Pradeep Phatak, Dr. Sushil Kumar, Dr. Akshant
Chandel, Dr. Vimal Prakash, Dr. Likhith Ram Naik, Dr. Aakash Choudhary , Dr.
Amandeep Bains, Dr. Sammarjanki Rymbai, Dr. Ronnie George, Dr. Naman Jain, Dr.
Raj Sinha, Dr. Amir Sohail, Dr. Syed Adnan, and Dr. Kiran Rani for their extreme care
and support in all difficult times. I would also like to acknowledge the role played by
my beloved juniors Dr. Aryan Mechu, Dr. S. A. Furqan Meer, Dr. Bharat Soni, Dr.
Kartikey Dubey, Dr. Pearl Lionel, Dr. Sagar Setia, Dr. Deepak Rao, Dr. Nitesh Jayant,
Dr. Debdeep Majumdar, Dr. Ritvik Sharma and Dr. Nikhil.

Family is the backbone that has prevented me from ever faltering in the quest
for excellence and knowledge. I am grateful to my parents Mr. Sandeep Singh
Dhillon and Mrs Amarjit Kaur Dhillon and my brother Harveer Singh Dhillon for
being a constant source of encouragement and inspiration throughout and who have
always stood like a rock behind me and whose prayers and sacrifices have made me
what I am today.
 I was raised observing my grandfather oversee the commissioning of power
projects in Punjab, which led me to believe that there was no greater calling than
serving in the civil services. However, my understanding of passion was reshaped
after meeting three individuals who profoundly influenced my perspective.

Those three people were Dr. Abhay Elhence sir, Dr. Sumit Banerjee sir and
Dr. Nitesh Gahlot sir.

DR. MANVEER SINGH

 LIST OF ABBREVIATIONS

Abbreviation Full Form

TKA Total knee arthroplasty

PCL Posterior cruciate ligament

CR Cruciate-retaining

PS Posterior-stabilized

KOOS Knee Injury and Osteoarthritis Outcome Score

PDT Posterior drawer test

ROM Range of motion

SR Stress radiograph
 INDEX

S. NO. PARTICULARS PAGE NO.

1. LIST OF TABLES i

2. LIST OF FIGURES ii

3. LIST OF ANNEXURES iii

4. SUMMARY iv-v

5. INTRODUCTION 1-3

6. REVIEW OF LITERATURE 4-11

7. AIM AND OBJECTIVES 12

8. MATERIALS AND METHODS 13-18

9. OBSERVATIONS AND RESULTS 19-37

10. DISCUSSION 38-43

11. CONCLUSION 44

12. STRENGTH AND LIMITATIONS 45

13. BIBLIOGRAPHY 46-49

14. ANNEXURES 50-64

 LIST OF TABLES

TABLE PAGE
DESCRIPTION
NO. NO.
1. Age distribution of patients 19
2. Gender distribution of patients 20
3. Distribution of laxity on Posterior Drawer test 21
4. Distribution of Stress Radiograph Translation 22
Correlation between Posterior Drawer test and Stress
5. 23
radiograph translation
Correlation between Stress radiograph and intra-operative
6. 24
Tension of PCL
Correlation between Stress radiograph and Shine of PCL
7. 26
fibres
8. Distribution of intra-operative cross-sectional area of PCL 27
Correlation between Cross-sectional area of PCL and
9. 28
Posterior Drawer Test
Correlation between Cross-sectional area of PCL and
10. 30
Stress Radiograph translation
11. Distribution of CR and PS designs 31
12. Correlation between Posterior Drawer test and procedure 32
Correlation between stress radiograph measurements and
13. 33
procedure
Variation of posterior drawer test and stress radiograph
14. 34
(SR) findings with type of procedure
Post operative Lysholm score variation at 3 month follow
15. 35
up between CR vs PS
Post operative KOOS score variation at 3 month follow up
16. 36
between CR vs PS

i
 LIST OF FIGURES

S. NO. DESCRIPTION PAGE NO.

1. Technique to demonstrate posterior drawer test 15
2. Stress radiograph for PCL assessment 15
Intra-operative evaluation of the PCL and the
3. technique for measuring it using an arthroscopic 16
probe
4. Age distribution of patients 19
5. Gender distribution of patients 20
6. Distribution of laxity on Posterior Drawer test 21
7. Distribution of Stress Radiograph Translation 22
Correlation between Posterior Drawer test and Stress
8. 23
radiograph translation
Correlation between Stress radiograph and intra-
9. 24
operative Tension of PCL
Correlation between Stress radiograph and Shine of
10. 25
PCL fibres
Distribution of intra-operative cross-sectional area of
11. 27
PCL
Correlation between Cross-sectional area of PCL and
12. 28
Posterior Drawer Test
Correlation between Cross-sectional area of PCL and
13. 29
Stress Radiograph translation
14. Distribution of CR and PS designs 30
Correlation between Posterior Drawer test and
15. 31
procedure
Correlation between stress radiograph measurements
16. 32
and procedure
Post operative Lysholm score variation at 3 month
17. 34
follow up between CR vs PS
Post operative KOOS score variation at 3 month
18. 36
follow up between CR vs PS

ii
 LIST OF ANNEXURES

Annexure
Description Page No.
No.
1. Ethical Clearance Certificate 50
2. Ethical Justification 51-52
3. Patient Information Sheet (English) 53
4. Patient Information Sheet (Hindi) 54
5. Documentation of Informed Consent (English) 55-56
6. Documentation of Informed Consent (Hindi) 57-58
7. Patient Proforma 59
8. Tegner Lysholm Knee Scoring Scale 60
The Knee Injury and Osteoarthritis Outcome Score
9. 61-63
(KOOS)
10. Plagiarism Certificate 64
11. Master Chart ---

iii
 SUMMARY

Background: The role of the posterior cruciate ligament (PCL) in total knee
arthroplasty (TKA) remains a subject of ongoing debate within the field of adult
reconstructive surgery. The decision to use a cruciate-retaining (CR) or posterior-
stabilized (PS) knee design is primarily based on the functional condition of the PCL.
This study is the first to evaluate the pre-operative status of the PCL, compare it with
intra-operative findings, and explore the impact of these findings on the resection of
the PCL during TKA.

Objectives: To assess the functional and anatomical status of PCL in patients

undergoing total knee arthroplasty. To calculate the rate of TKR patients requiring
PCL resection as per the assessment criteria.

Methods: 175 adult patients who underwent Total Knee Arthroplasty (TKA) were
assessed in this study. A thorough pre-operative evaluation was conducted for all
patients, which included functional assessments using the Tegner Lysholm and KOOS
scores, along with a clinical assessment via the posterior drawer test. Radiological
imaging, specifically stress radiographs, was performed to evaluate the PCL. Intra-
operative assessment involved evaluating the PCL’s Tension, integrity, appearance and
measurements. A detailed comparison was made between the pre-operative evaluation
and the intra-operative findings. At the 3-month follow-up, patients were reassessed
using the Tegner Lysholm and KOOS scores to monitor functional outcomes.

Results: In the study, Grade I laxity was the most frequently observed, accounting for
58.64% of cases, followed by no laxity at 39.66%, while Grade II was observed in
only 1.69% of cases. There was a weak negative correlation between the intra-
operative PCL cross-sectional area and the severity of laxity, indicating that larger
cross-sectional areas tend to be associated with lesser grade of laxity pre-operatively.
The mean cross-sectional area of the PCL was 101 ± 29.76 mm². A weak negative
correlation was identified between the intra-operative PCL cross-sectional area and
stress radiograph measurements, indicating that larger PCL cross-sectional areas are
associated with a lesser translation on pre-operative stress radiographs. Increased
laxity observed on the posterior drawer test, in conjunction with tibial translation
exceeding 5 mm, was more likely to be associated with intra-operative structural
changes in the PCL.

iv
A positive correlation was found between stress radiograph translation and PS
procedure indicating that an increase in stress radiograph translation is associated with
a higher likelihood of undergoing a posterior-stabilized (PS) procedure. No
statistically significant difference was observed in the postoperative KOOS and
Tegner Lysholm scores between the two procedures.

Conclusions: The results of this study indicates that knees with greater laxity in the
posterior drawer test and a preoperative stress radiograph translation exceeding 5 mm
are more likely to exhibit structural changes in the posterior cruciate ligament (PCL)
during intraoperative evaluation. These factors are also associated with the selection
of a posterior-stabilized (PS) prosthesis rather than a cruciate-retaining (CR)
prosthesis. This preoperative evaluation approach proves useful in guiding surgical
decision-making and improving patient outcomes in total knee arthroplasty (TKA).

v
 INTRODUCTION

Osteoarthritis is the most common joint ailment in India, affecting 22% to 39% of the
population. It's more common in women, with its frequency increasing notably as
people age. Around 45% of women over 65 experience symptoms, and 70% show
radiological evidence [1]. Knee osteoarthritis is a major cause of mobility issues,
especially among females, and is ranked as the 10th leading cause of nonfatal burden
[2]. OA is characterized by joint cartilage loss, bone enlargement, subchondral
sclerosis, and various changes in the synovial membrane and joint capsule.

Total knee arthroplasty (TKA) is considered as the most common treatment for end-
stage knee osteoarthritis (OA), and other underlying indications, including
inflammatory arthritis, fracture (post-traumatic OA and/or deformity), dysplasia, and
malignancy [3]. The primary goal of surgery is durable pain relief with the
improvement of functional status.

TKA is increasingly becoming the procedure of choice, with over 90% of patients
reporting a significant improvement in knee discomfort [4] and an increasing long-
term survivorship of roughly 82% at 25 years after surgery [5]. In India TKAs being
reported to ISHKS registry (Indian Society Of Hip & Knee Surgeons) increased from
1019 in 2006 to 27,000 in 2019 [6].

There have been significant changes in total knee arthroplasty (TKA) implant
design over recent decades. Initial constructs focused on recreating the hinge joint of
the knee, paying little attention to surrounding soft tissues [7]. In the 1970s, research
elucidated the impact the anterior cruciate ligament (ACL) and posterior cruciate
ligament (PCL) have on the kinematics and stability of a reconstructed knee [8] which
further gave birth to posterior stabilized and cruciate retaining designs based on
resection or preservation of PCL.

In the healthy knee, the posterior cruciate ligament (PCL) causes posterior translation
of the femur onto the tibia when the knee is flexed. This is produced by the nature of
its relative insertion sites posteriorly on the tibia and femur. As the knee is flexed, the
PCL is tensioned because the femoral insertion site moves anteriorly. As a result, the
femur is pulled posteriorly onto the tibia. This phenomenon is called ―roll-back‖ and

1
determines the AP contact position of the femur on the tibia at approximately 2–5 mm
posterior to the middle of the tibia plateau [9].

Theoretically, CR inserts preserve native knee kinematics, reduced shear stresses at

the fixation interface, with increased stability and proprioception from the retained
PCL. One of the most cited reasons for retaining the PCL is to preserve femoral
rollback, which improves extensor efficiency by lengthening the moment arm and
improves the range of flexion by minimizing the potential for impingement of the
femur on the tibial component [10].

PS inserts were developed to overcome an often attenuated PCL in osteoarthritis to

allow for improved range of motion (ROM), easier balancing, and more consistent
femoral rollback in flexion; however, they’re also associated with potential
complications such as increased fracture risk, cam-post wear, flexion instability, and
patellar clunk [11].

The severity of deformity should be considered before surgery. Presence of significant

coronal and sagittal malalignment (coronal deformity of >15°/ fixed flexion
contracture of > 20°) and possibility of difficulty in balancing often necessitate
resection of the PCL [12]. In patients with a past history of trauma or surgery around
the knee (fractures around the knee, high tibial osteotomy, and unicompartmental
knee arthroplasty) accurate soft tissue balancing would be easier with PS TKA [13].

Intraoperative appearance and tension of the PCL after arthrotomy becomes

paramount. In gross inspection, degenerative PCL with scattered bundles is
considered functionally impaired. The PCL quality is also examined by pulling the
ligament with a mosquito clamp. If the PCL shows firm and proper elasticity when
pulled, CR TKA can be performed as planned; however, if it shows abnormal stiffness
or poor elasticity, PS TKA becomes the treatment of choice from the beginning [14].

There was no difference in clinical results, ROM, kinematics, and survival rate
between CR and PS TKAs in most studies. Therefore, adherence to the surgical
indications and understanding of the differences in surgical principles might be more
important than the selection of the prosthesis type.

The question of whether to preserve or excise the posterior cruciate ligament (PCL)
during primary total knee arthroplasty (TKA) continues to be a topic of debate.

2
Posterior stress radiography with TELOS and kneeling stress radiography are the
most reliable methods to evaluate posterior cruciate ligament laxity.[15] However,
these methods have not yet been incorporated into pre-operative planning for total
knee arthroplasty. This study compares the pre-operative evaluation of the posterior
cruciate ligament (PCL) — including clinical examination (posterior drawer test) and
radiological assessment (stress radiography for PCL) — with the intraoperative
findings of the PCL.

Because Total Knee Arthroplasty (TKA) is a costly and frequently performed

procedure, health-related quality-of-life outcomes have been developed to measure
improvements in patient health status from before to after the surgery. The Knee
injury and Osteoarthritis Outcome Score (KOOS) is a valid, reliable, and responsive
outcome measure in total joint replacement.[16] Along with the KOOS, the study also
employs the Tegner-Lysholm score to evaluate and compare the pre-operative
functional status of the posterior cruciate ligament (PCL) with the follow-up
functional outcomes in patients who underwent cruciate-retaining (CR) and posterior-
stabilized (PS) total knee arthroplasty (TKA).

This study is planned to help patients, surgeons, and healthcare providers in achieving
optimal outcomes, improving surgical techniques, and ensuring cost-effective care.

3
 REVIEW OF LITERATURE

PCL AND TOTAL KNEE ARTHROPLASTY

Total knee arthroplasty has developed into a surprisingly effective and long-lasting
operation with the debut of condylar knee designs. Improvements in instrumentation
systems, fixation, and patellar resurfacing have been widely applied and have made
total knee arthroplasty a reproducible procedure. However, there is still disagreement
regarding the posterior cruciate ligament's proper function in total knee arthroplasty.

Function of PCL in total knee arthroplasty

In 1998, Pagnano et al. reviewed the role of the posterior cruciate ligament (PCL) in
total knee arthroplasty (TKA). They found that earlier claims of superior outcomes
with PCL retention, such as improved range of motion, stability, natural gait, and
prosthetic longevity, were not supported by later research. Both posterior-stabilized
(PS) and cruciate-retaining (CR) designs achieved a similar average range of motion
of 115°, with neither offering inherent varus-valgus stability. PS designs occasionally
faced dislocation, while CR knees were at risk of late PCL rupture and flexion
instability. Gait analysis and muscle strength studies showed no significant differences
between the two designs. Longevity was comparable, with survival rates exceeding
96% at 10–14 years for both PS and CR implants, depending on the tibial component
used.[17]

J I Sorger et al. conducted a observational study to investigate knee kinematics and

motion limits under five specific conditions: (1) an intact knee, (2) an anterior cruciate
ligament-deficient knee, (3) a posterior cruciate ligament (PCL)-retaining total knee
arthroplasty (TKA) using a single design, (4) a PCL-retaining TKA with the PCL
severed, and (5) a PCL-substituting TKA. Femoral rollback was analyzed across these
scenarios. The results indicated that preserving the PCL during TKA effectively
prevents posterior translation and supports femoral rollback, suggesting that the PCL
can remain functional in a cruciate-sparing TKA of a single design. In contrast,
severing the PCL led to notable changes in knee kinematics [18]

4
AN Misra et al. conducted a randomized study involving 129 knees undergoing
standard PCL-retaining cemented total knee arthroplasty (TKA), divided into two
groups: one with the PCL preserved and the other with the PCL resected. The groups
were well-matched in demographics, with a majority being women and a mean age of
67 years. After a mean follow-up of 57 months (range 56–60), there was no
statistically significant difference in the Hospital for Special Surgery scores between
the groups, despite 21 patients (24 knees) being lost to follow-up. Both groups
showed comparable outcomes in pain relief, deformity correction, range of motion,
stability, and strength. These findings suggest that retaining or excising the PCL in a
PCL-retaining TKA does not significantly affect five-year outcomes. Additionally, the
results imply that the PCL is not functional in most patients undergoing TKA, and
excellent outcomes can still be achieved with a PCL-retaining implant even when the
PCL is excised, questioning the necessity of posterior-stabilized designs in such
cases.[19]

Pre-operative assessment of PCL using stress radiographs

A systematic review conducted by J. Gared Guth et al. analyzed 13 studies

comparing stress radiography with instrumented knee devices, 6 studies examining
different stress radiography techniques, and 5 studies evaluating the reliability of
radiographic measurements. The findings revealed that stress radiography
demonstrated greater sensitivity in detecting posterior tibial translation compared to
the KT-1000 and KT-2000 devices and showed comparable sensitivity to the
Rolimeter knee arthrometer. TELOS stress radiography was identified as more
sensitive than gravity or hamstring contraction stress views in most studies, while
kneeling stress radiographs were found to be equivalent to TELOS in one study and
superior in another. Additionally, all methods of radiographic measurement exhibited
good-to-excellent intraobserver and interobserver reliability, with no single technique
demonstrating clear superiority. [15]

5
Selecting cruciate-retaining or posterior-stabilized total knee arthroplasty

Song SJ et al. conducted a critical review on the selection of prosthesis types for total
knee arthroplasty (TKA), highlighting that cruciate-retaining (CR) TKA may not be
suitable in certain situations, such as in patients with posterior cruciate ligament
insufficiency, severe deformities, or prior trauma or surgery. The likelihood of
converting from a CR prosthesis to a posterior-stabilized (PS) prosthesis increases in
cases with severe flexion contracture, a steep posterior tibial slope, or a small femoral
component size. These factors should be carefully evaluated when determining the
appropriate prosthesis. A thorough understanding of the technical differences between
CR and PS TKAs is essential for the surgeon. Key elements such as the extent of
distal femoral resection, femoral component size, and tibial slope are critical for
achieving successful outcomes in TKA. Failure to address these factors accurately can
result in complications such as stiffness or instability, which may be difficult to
resolve postoperatively. Most studies have shown no significant differences in
functional outcomes, range of motion, kinematics, or survival rates between CR and
PS TKAs. Ultimately, strict adherence to surgical guidelines and a solid understanding
of the underlying surgical principles may be more important than the selection of the
prosthesis type itself.[14]

6
STUDY TYPE OF CONCLUSION
STUDY

The function of the PCL and its pre-surgical evaluation

J I Sorger et al.Prospective Preserving the PCL during total knee

[1997] observational arthroplasty (TKA) helps prevent posterior
study translation and maintain femoral rollback,
allowing the PCL to function in a cruciate-
sparing TKA design. In contrast, removing the
PCL results in notable changes in knee
kinematics.
Pagnano et al. Review of Both posterior-stabilized and cruciate-retaining
[1998] literature designs, when combined with PCL recession,
provide an average range of motion of 115
degrees. Neither design offers inherent varus-
valgus stability. While the posterior-stabilized
design rarely causes dislocation, the cruciate-
retaining design may lead to late PCL rupture
and flexion instability.
AN misra et al. Randomized Relief from pain, correction of deformity, range
[2003] controlled of movement, stability and strength were
trial comparable in both (CR and PS). PCL is not
functional in most patients with a total knee
replacement even when retained. Secondly,
patients with an excised PCL show a good
result with a PCL-retaining implant.
Sang Jun Song et Review of Cruciate-retaining (CR) TKA may not be
al. [2019] literature appropriate in situations involving posterior
cruciate ligament insufficiency, significant
deformity, or a history of trauma or prior
surgery. Most studies have shown no significant
differences in functional outcomes, range of
motion, kinematics, or survival rates between
CR and PS TKAs.
JJ Guth et al. Systemic The most reliable methods for evaluating
[2022] review posterior cruciate ligament laxity are posterior
stress radiography with the TELOS system and
kneeling stress radiography.

7
The fate of PCL during total knee arthroplasty

Ashok Rajgopal et al. conducted a study on 100 posterior cruciate ligaments (PCLs)
obtained from 46 women and 16 men aged 49 to 91 years (mean age: 67) who
underwent PCL-retaining total knee replacement for osteoarthritis. Histological
analysis, performed using light microscopy, evaluated collagen fiber orientation,
mucoid degeneration, inflammation, and haemosiderin deposition. The PCLs were
classified into four categories: normal, mild degeneration, moderate degeneration, and
severe degeneration. Neural elements were assessed using immunohistochemical
staining for S100 protein and neurofilaments.

Of the 99 specimens analyzed, 72 were histologically normal, 4 exhibited mild

degeneration, 4 showed moderate degeneration, and 15 had severe degeneration.
Neural elements were identified in 76 specimens through immunohistochemical
staining. The study concluded that most PCLs in osteoarthritic knees remain viable,
supporting the practice of retaining the PCL during total knee replacement to enhance
kinematics, stability, and proprioception.[21]

Seiju Hayashi et al. conducted a prospective study on 61 consecutive knees from 40

patients who underwent Total Knee Arthroplasty (TKA). The study focused on
evaluating the intraoperative gross appearance of the posterior cruciate ligaments
(PCLs) and examining their correlations with various clinical parameters, histological
characteristics, and functional outcomes in cruciate-retaining TKA (CR-TKA). The
results revealed significant associations between the intraoperative appearance of the
PCL and factors such as the anterior cruciate ligament (ACL), the preoperative knee
flexion angle, and intercondylar notch stenosis. Additionally, a strong correlation was
found between the appearance of the middle portion of the PCL and its histological
features. However, no significant correlations were observed between either the
intraoperative appearance or histological characteristics of the PCL and factors such
as PCL tension, the amount of rollback, or the maximum knee flexion angle.[22]

Sherif M. Sherif et al. conducted a prospective study of 368 consecutive primary

total knee arthroplasties (TKAs) to assess the condition of the posterior cruciate
ligament (PCL) at three stages of the procedure: 1) during the initial arthrotomy, 2)
after all bone cuts were completed, and 3) after final knee balancing with all
components in place. At the start of the procedure, 94% of PCLs were found to be

8
intact. After the bone cuts, only 51% of PCLs remained intact, and by the final stage,
with the implants in place, only 33% of PCLs were intact. Additionally, 43% of PCLs
showed attenuation and were at risk for later PCL stretch-out. In cases of PCL
deficiency or attenuation, patients were treated with an anterior-stabilized bearing that
could be used with a cruciate-retaining femoral component. The authors suggest that a
cruciate-substituting bearing should always be available when performing cruciate-
retaining TKA. [23]

M A Ritter et al. conducted a study on 3,018 anatomic graduated component total

knee replacements, which included 1,846 knees with the posterior cruciate ligament
(PCL) retained, 455 with partially recessed PCLs, and 717 with the PCL completely
excised from the tibia.

The clinical results showed that flexion was significantly better in the PCL-excised
group (p < 0.0001), while stair functionality was superior in the PCL-recessed and
PCL-retained groups (p < 0.0001). Long-term aseptic survivorship revealed slight
differences between groups, with a 15-year survivorship rate of 96.4% for PCL-
retained knees, 96.6% for PCL-recessed knees, and 95.0% for PCL-excised knees,
with statistical significance (p = 0.0411, Wilcoxon; p = 0.0042, log-rank). Prosthesis
survival was 97.8% for PCL-retained knees, 98.2% for recessed knees, and 96.4% for
excised knees (p = 0.0934, Wilcoxon; p = 0.0202, log-rank).

While some trade-offs in clinical performance were observed, the study suggests that
conversion to a posterior-stabilized prosthesis may not be necessary if adequate
stability in the anteroposterior and coronal planes is achieved, even when the PCL is
excised. [24]

Posterior stabilized vs cruciate retaining total knee arthroplasty

Frank R. Kolisek et al. conducted a prospective observational study on 91 patients to

compare outcomes between posterior-stabilized (PS) and cruciate-retaining (CR) total
knee arthroplasty (TKA). Of these, 45 patients received a PS prosthesis, while 46
underwent CR TKA. At an average follow-up of 60 months (range: 49 to 69 months),
the Knee Society knee scores significantly improved in both groups. In the CR group,
the scores increased from a mean of 42 points (range: 20 to 73) to 93 points (range: 39
to 100), while in the PS group, they improved from 38 points (range: 20 to 70) to 94

9
points (range: 60 to 100). Similarly, the Knee Society functional scores increased
from an average of 36 points (range: 10 to 60) to 71 points (range: 15 to 100) in the
CR group and from 32 points (range: 10 to 70) to 73 points (range: 32 to 100) in the
PS group.

At the final follow-up, the CR group demonstrated a mean range of motion of 125°
(range: 100° to 140°), compared to 118° (range: 87° to 135°) in the PS group.
Radiographic analysis showed no progressive radiolucencies or radiolucencies
exceeding 1 millimeter in either group. Additionally, no re-operations were required
for any patient. The study concluded that neither knee design was definitively
superior, and the choice of implant should be guided by the surgeon’s preference and
the condition of the posterior cruciate ligament.[25]

Chao Jiang et al. performed a meta-analysis that included 14 randomized controlled

trials (RCTs) comparing posterior-stabilized (PS) and cruciate-retaining (CR) total
knee arthroplasty (TKA). The results showed no significant differences between the
two techniques in terms of Knee Society Knee Score (KSS), pain score (KSPS),
Hospital for Special Surgery Score (HSS), kinematic factors (such as postoperative
component alignment, tibial posterior slope, and joint line), or complication rates.
However, PS TKA was found to be superior to CR TKA in terms of postoperative
knee range of motion (ROM) [Random Effect model (RE), Mean Difference (MD) = -
7.07, 95% Confidence Interval (CI) -10.50 to -3.65, p < 0.0001], ROM improvement
[Fixed Effect model (FE), MD = -5.66, 95% CI -10.79 to -0.53, p = 0.03], and
femoral-tibial angle [FE, MD = 0.85, 95% CI 0.46 to 1.25, p < 0.0001].

In conclusion, the study found no clinically meaningful differences between CR and

PS TKA in terms of clinical, functional, radiological outcomes, or complication rates.
PS TKA, however, demonstrated superior ROM compared to CR TKA. The clinical
significance of this advantage requires further exploration and extended follow-up to
determine its relevance in practice. [26]

10
Study Type of study Conclusion
Intra-operative evaluation of PCL
Sherif M. Prospective In TKA at initial presentation, 94% of PCLs were
Sherif et al. observational intact, but after bone cuts, only 51% remained
[2013] study intact. Following knee balancing and implant
placement, 33% of PCLs stayed intact, and 43%
were attenuated, with a risk of late PCL stretch-out.
Patients with deficient or attenuated PCLs were
treated with an anterior-stabilized bearing
compatible with a cruciate-retaining femoral
component.
Ashok Prospective Most knees with osteoarthritis present with viable
rajgopal et al. observational PCLs confirmed on histopathological analysis.
[2014] study Retaining the PCL in total knee replacement is a
good option for better kinematics, stability, and
proprioception.
Seiju Hayashi Prospective A significant correlation was observed between the
et al. [2023] observational intraoperative gross appearance in the middle
study region and the corresponding histological
characteristics. However, no significant relationship
was found between the intraoperative gross
appearance or histological features and PCL
tension, rollback, or maximum knee flexion angle.
Functional outcomes in CR and PS procedure

F R kolisek et Prospective The mean Knee Society functional scores improved

al. [2009] observational from 36 to 71 points in the cruciate-retaining group
study and from 32 to 73 points in the posterior-stabilized
group. At final follow-up, the ranges of motion
were 125° (range, 100–140) for the cruciate-
retaining group and 118° (range, 87–135) for the
posterior-stabilized group. This study did not
demonstrate a clear superiority of one knee design
over the other.
Chao Jiang et Randomized No significant differences were found between PS
al. [2016] controlled and CR TKA in terms of Knee Society Knee Score
trial (KSS), pain score (KSPS), Hospital for Special
Surgery score (HSS), kinematic characteristics
(such as postoperative component alignment, tibial
posterior slope, and joint line), or complication
rates.

11
 AIM AND OBJECTIVES

AIM: Assessment of PCL status in patients undergoing TKR to objectively determine

the need of PCL resection

PRIMARY OBJECTIVES:

1. To assess the functional and anatomical status of PCL in patients undergoing

total knee arthroplasty.

2. To calculate the rate of TKR patients requiring PCL resection as per the
assessment criteria.

SECONDARY OBJECTIVES

1. To assess the functional status of PCL at 3 months post-total knee

arthroplasty.

2. To correlate the pre-operative clinical assessment with intra-operative

findings.

12
 MATERIALS AND METHODS

STUDY SETTING:

This study was conducted in patients undergoing total knee arthroplasty in the
Department of Orthopaedics at AIIMS Jodhpur.

STUDY DESIGN:

Prospective Observational study

STUDY PARTICIPANTS (CRITERIA OF SELECTION)

Inclusion criteria

1. All patients undergoing total knee arthroplasty

Exclusion criteria

1. Patients undergoing revision total knee arthroplasty

2. Patients with a history of knee trauma who were likely to undergo ligament
reconstruction and repair.

3. Patients with previous PCL deficient knees

4. Patient with knee ROM less than 90 degrees

STUDY PERIOD: April 2023- September 2024

SAMPLE SIZE: All eligible patients within the study period were included.

13
STUDY PROCEDURE AND DATA COLLECTION

All the patients admitted for primary Total Knee Arthroplasty in the Department of
Orthopaedics, AIIMS, Jodhpur, with complaints of severe knee pain were assessed
clinically after collecting basic demographic details (Name, Age, Sex, and registration
number).

Pre-operative Evaluation:
Following the acquisition of informed consent, a thorough pre-operative assessment
was performed, encompassing both clinical and radiological examinations:

1. Clinical Evaluation:
o Knee Function Scores:
 Tegner-Lyholm Score: This score was used to assess the patient's
activity level and knee function, specifically in relation to sports
and recreational activities, providing a measure of the knee's
performance in dynamic movements. It grades an overall score
from 0 to 100 based on 8 domains: squatting, locking, pain, stair
climbing, support, instability, and edema. [Annexure-8]

 KOOS (Knee injury and Osteoarthritis Outcome Score): This

instrument was employed to evaluate knee-related symptoms, daily
function, sports/recreation, quality of life, and the impact of knee
issues on physical activities. The KOOS score is a percentage that
ranges from 0 to 100, with 100 representing no knee problems and
0 representing extreme knee problems. [Annexure-9]

o Posterior Drawer Test: This physical test was conducted to assess the
stability of the posterior cruciate ligament (PCL). The test involves applying
posterior force to the tibia to check for abnormal movement, indicating
potential PCL instability or injury. The posterior drawer test was performed
to assess the degree of posterior translation of the tibia relative to the femur.
The grading system for this test was as follows: no laxity was observed
when there was no posterior translation. Grade 1 indicated a translation of
less than 5 mm, while Grade 2 represented a translation ranging from 6 to 10
mm. Finally, Grade 3 was assigned when the posterior translation exceeded
11 mm.

14
Figure 1 - Illustrates the technique used to perform the posterior drawer test

2. Radiological Assessment:
o Stress Radiography: This technique was used to evaluate the stability of
the knee joint under applied stress. It helps to determine the alignment and
displacement of the tibia, which provides valuable information about
ligamentous integrity and knee joint stability.

o For the purpose of this study, posterior translation was classified into three
distinct groups: 0-5 mm, 5-10 mm, and greater than 10 mm.

Figure 2- Stress radiograph for PCL assessment

Lateral radiograph demonstrating measurement of posterior tibial translation using the

Staubli method. A horizontal line is drawn along the tibial articular surface. Two
perpendicular lines are drawn through the posterior-most aspect of the femoral
and tibial condyles, respectively. The distance between these lines is measured. [15]

15
Intraoperative Evaluation:

All TKA procedures were performed under combined spinal epidural anesthesia by a
surgical team of orthopaedic surgeons. After elevation and exsanguination of the limb,
the tourniquet was inflated to 300 mmHg. A midline incision was made, and the knee
joint was exposed using the traditional medial parapatellar approach. An
intramedullary femoral guide with a 5° valgus angle was used for the femoral cut to
restore nearly normal anatomical articulation of the distal femur on the proximal tibia.
Approximately 7 mm of bone was removed from the distal femur. Patellar osteophytes
were excised, and patellar denervation was performed by circumferential
electrocautery.

Any medial osteophytes, the anterior cruciate ligaments (ACLs), and both menisci
were resected. The posterior bone spur was resected, and, if required, posterior
capsular release was also performed. A thorough evaluation of the posterior cruciate
ligament (PCL) is performed intraoperatively. This assessment includes examining the
ligament's tone (whether tense or lax), shine (indicating either normal or degenerative
changes), and measuring its medio-lateral and antero-posterior widths using an
arthroscopic probe to assess its condition and functionality.

Figure 3- Intra-operative evaluation of the PCL and the technique for measuring
it using an arthroscopic probe.

An extramedullary tibial guide with a perpendicular cut to the tibial anatomical axis
was used for the tibial cut. Medial or lateral soft tissue contracture was manually
evaluated carefully and released as needed. Flexion‐ extension balance, bilateral

16
stability and range of motion (ROM) were tested using trial components. The same
procedure was repeated for the other side after wound closure and dressing of the first
operated side. Closed suction drains were placed on each side. Intravenous tranexamic
acid was administered 5 to 10 minutes before the skin incision (20 mg/kg), along with
1.5 gm Cefoperazone and Sulbactam with 80 mg Gentamicin injected 30 minutes
before the incision.

For pain management, periarticular infiltration of Ranawat’s cocktail with

epinephrine, morphine, methylprednisolone, and Cefuroxime 1 gm in 50 mL of
normal saline was used, along with postoperative Inj Ropivacaine 0.2% through
epidural and IV PCM 1 gm TDS. Patients were assessed by a physical therapist and
began walking with full weight-bearing after their post-op X-rays were done on POD-
1, continuing three times daily until discharge. Both mechanical and chemical
prophylaxis were used to prevent venous thromboembolism, including an intermittent
foot-pump system and oral Aspirin 75 mg daily until discharge. After discharge, 2.5
mg of Apixaban was administered orally for 14 days if no bleeding events occurred.
All patients were discharged after drain removal around POD-6 postoperatively.

A comprehensive evaluation of the patient's condition was conducted using the Knee
Functional Score (KFS), Knee Society Score (KSS), Tegner-Lysholm Score, and
KOOS Score. Patients, with assistance from relatives and healthcare providers,
completed these assessments both preoperatively and at the 3-month postoperative
follow-up.

Data management and statistical analysis

The data from various cases were collected and analyzed using appropriate statistical
methods. Statistical analysis was conducted using SPSS software version 20.0
(Chicago, Illinois, USA). Numerical values were summarized as means and standard
deviations (SD), with 95% confidence intervals (CI) calculated when applicable. The
Pearson correlation coefficient, a common method for measuring linear correlation,
was used to evaluate the relationships between different variables. This coefficient
ranges from -1 to 1, indicating the strength and direction of the relationship. Subgroup
comparisons for significant changes were made using repeated measures analysis of
variance. The 'p' value indicates the probability that the observed difference between

17
 two groups occurred by chance. A 'p' value of less than 0.05 was considered
significant, less than 0.01 highly significant, and greater than 0.05 as non-significant.

Exclusions (n=11)
All Patient Undergoing TKA
Enrolment

(n=186) 1. Patients undergoing revision

total knee arthroplasty

2. Patients with history of knee

trauma which are likely to undergo
ligament reconstruction and repair
Fulfillment of inclusion criteria
and Provision of Informed
Consent(n=175) 3. Patients with previous PCL
deficient knees
Pre-operative

4. Patient with knee ROM less than

evaluation

Clinical evaluation (functional 90 degrees

scores and posterior drawer test) &
radiological evaluation using stress
radiograph for PCL
Intra-operative

Evaluation of the posterior cruciate ligament

evaluation of

(PCL) includes the assessment of its shine,

tension, and precise measurements
PCL

Post-surgery follow-up included functional

assessment using tegner-lysholm, KOOS score
Follow up

specifically at the 3-month follow-up.

Analysis

Data Analyzed and

Results interpreted

18
 OBSERVATIONS AND RESULTS

Figure 4- Age distribution of patients

Age distribution of patients

40.00%
36.57%
35.00%
30.28%
30.00%

25.00%
Percentage

20.00% 18.28%

15.00% 12%

10.00%

5.00%
1.14%
0.00%
31-40 years 41-50 years 51-60 years 61-70 years 71-80 years
Age group

Table 1: Age distribution of patients

Age Group (Years) Patients Percentage

31-40 years 5 1.14%
41-50 years 21 12%
51-60 years 53 30.28%
61-70 years 64 36.57%
71-80 years 32 18.28%
Total 175 100%
Mean±SD 60.92±9.57
Range 32-80

The age distribution of the study participants is presented in Table 1. The sample
comprised a total of 175 patients, with the largest group falling within the 61-70 years
age range, accounting for 36.57% (n=64) of the participants. The second most

19
prevalent group was the 51-60 years category, which represented 30.28% (n=53) of
the sample. Patients aged 71-80 years made up 18.28% (n=32) of the cohort, while
those in the 41-50 years and 31-40 years age groups represented 12.00% (n=21) and
1.14% (n=5), respectively. The mean age of participants was 60.92 years (±9.57), with
a range from 32 to 80 years.

Figure 5: Gender distribution of patients

Gender distribution of patients

28%
72%

Female Male

Table 2: Gender distribution of patients

Gender Patients Percentage

Female 126 72%
Male 49 28%
Total 175 100%

Table 2 presents the gender distribution of the study participants. Out of the total 175
patients, 126 (72%) were female, and 49 (28%) were male.

20
Figure 6: Distribution of laxity on Posterior Drawer test

Posterior Drawer test in knees

1.69%

39.66%

58.64%

Grade 0 (No laxity) Grade I Grade II

Table 3: Distribution of laxity on Posterior Drawer test

Posterior Drawer test Number of knees Percentage

Grade 0 (No laxity) 117 39.66%
Grade I 173 58.64%
Grade II 5 1.69%
Total number of knees 295 100%

The results of the Posterior Drawer test for the knees are summarized in Table 3. Out
of the total 295 knees assessed, the majority (58.64%, n=173) exhibited Grade I
laxity, while 39.66% (n=117) showed no laxity (Grade 0). A small proportion, 1.69%
(n=5), were classified as Grade II, indicating moderate laxity.

21
Figure 7: Distribution of Stress Radiograph Translation

Stress radiograph
0.34%

7.12%

92.54%

0-5 mm >5-10 mm >10 mm

Table 4: Distribution of Stress Radiograph Translation

Stress radiograph (mm) Number of knees Percentage

0-5 mm 273 92.54%
>5-10 mm 21 7.12%
>10 mm 1 0.34%
Total number of knees 295 100%
Mean±SD 3.19±1.64 mm
Range 0.8- 11 mm

Table 4 provides a detailed overview of the stress radiograph measurements taken for
the 295 knees included in the study. The majority of the knees (92.54%, n=273)
displayed displacement, ranging from 0 to 5 mm. A smaller percentage (7.12%, n=21)
showed a displacement between 5 and 10 mm, while only one knee (0.34%)
demonstrated a displacement greater than 10 mm. The mean displacement across all
knees was 3.19 mm, with a standard deviation of 1.64 mm, indicating some variability
in the measurements. The range of displacement observed was from 0.8 mm to 11
mm, highlighting a broad spectrum of stress response across the sample.

22
 Figure 8: Correlation between Posterior Drawer test and Stress radiograph

Correlation between Posterior Drawer test

and Stress radiograph translation
60.00% 53.56%
50.00%
38.64%
40.00%
Percentage

30.00%

20.00%

10.00% 5.08%
2.37% 0% 0.00% 0.34% 1.02% 0.34%
0.00%
Grade 0 (No laxity) Grade I Grade II
Posterior Drawer test

0-5 mm >5-10 mm >10 mm

Table 5: Correlation between Posterior Drawer test and Stress radiograph

Posterior Drawer Stress radiograph (mm)

test 0-5 mm >5-10 mm >10 mm
No laxity 114 (38.64%) 7 (2.37%) 0 (0%)
Grade I 158 (53.56%) 15 (5.08%) 0 (0%)
Grade II 1 (0.34%) 3 (1.02%) 1 (0.34%)
Total number of 273 (92.54%) 25 (8.47%) 1 (0.34%)
knees
Pearson correlation 0.3019 (weak positive correlation)
coefficient
P-value < 0.00001 (HS)

The distribution of posterior drawer test results and stress radiograph measurements
revealed that 94.21% of knees under no laxity group exhibited a translation of 0-5
mm, 5.78% showed >5-10 mm, and none had a translation greater than 10 mm. For
Grade I laxity, 91.32% of knees had a translation of 0-5 mm, 8.67% showed >5-10
mm, and none exhibited >10 mm. Grade II laxity was rare, with only 1 patient having
a 0-5 mm translation, 60% showing >5-10 mm, and 20% exhibiting >10 mm

23
translation. Overall, 92.54% of knees had a translation of 0-5 mm, 8.47% showed >5-
10 mm, and 0.34% presented with >10 mm. A Pearson correlation coefficient of
0.3019 indicates a weak positive correlation between the posterior drawer test and
stress radiograph measurements, with a statistically significant p-value of <0.00001.

Figure 9: Correlation between Stress radiograph and Tension of PCL found

intra-operatively

Correlation between Stress radiograph and PCL

Tension
80.00%
69.15%
70.00%
60.00%
Percentage

50.00%
40.00%
30.00% 23.39%
20.00%
10.00% 4.07% 3.05%
0.34% 0%
0.00%
0-5 mm >5-10 mm >10 mm
Stress radiograph

Lax tension Tense

Table 6: Correlation between Stress radiograph and Tension of PCL found intra-
operatively

Stress radiograph Lax Tense

(mm) Number Percentage Number Percentage
of knees of knees
0-5 mm 69 23.39% 204 69.15%
>5-10 mm 12 4.07% 9 3.05%
>10 mm 1 0.34% 0 0%
Total number of knees 82 27.79% 213 72.20%
Pearson correlation -0.2912 (weak negative correlation)
coefficient
P-value < 0.00001 (HS)

24
Table 6 presents the relationship between the stress radiograph measurements and
PCL tension, categorized as "lax" or "tense." Among the total of 295 knees, 82
(27.79%) were classified as "lax," while 213 (72.20%) were categorized as "tense." In
the "lax" group, 69 knees (84.14%) had a stress radiograph measurement between 0
and 5 mm, 12 knees (14.63%) had a measurement between 5 and 10 mm, and 1 knee
showed a displacement greater than 10 mm. Conversely, in the "tense" group, the
majority (204 knees, 95.77%) displayed a displacement of 0-5 mm, while 9 knees
(4.22%) showed a displacement of 5-10 mm, and none had a displacement exceeding
10 mm.

The correlation between the stress radiograph measurements and PCL tension was
found to be weakly negative, as indicated by the Pearson correlation coefficient of -
0.2912. This suggests that, as the stress radiograph displacement increases, the PCL
tends to exhibit less tension, although the correlation is weak. The statistical
significance of this correlation is confirmed by a p-value of less than 0.00001, which
indicates a highly significant result (HS).

Figure 10: Correlation between Stress radiograph and Shine of PCL fibres

Correlation between Stress radiograph and Shine

Of PCL fibres
80.00%
70.00% 66.78%

60.00%
Percentage

50.00%
40.00%
30.00% 25.76%
20.00%
10.00% 3.73% 3.39%
0% 0.34%
0.00%
0-5 mm >5-10 mm >10 mm
Stress radiograph

Shiny Degenerative changes

25
 Table 7: Correlation between Stress radiograph and Shine of PCL fibres

Stress radiograph (mm) Shiny Degenerative changes

Number Percentage Number Percentage
of knees of knees
0-5 mm 197 66.78% 76 25.76%
>5-10 mm 11 3.73% 10 3.39%
>10 mm 0 0% 1 0.34%
Total number of knees 208 70.51% 87 29.49%
Pearson correlation -0.2001 (weak negative correlation)
coefficient
P-value 0.0005 (HS)

The data presented in Table 7 show a correlation between stress radiograph

measurements and the condition of the posterior cruciate ligament (PCL) fibers,
specifically focusing on the appearance of shiny fibers and the presence of
degenerative changes. The majority of knees with stress radiograph measurements
between 0-5 mm (72.16%) exhibited shiny PCL fibers, while only 11 knees in the >5-
10 mm range and no knees in the >10 mm range showed this characteristic. In
contrast, 27.83% of knees in the 0-5 mm group depicted degenerative changes,
compared to larger percentages in the >5-10 mm (47.61%) and >10 mm (100%)
groups. The Pearson correlation coefficient of -0.2001 indicates a weak negative
correlation between stress radiograph measurements and the presence of shiny PCL
fibers, suggesting that greater stress displacement may be associated with a decrease
in healthy, shiny fibers. However, this relationship is weak. The p-value of 0.0005
confirms the statistical significance of the findings, indicating that the observed trends
are unlikely to be due to chance. Overall, the results imply that lower stress
radiograph displacement levels are linked to better-preserved PCL fibers, while higher
displacement in stress radiograph may contribute to the development of degenerative
changes.

26
 Figure 11: Cross-sectional area of PCL

Cross-sectional area of PCL

60.00%
50.85%
50.00%

40.68%
40.00%
Percentage

30.00%

20.00%

10.00% 5.76%
2.71%
0.00%
≤50 51-100 101-150 >150
Cross-sectional area

Table 8: Cross-sectional area of PCL

Cross-sectional area (mm2) Patients Percentage

≤50 8 2.71%
51-100 150 50.85%
101-150 120 40.68%
>150 17 5.76%
Total number of knees 295 100%
Mean±SD 101±29.76
Range 40-180

Table 8 outlines the distribution of the posterior cruciate ligament (PCL) cross-
sectional area across 295 patients. The largest proportion of patients (50.85%) had a
PCL cross-sectional area in the 51-100 mm² range, followed by 40.68% with areas
between 101-150 mm². A smaller group of patients (5.76%) had a cross-sectional area
greater than 150 mm², while only 2.71% had an area of ≤50 mm². The mean cross-
sectional area was found to be 101 mm², with a standard deviation of 29.76 mm²,

27
indicating a moderate level of variability in the measurements. The cross-sectional
area ranged from 40 mm² to 180 mm², reflecting a diverse range of sizes across the
sample.

Figure 12: Correlation between Cross-sectional area of PCL and PDT

Correlation between Cross-sectional area of PCL

and Posterior Drawer Test
40.00% 37.63%
35.00%
30.00%
23.39%
Percentage

25.00%
20.00% 17.29%
15.00% 11.52%
10.00%
5.00% 0.68%2.03%0% 1.69%
0% 0%
1.69%
0%
0.00%
≤50 51-100 101-150 >150
Cross-sectional area

Grade 0 (No laxity) Grade I Grade II

Table 9: Correlation between Cross-sectional area of PCL and Posterior Drawer

Test

Cross-sectional area (mm2) Grade 0 Grade I Grade II

(No laxity)
≤50 2 (0.68%) 6 (2.03%) 0 (0%)
51-100 34 (11.52%) 111 (37.63%) 5 (1.69%)
101-150 69 (23.39%) 51 (17.29%) 0 (0%)
>150 0 (0%) 5 (1.69%) 0 (0%)
Total 117 (39.66%) 173 (58.64%) 5 (1.69%)
Pearson correlation -0.3192 (weak negative correlation)
coefficient
P-value <0.00001 (HS)

28
Table 9 presents the relationship between the intraoperative cross-sectional area of the
posterior cruciate ligament (PCL) and the pre-operative posterior drawer Test, which
assess the degree of ligament laxity. Among patients with a cross-sectional area ≤50
mm², 25% exhibited Grade 0 (no laxity) pre -operatively, with a large proportion
showing Grade I (75%) and no patients having Grade II laxity. In the group with a
cross-sectional area of 51-100 mm², most patients were classified with Grade I laxity
(74%) pre -operatively, followed by Grade 0 (22.66%), and only a few showed Grade
II laxity (3.33%). For those with a cross-sectional area of 101-150 mm², Grade 0
results were most common (57.5%), with 42.5% patients showing Grade I laxity and
no patients presenting with Grade II laxity. The group with a cross-sectional area
>150 mm² had all the 5 patients(100%) under grade I laxity.

Overall, Grade I laxity was the most frequently observed (58.64%), followed by
Grade 0 (39.66%), and Grade II was rare (1.69%). The Pearson correlation coefficient
of -0.3192 indicates a weak negative correlation between PCL cross-sectional area
and the severity of laxity, suggesting that larger cross-sectional areas are associated
with less severe laxity pre-operatively, although the relationship is weak. The p-value
of <0.00001 confirms the statistical significance of this correlation.

Figure 13: Correlation between Cross-sectional area of PCL and Stress

Radiograph translation

Correlation between Cross-sectional area of PCL

and pre-operative Stress Radiograph
4
3.57 3.47
Mean values of Stress Radiograph

3.5
3.12
3 2.83

2.5

1.5

0.5

0
≤50 51-100 101-150 >150
Cross-sectional area

29
 Table 10: Correlation between Cross-sectional area of PCL and Stress
Radiograph translation

Cross-sectional area (mm2) Stress Radiograph (Mean ±SD)

≤50 3.57 ±1.27
51-100 3.47 ±1.81
101-150 2.83 ±1.41
>150 3.12 ±1.39
Pearson correlation coefficient -0.1481 (weak negative correlation)
P-value 0.0108 (S)

Table 10 presents the correlation between the cross-sectional area of the posterior
cruciate ligament (PCL) and the stress radiograph measurement, which assesses
posterior translation under stress. The mean stress radiograph values for different PCL
cross-sectional area categories are as follows: for ≤50 mm², the mean was 3.57 ± 1.27
mm, for 51-100 mm², it was 3.47 ± 1.81 mm, for 101-150 mm², it was 2.83 ± 1.41
mm, and for >150 mm², the mean was 3.12 ± 1.39 mm. The Pearson correlation
coefficient of -0.1481 indicates a weak negative correlation between cross-sectional
area and stress radiograph measurements, meaning that as the PCL cross-sectional
area increases, there is a decrease in stress radiograph translation. However, the
strength of this relationship is weak. The p-value of 0.0108 suggests that this
correlation is statistically significant.

Figure 14: distribution of CR and PS designs

Procedure

51.19%

48.81%

CR PS

30
 Table 11: Distribution of CR and PS designs

Procedure Patients Percentage

CR 151 51.19%
PS 144 48.81%
Total number of knees 295 100%

Table 11 illustrates the distribution of patients who underwent two distinct surgical
procedures: Cruciate Retaining (CR) and Posterior Stabilized (PS). Of the total 295
knees, 151 knees (51.19%) were treated with the CR procedure, while 144 knees
(48.81%) received the PS procedure. This distribution reflects a nearly balanced
allocation of patients between the two procedures.

Figure 15: Correlation between Posterior Drawer test and procedure

Correlation between posterior Drawer test

and procedure
40.00% 37.63%
35.00% 30.17%
30.00%
Percentage

25.00% 21.02%
20.00%
15.00%
9.49%
10.00%
5.00% 1.69%
0%
0.00%
Grade 0 (No laxity) Grade I Grade II
Cross-sectional area

CR PS

31
 Table 12: Correlation between Posterior Drawer test and procedure

Posterior Drawer test CR PS

Number Percentage Number Percentage
of knees of knees
Grade 0 (No laxity) 89 30.17% 28 9.49%
Grade I 62 21.02% 111 37.63%
Grade II 0 0% 5 1.69%
Total number of knees 151 51.19% 144 48.81%
Pearson correlation 0.4138 (weak positive correlation)
coefficient
P-value <0.00001 (HS)

Of the 117 knees that demonstrated no laxity pre-operatively, 89 knees (76.06%)

underwent the CR procedure. In contrast, 111 knees (64.16%) out of 173 knees with
Grade I laxity pre-operatively were treated with the PS procedure. Additionally, all 5
knees exhibiting Grade II laxity pre-operatively were managed with the PS procedure.

The Pearson correlation coefficient was calculated to be 0.4138, suggesting a weak

positive correlation between the degree of pre-operative laxity and the choice of
surgical procedure.

Figure 16: Correlation between stress radiograph measurements and type of

procedure

Correlation between stress radiograph

measurments and type of procedure
60.00%
49.15%
50.00% 43.39%
Percentage

40.00%
30.00%
20.00%
10.00% 2.03% 5.08%
0% 0.34%
0.00%
0-5 mm >5-10 mm >10 mm
Cross-sectional area

CR PS

32
 Table 13: Correlation between stress radiograph measurements and type of
procedure

Stress radiograph CR PS
translation (mm) Number Percentage Number Percentage
of knees of knees
0-5 mm 145 49.15% 128 43.39%
>5-10 mm 6 2.03% 15 5.08%
>10 mm 0 0% 1 0.34%
Total number of knees 151 51.19% 144 48.81%
Pearson correlation 0.3142 (weak positive correlation): With increasing
coefficient stress radiograph, chances of PS increase
P-value < 0.00001 (HS)

Table 13 illustrates the relationship between stress radiograph measurements and the
type of surgical procedure performed, specifically between Cruciate Retaining (CR)
and Posterior Stabilized (PS) procedures. Among the 151 knees that underwent CR,
the majority (96.02%) had a stress radiograph measurement of 0-5 mm, with very few
cases (3.97%) showing measurements between >5-10 mm. In contrast, among the 5-
10 mm group, 15 of the 21 knees underwent the PS procedure. Only one knee
demonstrated a translation greater than 10 mm on the stress radiograph, and this
patient subsequently underwent the PS procedure. The weak positive correlation of
0.3142 suggests that as stress radiograph displacement increases, the likelihood of
undergoing a PS procedure also increases, although the relationship is not strong. The
highly significant p-value of < 0.00001 supports the statistical relevance of this
finding.

33
Table 14: Variation of posterior drawer test and stress radiograph (SR) findings
with type of procedure

Pre-operative laxity Type of procedure

CR PS
Posterior drawer test (grade 0 or 1) and 145 127
stress radiograph (<5 mm)
Grade II posterior drawer test or stress 6 17
radiograph translation (>5 mm)
Chi square value 6.289
P value 0.0121

Out of the 23 knees with pre-operative grade II laxity on the posterior drawer test or
stress radiograph, 17 underwent a posterior-stabilized (PS) procedure. Conversely,
145 of the 272 knees (53.30%) with pre-operative grade 0 or 1 laxity received a
cruciate-retaining (CR) procedure. The chi-square value was 6.289, with a p-value of
0.0121.

This pattern of surgical choices highlights the importance of pre-operative

assessment, including the posterior drawer test and stress radiograph, in guiding the
decision-making process for selecting the most appropriate procedure.

Figure 17: Post operative Lysholm score variation at 3 month follow up between
CR vs PS

Post operative Lysholm score variation

between CR vs PS
50.00%
39.17%
40.00% 34.71%
Percentage

30.00%
20.00% 10.31%
4.47% 4.12% 7.22%
10.00%
0.00%
71-80 81-90 91-100
Lysholm score

CR PS

34
 Table 15: Post operative Lysholm score variation at 3 month follow up between
CR vs PS

Lysholm Score CR PS
Number Percentage Number Percentage
of knees of knees
71-80 13 4.47% 12 4.12%
81-90 114 39.17% 101 34.71%
91-100 21 7.22% 30 10.31%
Total number of knees 148 50.86% 143 49.14%
Range 75-91 80-96
Mean ±SD 86.25 ±3.56 86.74 ±3.64
P-value 0.2466 (NS)

Table 15 presents the variation in postoperative Lysholm scores between the Cruciate
Retaining (CR) and Posterior Stabilized (PS) procedures. Among the 148 knees that
underwent the CR procedure, 13 knees had a Lysholm score between 71-80, 114
(77.02%) knees scored between 81-90, and 21 knees had scores between 91-100. In
the 143 knees that underwent the PS procedure, 12 knees (8.39%) had scores between
71-80, 101 knees (70.62%) had scores between 81-90, and 30 knees (20.97%) scored
between 91-100.

The range of scores for the CR group was between 75-91, while for the PS group, it
ranged from 80-96. The mean Lysholm score for the CR group was 86.25 ± 3.56, and
for the PS group, it was 86.74 ± 3.64. The p-value of 0.2466 indicates that the
difference in postoperative Lysholm scores between the two procedures is not
statistically significant.

35
 Figure 18: Post operative KOOS score variation at 3 month follow up between
CR vs PS

Post operative KOOS score variation

between CR vs PS
50.00%
43.64% 42.27%
40.00%
Percentage

30.00%

20.00%

10.00% 5.84% 5.49%

1.37% 1.37%
0.00%
≤70 >70-80 >80
KOOS score

CR PS

Table 16: Post operative KOOS score variation at 3 month follow up between CR
vs PS

KOOS Score CR PS
Number of Percentage Number Percentage
knees of knees
≤70 4 1.37% 4 1.37%
>70-80 127 43.64% 123 42.27%
>80 17 5.84% 16 5.49%
Total number of knees 148 50.86% 143 49.14%
Range 69-81.6 69-82.7
Mean ±SD 75.87 ±3.04 75.95 ±3.13
P-value 0.8251 (NS)

36
Table 16 compares the postoperative KOOS (Knee injury and Osteoarthritis Outcome
Score) between the Cruciate Retaining (CR) and Posterior Stabilized (PS) procedures.
In the CR group, 4 knees (2.7%) had a KOOS score of ≤70, 127 knees (85.81%) fell
in the >70-80 range, and 17 knees (11.48%) had scores >80. In the PS group, 4 knees
(2.79%) had a score of ≤70, 123 knees (86.01%) were in the >70-80 range, and 16
knees (11.18%) scored >80. The range of KOOS scores was 69-81.6 for the CR group
and 69-82.7 for the PS group. The mean KOOS score for the CR group was 75.87 ±
3.04, and for the PS group, it was 75.95 ± 3.13. The p-value of 0.8251 indicates that
there is no statistically significant difference in the postoperative KOOS scores
between the two procedures.

37
 DISCUSSION

Total knee arthroplasty (TKA) is considered one of the most effective, cost-efficient,
and reliably successful surgical procedures in the field of orthopaedics. Total Knee
Arthroplasty (TKA) has a history of 50 years in the treatment of chronic degenerative
knee conditions. During this period the collaboration between surgeons and engineers
produced many developments in the design of the prosthesis. [27]

Orthopaedic surgeons are trained to perform surgical techniques that rely on the
integrity of the posterior cruciate ligament (PCL) by choosing between two main
Total Knee Arthroplasty (TKA) designs: the cruciate-retaining (CR) type and the
posterior-stabilized (PS) type.[28] The decision to retain or sacrifice the posterior
cruciate ligament (PCL) during total knee arthroplasty (TKA) remains a controversial
issue. One of the most commonly cited reasons for retaining the posterior cruciate
ligament (PCL) during total knee arthroplasty is to preserve femoral rollback and
theoretically improve extensor mechanism efficiency (lengthening the moment
arm).[10] For that reason CR prostheses have posterior displacement of femoral
condyles similar to a native knee, whereas in PS protheses tibial component contacts
the femoral cam causing posterior displacement of the femur.

Intraoperatively, the status of PCL should be evaluated carefully. The finding of PCL
insufficiency and poor elasticity of the degenerated PCL constitutes a contrain-
dication to CR TKA. CR TKA may not be feasible in certain conditions; PCL
insufficiency, severe deformity, and the history of previous traumas or operations
should be carefully examined for appropriate selection of the prosthesis type. [14]

This study represents a pioneering investigation into the assessment of posterior

cruciate ligament (PCL) status in patients undergoing total knee replacement (TKR)
and explores its implications for PCL resection. The study included a total of 175
patients, comprising 295 knees in total. The mean age of the participants was 60.92
years (±9.57), with females comprising 72% of the total sample. Two patients passed
away prior to their 3-month follow-up.

Among the 295 knees assessed, the largest proportion (58.64%, n=173) exhibited
Grade I laxity. A significant number of knees (39.66%, n=117) demonstrated no
laxity. Only a small fraction of the knees (1.69%, n=5) showed Grade II laxity, which

38
is indicative of moderate instability. This distribution highlights that the majority of
knees in the study had mild or no laxity, with a minimal number showing more
significant instability.

Earlier, Lukas B. Moser et al. [29] utilized stress radiographs to assess postoperative
flexion instability in Cruciate Retaining (CR) Total Knee Arthroplasty (TKA). Their
sensitivity and specificity testing revealed that the best sensitivity (90.5%) and the
best specificity (94.7%) were observed at 90° posterior drawer radiographs, with a
cut-off value of 10 mm. They concluded that stress radiographs, including the
posterior drawer position at 90° flexion, should be an integral part of the diagnostic
process for patients with suspected flexion instability. A posterior translation of more
than 10 mm in CR TKA strongly suggests PCL insufficiency.

Mutsumi Watanabe's study found that the mean PCL laxity was 2.3 mm on
postoperative stress radiographs following Cruciate Retaining (CR) Total Knee
Arthroplasty (TKA). Furthermore, postoperative satisfaction scores were significantly
highest in the subgroup exhibiting 2-4 mm of PCL laxity.[30]

Our study introduces a novel approach for evaluating the Posterior Cruciate Ligament
(PCL) by utilizing stress radiographs as part of the pre-operative workup, and
subsequently correlating these findings with intra-operative observations. The mean
translation observed on the stress radiograph across all knees pre-operatively was 3.19
± 1.64 mm. The relationship between tibial translation on the stress radiograph and
intraoperative degenerative changes was found to have a Pearson correlation
coefficient of +0.2001, indicating a weak positive correlation. A total of 273 knees
were classified into the 0-5 mm translation group on stress radiograph, of which 76
knees (27.83%) displayed degenerative changes. 21 patients were classified under 5-
10 mm translation group, with 10 knees (47.61%) showing signs of degenerative
changes. Only 1 patient exhibited more than 10 mm translation on the stress
radiograph, and this knee also demonstrated degenerative changes. In our study, we
evaluated PCL degenerative changes through a gross assessment method. This
approach involved directly examining the PCL during the surgical procedure to
identify any visible signs of degeneration, such as fraying, or other structural changes.

39
Earlier Rajgopal et al. also assessed degenerative changes in patients undergoing Total
Knee Arthroplasty (TKA) using histopathological analysis. Their findings revealed
that out of 99 patients, 72 exhibited normal histology, while 4 showed mild
degenerative changes, 4 had moderately degenerative changes, and 15 presented with
severe degenerative changes.[21]

RGHH Nelissen et al. conducted a histopathological investigation of the cruciate

ligaments in patients with osteoarthritis and rheumatoid arthritis. The study
highlighted considerable architectural and potential functional damage to the posterior
cruciate ligament (PCL) in patients with grade five radiological knee joint destruction.
Based on these observations, Nelissen et al recommended against retaining the
posterior cruciate ligament in knee prosthesis for such patients. [31]

Seiju Hayashi et al. conducted a study on the gross appearances of the posterior
cruciate ligament (PCL) and its correlation with histological characteristics. Their
findings revealed a significant correlation between the intraoperative gross
appearance of the middle portion of the PCL and its corresponding histological
features. However, no significant correlation was identified between the intraoperative
gross appearance or histological characteristics and PCL tension, the amount of
rollback, or the maximum knee flexion angle. [32]

This cohort also analyzed the cross-sectional area of the PCL at its tibial insertion site
and its correlation with the pre-operative assessment. The distribution suggested that
the majority of knees (around 91.5%) had a cross-sectional area within the range of
51-150 mm², with the largest proportion falling between 51-100 mm² (50.85%). The
mean of 101 mm² indicates that most knees in the study had a moderate-sized PCL
cross-section, with relatively low variability, as indicated by the standard deviation of
29.76 mm². Our analysis suggests that a larger cross-sectional area of the PCL is
weakly associated with a lower degree of PCL laxity on posterior drawer test. Knees
with smaller cross-sectional areas tended to exhibit more significant preoperative
laxity, while larger areas were more likely to show no laxity or only mild laxity.
Despite the weak correlation, the statistically significant p-value indicates that the
relationship is meaningful and supports the idea that larger PCL cross-sectional areas
may contribute to better ligament stability, although other factors may also play a role
in the development of PCL laxity.

40
Also, there was a weak negative correlation between cross-sectional area and stress
radiograph translation measurements, with a Pearson correlation coefficient of -
0.1481. This suggests that as the cross-sectional area of the posterior cruciate ligament
increases, there is a slight reduction in posterior translation on the stress radiograph,
although the correlation is weak. The statistically significant p-value of 0.0108 further
supports the existence of a meaningful relationship, despite the correlation being
weak.

In an earlier cadaveric study by Goyal et al., the anatomy of the posterior cruciate
ligament (PCL) retained in a posterior cruciate ligament-retaining total knee
replacement (TKR) was examined. The study reported that the average area of the
tibial insertion of the PCL was 98.1 ± 7.4 mm². Following the bone cuts made during
the procedure, the mean area of the remaining PCL insertion on the tibia was
89.2 ± 6.9 mm². These findings suggest that both the tibial and femoral insertions of
the PCL are relatively well preserved after the bone cuts in a posterior cruciate
ligament-retaining TKR.[32]

In this study, a total of 295 knees were evaluated, with 151 knees (51.19%)
undergoing the Cruciate Retaining (CR) procedure, and 144 knees being treated with
the Posterior Stabilizing (PS) procedure, indicating an almost equal distribution
between the two procedures. In a study by Yi Wang et al., a total of 307 knees from
266 patients who underwent primary Total Knee Arthroplasty (TKA) were analyzed.
Of these, 89 knees (29.0%) had the posterior cruciate ligament (PCL) sacrificed in
conjunction with the use of posterior-stabilized (PS) prostheses. The analysis revealed
that certain factors increased the likelihood of intraoperative PCL sacrifice.
Specifically, knees with rheumatoid arthritis were significantly more likely to have the
PCL sacrificed (P < 0.01). Additionally, a lower Insall-Salvati index (P < 0.01) and
more severe varus deformity (P = 0.011) were also associated with a higher risk of
PCL sacrifice. These findings highlight the importance of considering these factors
when determining the appropriate prosthesis type preoperatively.[33] Many knee
systems currently under use do not allow a conversion from CR to PS. Therefore,
from a technical perspective, as a part of the preoperative plan, it is preferable to
make the decision to use CR or PS prostheses preoperatively.

41
The data from our study indicated a weak positive correlation between pre-operative
laxity, as measured by the posterior drawer test, and the selection of prosthesis design
(Posterior Stabilized), with a Pearson correlation coefficient of 0.4138. Furthermore, a
weak positive correlation was also observed between stress radiograph measurements
and the choice of prosthesis design (PS). Of the 151 knees that underwent cruciate-
retaining (CR) procedures, most (96.02%) had a stress radiograph measurement
between 0-5 mm. In comparison, 15 out of 21 knees in the 5-10 mm group underwent
the posterior-stabilized (PS) procedure. Additionally, only one knee displayed a
translation greater than 10 mm on the stress radiograph, and this patient subsequently
underwent the PS procedure. As the translation on the stress radiograph increases, the
likelihood of using a posterior-stabilized (PS) prosthesis also increases, as indicated
by the Pearson correlation coefficient of 0.3142. This relationship is statistically
significant, as evidenced by the p-value of < 0.00001. All the 5 knees that had grade II
laxity pre-operatively underwent PS type procedure. Seventeen of the 23 knees
showing preoperative grade II laxity on stress radiographs or the posterior drawer test
underwent a posterior-stabilized (PS) procedure, with a chi-square value of 6.289,
demonstrating statistical significance.

These findings may serve as an important clue in selecting TKA designs,

underscoring the importance of incorporating the posterior drawer test and stress
radiographs into the preoperative evaluation of TKR. By providing valuable insights
into the functional status of the PCL, this approach has the potential to enhance
patient outcomes and ensure a more precise alignment with individual clinical needs.

In terms of functional outcomes, our data suggested that there was minimal difference
in KOOS scores between the CR and PS groups at the 3-month follow-up. Both
groups had a similar distribution of scores, with the majority of knees falling in the
>70-80 range (around 43-44%) and very few knees in the extreme low (≤70) or high
(>80) ranges. The mean KOOS scores for CR (75.87 ± 3.04) and PS (75.95 ± 3.13)
were nearly identical, indicating comparable functional outcomes between the two
prosthesis designs.

Earlier Ryan C. LeDuc et al. conducted a meta-analysis which indicated that there
were no significant differences in survivorship, range of motion (ROM), or clinical
knee scores between CR and PS knees. [34] Siraj Benbarka et al. performed a meta-

42
analysis of randomized controlled trials comparing CR and PS prosthesis designs. The
findings indicated that the CR approach resulted in significantly lower range of
motion and HSS scores. However, there were no significant differences between the
two groups in terms of KSS, OKS, VAS, or WOMAC scores.[35]

Our study also indicated that there was no statistically significant difference in the
postoperative Lysholm scores between the CR and PS groups at the 3-month follow-
up, as reflected by the p-value of 0.2466. Both groups exhibited similar distributions
in terms of the number of knees within each score range. The mean Lysholm scores
for the CR (86.25 ± 3.56) and PS (86.74 ± 3.64) groups were nearly identical,
suggesting comparable outcomes in terms of knee function and patient satisfaction
between the two prosthesis designs.

43
 CONCLUSION

1. The combination of grade II PCL laxity and tibial translation greater than 5
mm was more frequently associated with the selection of the Posterior
Stabilized (PS) procedure.

2. The mean cross-sectional area of the PCL at its tibial insertion site was
101±29.76 mm². Larger cross-sectional areas showed a weak negative
correlation with tibial translation on stress radiographs.

3. Increased laxity observed on the posterior drawer test, in conjunction with

tibial translation exceeding 5 mm, was more likely to be associated with intra-
operative structural changes in the PCL.

However, no significant differences were noted in the functional outcomes between

the Cruciate Retaining (CR) and PS procedures.

Recommendations

Pre-operative laxity, as assessed through radiological and clinical examination, may

provide valuable guidance in the selection of either the PS or CR procedure. However,
we recommend conducting a large-scale assessment with a multicentric approach to
incorporate this evaluation into the standard pre-operative workup protocol.

The posterior drawer test and stress radiograph for the PCL may serve as important
pre-operative evaluations that can help determine the appropriate procedure for total
knee replacement further optimizing surgical planning and improving patient
outcomes in TKA.

44
 STRENGTHS

1. This study represents the first attempt to assess the pre-operative condition of
the PCL and compare it with intra-operative findings during TKA.

2. This study is the pioneering effort to examine both the functional and
anatomical integrity of the PCL during TKA.

3. Since the study was performed by a single surgeon, there was no inter-
observer variability in the findings.

LIMITATIONS

1. The small sample size and the fact that the study was conducted at a single
tertiary care center constrain the generalizability of the results.

2. The lack of long-term follow-up precludes the availability of long-term

functional outcomes and survivorship data.

3. All intra-operative observations were derived from subjective parameters.

45
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49
ANNEXURE 1: ETHICAL CLEARANCE CERTIFICATE

50
 ANNEXURE 2: ETHICAL JUSTIFICATION

According to guideline setup by ICMR (2000) and Helsinki declaration modified

(2008) the following will be adhered to in all patients / volunteers involved in the
study.

1) All the possible treatment options will be given and none will be withheld.

2) Patients will be enrolled in the study with their knowledge and study will be done
by utilizing known investigation modalities, regarding which proper information will
be provided to the patients.

3) Patients will be informed about all the major and minor risk factors and the
remedies thereof and a refusal to participate in this study will not interfere with
patient doctor relationship.

4) Patients will be given the option of quitting from the study at any point during the
study if he or she so desires and no element of compulsion will be exerted.

5) Confidentially of data collected from contribution source or individual will be

maintained.

6) Written informed consent will be obtained from all the patients included in the
study after informing them about the aims and method of the study and the
institutional affiliation of the researcher.

7) In the cases where the patients are legally incompetent minors or are not eligible
for giving consent due to poor neurological status, consent of the close relative
available will be taken.

8) The study will not lead to extra expenditure from the part of patient. The subject
will be free to withdraw from the study at any time of their choice.

9) Participation or withdrawal from this study would have no bearing on the treatment
being offered to patients.

10) All the patients will be treated by standard protocol of the department of
Orthopaedics, AIIMS Jodhpur in the best interest of the patient. All effort will be
made to ensure that no extra visits are required for the purpose of study.

51
11) In publication of the results of this study all efforts would be made to preserve the
accuracy of both the positive and negative results of this study.

12) At conclusion of study every patient entered into this study will be assured of
access to the best proven diagnostic and therapeutic methods identified by this study.

52
 ANNEXURE 3: PATIENT INFORMATION SHEET (ENGLISH)

ASSESSMENT OF PCL STATUS IN PATIENTS UNDERGOING TKR AND

ITS IMPLICATIONS ON PCL RESECTION - PROSPECTIVE
OBSERVATIONAL STUDY

I am from All India Institute of Medical Sciences, Jodhpur. I have decided to conduct
a study on evaluation of PCL ( posterior cruciate ligament ) status in preoperative,
intraoperative and post operative period for total knee arthroplasty. The study requires
your regular follow up for 6 months.The information provided by you will be kept
confidential and the results will be presented as summary only. All the data collected
will be kept safely and it will not be communicated to your employer or co-workers
under any circumstance.

The information will be pooled and used to derive conclusions which if found
relevant will be shared with the scientific community as collective only.

There is no risk involved to you. Some questions during the interview will be
sensitive and you can refuse to answer without any consequence. You will not need to
spend any money for this study.

You are free to participate or withdraw from this research study at any time. Your
decision to participate or withdraw will not affect our relation.

In case of any medical complaints, consultation and referral to Government Hospital

will be provided.

In case of further information or clarification you can contact the following at All
India Institute of Medical Sciences, Jodhpur or the investigator over telephone.

In any case of queries, you may contact:

Dr. Manveer Singh

+91-9680790481

53
 ANNEXURE 4: PATIENT INFORMATION SHEET (HINDI)

आर्थोपेडिक्स डिभाग
ऑल इडं िया इडं टिि्यिू ऑफ मैडिकल साईडसस,
ं जोधपरु
सच
ू ना पत्र

TITLE: "“कुल घुटने का प्रतिस्थापन से गुजर रहे मरीजों में पीसीएल की तस्थति का आकलन और पीसीएल ररजेक्शन

पर इसके प्रभाव - संभावित अिलोकन अध्ययन"

मैं अवखल भारतीय आयवु ििज्ञान संस्थान, जोधपरु से ह।ूँ मैंने कुल घटु ने के आर्थ्रोप्लास्टी के वलए प्रीऑपरे वटि, इट्रं ाऑपरे वटि और
ऑपरे वटि उपचार के बाद पीसीएल वस्थवत के मलू यांकन पर एक अध्ययन करने का वनर्िय वलया है।अध्ययन के वलए 6 महीने के वलए
आपके वनयवमत अनिु ती कारि िाई की आिश्यकता है। आपके द्वारा प्रदान की गई जानकारी को गोपनीय रखा जाएगा और पररर्ाम
के िल साराश
ं के रूप में प्रस्ततु वकए जाएगं े। एकत्र वकए गए सभी डेटा को सरु वित रखा जाएगा और इसे वकसी भी पररवस्थवत में आपके
वनयोक्ता या सहकवमियों को सूवचत नहीं वकया जाएगा।

जानकारी को एकवत्रत वकया जाएगा और वनष्कर्ि वनकालने के वलए उपयोग वकया जाएगा, जो प्रासंवगक पाए जाने पर िैज्ञावनक समदु ाय
के साथ सामवू हक रूप से साझा वकया जाएगा।

आपके वलए कोई जोवखम शावमल नहीं है। सािात्कार के दौरान कुछ प्रश्न संिेदनशील होंगे और आप वबना वकसी पररर्ाम के उत्तर देने
से मना कर सकते हैं। इस अध्ययन के वलए आपको कोई पैसा खचि करने की आिश्यकता नहीं होगी।

आप वकसी भी समय इस शोध अध्ययन में भाग लेने या इसमें भाग लेने के वलए स्ितंत्र हैं। भाग लेने या िापस लेने का आपका वनर्िय
हमारे संबंध को प्रभावित नहीं करे गा।

वकसी भी वचवकत्सीय वशकायत के मामले में, परामशि और सरकारी अस्पताल को रे फरल प्रदान वकया जाएगा।

अवधक जानकारी या स्पष्टीकरर् के मामले में आप अवखल भारतीय आयवु ििज्ञान सस्ं थान, जोधपरु या अन्िेर्क से टेलीफोन पर सपं कि
कर सकते हैं।

वकसी भी प्रश्न के मामले में, आप संपकि कर सकते हैं:

अवधक प्रश्नों के वलए व्यवक्त से संपकि करें

डॉ. मनिीर वसंह

+91- 9680790481

54
ANNEXURE 5: DOCUMENTATION OF INFORMED CONSENT (ENGLISH)

I.….….….….….….….….….….….….….….…. have read the information in this

form (or it has been read to me). I was free to participate in the study. I am over 18
years of age and, exercising my free power of choice, hereby give my consent to be
include as a participant in

"ASSESSMENT OF PCL STATUS IN PATIENTS UNDERGOING TKR AND

ITS IMPLICATIONS ON PCL RESECTION - -PROSPECTIVE
OBSERVATIONAL STUDY"

(1) I have read and understood this consent form and the information provided to me.

(2) I have had the consent document explained to me.

(3) I have been explained about the nature of the study.

(4) My rights and responsibilities have been explained to me by the investigator.

(5) I have been advised about the risks associated with my participation in the study.

(6) I have informed the investigator of all the treatments I am taking or have taken in
the past……..

months including any desi (alternative) treatments.

(7) I agree to cooperate with the investigator and I will inform him/her immediately if
I suffer unusual symptoms.

(8) I have not participated in any research study within the past ….... month(s).

(9) I have not donated blood within the past …..… months

(10) I am aware of the fact that I can opt out of the study at any time without having
to give any reason and this will not affect my future treatment in the hospital.

(11) I am also aware that the investigators may terminate my participation in the study
at any time, for any reason, without my consent.

(12) I hereby give permission to the investigators to release the information obtained
from me as result of participation in this study to the sponsors, regulatory authorities,

55
Government agencies, and ethics committee. I understand that they may inspect my
original records.

(13) My identity will be kept confidential if my data are publicly presented.

(14) If, despite following the instructions, I am physically harmed because of any
substance or any procedure as stipulated in the study plan, [my treatment will be
carried out free at the investigational site / the sponsor will bear all the expenses], if
they are not covered by my insurance agency or by a Government program or any
third party.

(15) I have had my questions answered to my satisfaction.

(16) I have decided to be in the research study.

I am aware, that if I have any questions during this study, I should contact at one of
the addresses listed above. By signing this consent from, I attest that the information
given in this document
I will be given a copy of this consent document.
Date:
Participant’s initials
Place:
Name of the participant:
Complete postal Address:
Signature of principal investigator:
Date: Place:
This is to certify that above consent has been obtained in my presence.
Witness Signature
Name:
Address:
Investigator Name: Guide’s Name:

Dr. Manveer Singh Dr. Sumit Banerjee

+91-9680790481 +91 9910895314

56
ANNEXURE 6: DOCUMENTATION OF INFORMED CONSENT (HINDI)

सूचित सहमचत का दस्तावेज:

मैं............................................. ने इस फॉमम में जानकारी पढ़ली है (या यह मुझे पढ़ी गई है ) मैं

अध्ययन में भाग लेने के चलए स्वतंत्र हं । 18 वर्म से अचधक आयु का हं और अपनी स्वतंत्र शक्ति

का प्रयोग कर रहा/रही हं व इस अध्ययन में भाग लेने की सहमचत दे ता/ दे ती हूँ ।

“कुल घुटने का प्रतिस्थापन से गुजर रहे मरीजों में पीसीएल की तस्थति का आकलन और पीसीएल
ररजेक्शन पर इसके प्रभाव - संभावित अिलोकन अध्ययन "

(1) मैंने इस सहमचत फॉमम को पढ़ा और समझ चलया है ।

(2) मु झे सहमचत दस्तावेज अच्छे से समझा चदया गया है ।

(3) मु झे अध्ययन के चववरण समझाया गया है ।

(4) अन्वे र्क द्वारा मु झे मे रे अचधकार और चजम्मेदाररयों को समझाया गया है ।

(5) मु झे मे रे उपिार के बारे में सभी रूपरे खाओं के अन्वेर्क द्वारा सूचित चकया गया है ।

(6) मैं जां िकताम को आजतक चजतनी भी दवाइयां या इलाज करवाए है चजनमे दे सी इलाज भी
शाचमल है बता िूका हु

(7) मैं जां िकताम से सहयोग करने के चलए सहमत हं और मैं चनयचमत अंतरालों पर क्तिचनकों में
उपक्तथथत रहं गा जै सा चक जां िकताम ने बताया है ।

(8) मैं ने चपछले ... .. महीने / साल के भीतर चकसी भी शोध अध्ययन में चहस्सा नहीं चलया है ।

(9) मैं ने चपछले ...... महीनो से रि दान नहीं चकया है

(10) मैं इस तथ्य से अवगत हं चक मैं चकसी भी समय चबना चकसी कारण के अध्ययन से बाहर चनकल
सकता है और यह इस अस्पताल में मे रे भचवष्य के उपिार को प्रभाचवत नहीं करे गा।

(11) मैं यह भी जानता हं चक जां िकताम मे री सहमचत के चबना, चकसी भी कारण, चकसी भी समय
अध्ययन में मे रे वार्म की भागीदारी को समाप्त कर सकते हैं ।

(12) प्रायोजकों, चवचनयामक प्राचधकाररयों, सरकारी एजेंचसयों और नै चतकता सचमचत को इस अध्ययन

में भाग ले ने के पररणामस्वरूप, मैं ने इनके द्वारा प्राप्त जानकारी को जारी करने के चलए
जां िकताम ओं को अनु मचत दी है । मैं समझता हं चक वे मे रे मू ल अचभले खों का चनरीक्षण कर सकते
हैं ।

57
 (13) अगर मे रे र्े टा को सावमजचनक रूप से प्रस्तु त चकया गया है तो मे री पहिान को गोपनीय रखा
जाएगा।

(14) यचद चनदे शों का पालन करने के बावजू द, मु झे शारीररक रूप से नु कसान पहुं िाया जाता है
क्ोंचक अध्ययन योजना में चनधाम ररत चकसी भी प्रचिया के कारण, मे रा इलाज जां ि थथल पर
मु फ्त में चकया जाएगा / प्रायोजक सभी खिों को सहन करें गे, यचद वे मे री बीमा एजें सी या चकसी
सरकारी कायमिम या चकसी तीसरे पक्ष द्वारा कवर नहीं चकया जाता है

(15) मे रे सवालों के मे री संतुचि के अनु सार उत्तर चदए गए हैं ।

(16) मैं ने शोध अध्ययन में शाचमल होने का चनणमय चलया है ।

चदनां क:
प्रचतभागी के हस्ताक्षर:
जगह:
प्रचतभागी का नाम:

पूरा र्ाक पता:

प्रमु ख अन्वे र्क के हस्ताक्षर:

चतचथ:
जगह:

यह प्रमाचणत करना है चक उपरोि सहमचत मेरी उपक्तथथचत में प्राप्त की गई है ।

गवाह के हस्ताक्षर

नाम:
पता:

58
 ANNEXURE 7: PATIENT PROFORMA

Patient’s Name:

Age/sex:

Height/weight -

AIIMS ID:

Group:

Comorbidities:

Complaint (duration):

Lysholm knee score:

KOOS score:

PCL integrity tests:

Posterior drawer test:

Date of surgery:

Procedure:

intra-op specific findings:

Right knee Left knee

Shine
Tension
Intra-operative measurements
(Antero-posterior width and
medio-lateral width)

TEGNER LYSHOLM
Follow up KOOS
SCORE
3 months

59
ANNEXURE 8: TEGNER LYSHOLM SCORE

60
ANNEXURE 9: KNEE INJURY AND OSTEOARTHRITIS OUTCOME
SCORE (KOOS)

61
62
63
PLAGIARISM REPORT

64
 MASTER CHART
POSTERIOR CROSS
DATE OF KNEE LYSHOLM STRESS INTRAOPERATIVE CR VS LYHOLM ALPHA BETA GAMMA DELTA
NAME AGE AIIMS ID CONTACT NO DIAGNOSIS COMORBIDITIES VARUS KFS KSS KOOS DRAWER SECTION KFS KSS KOOS
SURGERY ROM SCORE RADIOGRAPH FINDINGS PS SCORE ANGLE ANGLE A NGLE ANGLE
TEST AREA
SHINE TESNION
AMAN SINGH. 59/M AIIMS/JDH/2015/12/009929 94175- 84320 18/04/2023 BILATERAL OA KNEE (KL GRADE IV) HTN AND DM 10-100 0-5 40 48 57 44.6 GRADE I 4 SHINY TENSE R 10 7 PS 70 80 80 90 75.6 94 90 7 86
. 0-100 5-10 50 57 45.2 GRADE I 2.4 SHINY TENSE L 10 8 PS 80 85 90 74.4 91 94 5 86
MRIDULA AGGARWAL 67/F AIIMS/JDH/2021/08/007390 84172- 84320 11/04/2023 BILATERAL OA KNEE HTN 0-110 5-10 50 50 64 48.8 GRADE I 2.6 SHINY TENSE R 12 9 CR 108 70 84 85 73.2 93 90 6 85
5-110 5-10 48 62 50.6 GRADE I 1.4 SHINY TENSE L 13 8 CR 104 84 85 73.8 92 89 5 84
KHAMA KANWAR 68/F AIIMS/JDH/2022/07/013525 9571957488 25/04/2023 BILATERAL OA KNEE DM AND HTN 0-120 5-10 35 50 53 45.2 GRADE I 3 SHINY LAX R 12 9 PS 108 70 84 85 73.2 94 87 8 87
0-120 5-10 49 57 47.6 GRADE I 2 SHINY TENSE L 13 8 CR 104 86 85 72.6 95 88 7 85
SANTOSH SONI 64/F AIIMS/JDH/2014/12/005243 9460250130 / 291263854 25/04/2023 BILATERAL OA KNEE HTN AND DM 5-100 5-10 50 39 49 44.6 GRADE I 3 DEGNERATIVE CHANGES TENSE R 10 7 PS 70 80 90 90 75.6 93 86 5 86
5-100 5-10 38 49 43.5 GRADE I 3 DEGNERATIVE CHANGES LAX L 11 7 PS 77 89 90 76.2 95 88 5 88
USHRANI RANAWAT 67/F AIIMS/JDH/2023/03/002082 27/04/2023 BILATERAL OA KNEE HTN 0-120 5-10 54 66 51 45.8 NO LAXITY 4 DEGNERATIVE CHANGES TENSE R 10 8 PS 80 80 84 86 76.8 96 87 4 83

INDU BISSA 64/F AIIMS/JDH/2019/03/006471 9.1862E+11 27/04/2023 BILATERAL OA KNEE HTN AND DM 0-120 5-10 40 50 49 42.9 NO LAXITY 3.2 SHINY TENSE R 12 8 PS 96 80 85 90 78 97 86 6 82
10-110 5-10 42 47 41.1 GRADE I 3.6 SHINY LAX L 11 8 PS 88 85 90 77.4 94 87 7 84
PREM LATA 60/F AIIMS/JDH/2023/04/018346 9414108251 01/05/2023 BILATERAL OA KNEE HTN 0-110 5-10 50 50 58 48.2 NO LAXITY 2.2 SHINY TENSE R 14 7 CR 98 70 80 85 74.4 95 86 4 82
0-110 5-10 49 56 47.6 NO LAXITY 2.6 SHINY TENSE L 13 8 CR 104 80 85 73.8 96 89 5 84
PRAKASH CHAND 75/M AIIMS/JDH/2016/09/007248 9829157729 03/05/2023 BILATERAL OA KNEE HTN 0-120 5-10 45 40 52 42.9 NO LAXITY 3.2 DEGENERATIVE CHANGES TENSE R 13 11 CR 143 80 90 90 77.4 97 87 7 85
0-120 5-10 39 52 41.7 NO LAXITY 3.2 DEGENERATIVE CHANGES TENSE L 14 11 CR 154 90 90 76.8 95 89 7 86
SHANTA 71/F AIIMS/JDH/2023/04/012674 9541274310 18/05/2023 BILATERAL OA KNEE NIL 5-100 5-10 40 38 58 40.5 GRADE I 4.2 DEGENERATIVE CHANGES LAX R 10 7 PS 70 70 85 90 75.6 95 87 4 84
5-100 5-10 37 58 39.3 GRADE I 3.8 DEGENERATIVE CHANGES LAX L 11 7 PS 77 85 85 75 94 86 5 87
PREMLATA 51/F AIIMS/JDH/2023/04/015409 9414108251 08/05/2023 BILATERAL RA KNEE RA 0-120 0-5 50 50 54 41.1 NO LAXITY 4 DEGENERATIVE CHANGES TENSE R 13 6 PS 78 80 90 91 77.4 96 87 7 84
0-120 0-5 49 49 42.3 NO LAXITY 3 DEGENERATIVE CHANGES TENSE L 12 9 PS 108 90 91 78 97 88 8 83
KEWALCHAND 76 /M AIIMS/JDH/2022/02/011868 8000247728 / 9983278910 22/06/23 BILATERAL OA KNEE HTN 5-120 5-10 45 47 61 45.2 NO LAXITY 2 SHINY TENSE L 14 8 CR 112 70 85 86 76.2 95 89 6 85

NARAYAN RAM 67/M AIIMS/JDH/2023/05/017934 9509849255 22/06/2023 BILATERAL OA KNEE HTN DM 0-110 5-10 40 40 60 47 GRADE I 1.6 SHINY TENSE R 16 10 CR 160 death 94 86 7 84
0-110 5-10 39 56 48.2 GRADE I 2.4 SHINY TNESE L 14 8 PS 112 97 86 7 86
KAMLA DEVI JANGID 71/F AIIMS/JDH/2023/04/014598 27/06/2023 BILATERAL OA KNEE NIL 5-120 5-10 45 36 54 41.7 GRADE I 4 SHINY LAX R 12 8 PS 96 70 85 90 75.6 95 89 6 83
10-120 5-10 35 54 42.3 GRADE I 3.6 SHINY LAX L 11 9 PS 99 85 90 76.2 94 90 5 82
NIRMAL PRAJAPAT 50/M AIIMS/JDH/2023/04/003261 9460547891 28/6/23 BILATERAL OA KNEE NIL 0-110 5-10 50 48 64 53 NO LAXITY 4 DEGERNATIVE CHANGES LAX R 12 8 PS 96 80 84 90 75 97 88 7 84
0-110 5-10 48 62 53.6 NO LAXITY 4 SHINY TENSE L 11 7 PS 77 84 90 74.4 96 87 8 85
DISHA PAHUJA 43/F AIIMS/JDH/2022/04/006128 9414295610 30/6/23 BILATERAL RA KNEE AF 5-120 5-10 60 48 65 55.4 NO LAXITY 2 SHINY TENSE R 15 10 CR 150 80 90 91 78 94 88 6 86

SHANTI LAL BANG 73/M AIIMS/JDH/2023/07/004330 9680204730 12/7/2023 BILATERAL OA KNEE ASTHMA, HTN 0-120 0-5 60 53 63 50 NO LAXITY 1.6 SHIINY TENSE R 13 11 CR 143 80 91 91 78.6 97 86 7 87

URMILA TRIVEDI 58/F AIIMS/JDH/2023/07/003613 7727899510 20/07/2023 BILATERAL OA KNEE(KL GRADE IV) HTN,DM-2 0-110 5-10 50 48 65 50 NO LAXITY 1.6 SHIINY TENSE R 16 10 CR 160 60 86 80 72 95 89 6 85
0-110 5-10 48 63 48.2 NO LAXITY 2 SHINY TENSE L 15 11 CR 165 81 75 71.4 95 87 7 83

BHAGWATI DEVI 65/F AIIMS/JDH/2023/05/009929 9214833207 / 9252886863 21/07/2023 BILATERAL OA KNEE HTN 5-120 5-10 45 41 60 41.1 GRADE I 1.6 SHINY TENSE R 15 10 CR 150 70 85 90 76.8 94 89 4 84
5-120 5-10 40 54 39.3 GRADE I 1.2 SHINY TENSE L 14 9 PS 126 85 85 78.6 97 86 5 83
MEENAKSHI 36/F AIIMS/JDH/2023/05/020817 6376235974 26/07/2023 BILATERAL OA KNEE IN K/C/O RA NIL 20-100 5-10 0 22 35 5 GRADE II 8 DULL LAX R 10 8 PS 80 60 79 82 72 95 87 6 86

DHAKU DEVI 65/F AIIMS/JDH/2023/04/006861 9950816243 26/7/2023 BILATERAL OA KNEE(KL GRADE IV) HTN 5-100 5-10 35 42 41.1 40 GRADE I 7 SHINY LAX R 12 8 PS 96 70 87 86 75.6 97 87 7 85
5-100 5-10 41 39.3 GRADE I 7 SHINY LAX L 11 7 PS 77 87 86 76.8 98 88 8 87
PARVATI 55/F AIIMS/JDH/2023/06/004380 9649351023 27/7/2023 BILATERAL OA KNEE HTN, DM 0-110 5-10 40 50 58 38.7 NO LAXITY 3.6 SHINY TENSE R 14 9 PS 126 80 91 91 79.2 95 87 6 83
0-110 5-10 50 58 41.1 NO LAXITY 4.2 SHINY TENSE L 12 9 PS 108 91 91 78 94 88 5 84
CHANDRA PRAKASH
74/M AIIMS/JDH/2014/01/011361 9166004833 25/07/2023 RIGHT OA KNEE(KL GRADE IV) BPH 0-120 0-5 45 47 62 47.6 NO LAXITY 4.2 SHINY TENSE R 12 10 CR 120 70 87 86 75 95 86 7 85
ARORA

MUBARKI 63/F AIIMS/JDH/2022/08/008599 28/07/2023 RIGHT OA KNEE NIL 0-110 5-10 50 40 54 44.6 GRADE I 3 SHINY LAX R 11 8 PS 88 70 88 86 78 96 85 4 87

VIMLA SHAH 63/F AIIMS/JDH/2023/05/003216 9414382650 4/8/2023 BILATERAL OA KNEE(KL GRADE IV) HTN 0-110 5-10 40 42 58 41.1 GRADE I 4.8 DULL LAX R 14 8 PS 112 70 88 82 74.4 95 86 5 86
0-110 5-10 41 58 39.3 GRADE I 3.2 DULL LAX L 12 7 PS 84 88 82 75 94 87 7 84
OM PRAKASH RAMWAT 72/M AIIMS/JDH/2023/07/017463 7976256347 07/08/2023 BILATERAL OA KNEE(KL GRADE IV) HTN,DM-2 0-120 5-10 40 51 63 42.3 NO LAXITY 5 SHINY LAX R 14 8 PS 112 80 91 91 78.6 97 85 4 83
0-120 5-10 52 63 44 NO LAXITY 3 SHINY TENSE L 15 7 PS 105 91 91 77.4 96 86 6 82
KAMLA DEVI 61/F AIIMS/JDH/2023 9413395615 08/08/2023 BILATERAL OA KNEE(KL GRADE IV) NIL 10-100 5-10 35 40 58 42.3 GRADE I 4.8 SHINY TENSE R 10 7 PS 70 70 87 91 75.6 96 87 7 84
10-100 0-5 39 56 41.1 GARDE I 3.2 SHINY TENSE L 11 8 PS 88 87 91 74.4 97 86 7 83
MUNNI SOLANKI 52/F AIIMS/JDH/2023/08/3513 9414054843 09/08/2023 BILATERAL OA KNEE(KL GRADE IV) NIL 5-100 5-10 40 37 62 44.6 NO LAXITY 1.6 SHINY TENSE R 14 8 CR 112 80 91 91 77.4 96 88 6 85
5-100 5-10 35 62 45.8 NO LAXITY 1.6 SHINY TENSE L 12 9 CR 108 91 91 78.6 94 89 7 87
GANI MOHAMMAD 79/M AIIMS/JDH/2023/05/009826 10/08/2023 BILATERAL OA KNEE(KL GRADE IV) NIL 0-100 0-5 35 32 54 41.7 GRADE I 4.8 SHINY LAX R 15 10 PS 150 60 81 81 73.2 96 86 4 85
0-100 0-5 38 56 44 GRADE I 1.6 SHINY TENSE L 16 10 PS 160 81 81 72 95 87 5 86
PEPPI DEVI 60/F AIIMS/JDH/2023/07/019437 14/08/2023 BILATERAL OA KNEE ( KL GRADE IV) HTN HYPOTHYROIDISM 10-90 5-10 40 37 53 40.5 GRADE I 4 SHINY TENSE R 14 10 PS 140 70 86 86 75.6 97 86 6 87
5-100 5-10 36 56 42.3 GRADE I 3.2 SHINY TENSE L 14 9 PS 126 86 86 74.4 94 88 7 85
CHOTI BAI 59/F AIIMS/JDH/2023/04/013034 16/08/2023 BILATERAL OA KNEE(KL GRADE IV) HTN 0-100 5-10 40 36 63 47.6 GRADE I 6 SHINY LAX R 8 8 PS 64 70 85 86 76.2 97 85 6 84
0-90 5-10 35 61 48.8 GRADE I 4.8 SHINY LAX L 8 6 PS 48 86 86 77.4 95 88 8 83
PREMLATA 62/F 9.82623E+13 9414108251 21/08/2023 BILATERAL OA KNEE(KL GRADE IV),HTN 10-90 0-5 25 30 52 39.3 GRADE I 2.4 SHINY LAX R 10 6 PS 60 70 86 86 76.2 97 86 6 84
30-90 5-10 21 54 38.1 GRADE I 3 SHINY LAX L 12 7 PS 84 85 86 75.6 96 86 6 85
PUSHPA DEVI 75/F AIIMS/JDH/2023/07/001775 9414269397 28/08/2023 BILATERAL OA KNEE(KL GRADE IV),HTN 10-100 0-5 35 37 54 42.9 GRADE I 4 SHINY TENSE R 11 8 PS 88 80 91 91 79.2 95 88 7 86
10-100 0-5 36 52 41.1 GRADE I 3.2 SHINY TENSE L 12 7 PS 84 91 91 79.8 96 88 4 82
BILATERAL OA KNEE(KL GRADE IV)
RAM PRAKASH SONI 66/M AIIMS/JDH/2017/06/006019 0.941756745 28/08/2023 CAD,HTN,DM-2 5-100 0-5 40
SECONDARY TO RA
10-90 0-5 36 61 44.6 GRADE I 2 SHINY TENSE L 13 10 CR 130 70 85 86 75 95 89 6 84
HARISH CHANDRA 70/M 9.89262E+14 9414120050 31/08/2023 BILATERAL OA KNEE(KL GRADE IV) HTN 15-90 10 30 41 57 48.8 GRADE I 6.4 SHINY TENSE R 14 10 CR 140 70 84 86 74.4 94 90 4 82

PANCHI D 63/F 9.89262E+14 9571684680 31/08/2023 BILATERAL OA KNEE(KL GRADE IV) NIL 30- 100 5-10 35 37 61 44 GRADE I 4.8 SHINY TENSE R 12 7 PS 84 80 91 91 79.2 96 86 6 84
10-90 5-10 46 56 45.8 GRADE I 3.2 SHINY TENSE L 14 8 CR 112 91 91 78.6 95 86 7 85
BUDHA RAM 62/M 9.89262E+14 9887741050 11/9/23 RIGHT OA KNEE(KL GRADE IV)IN O/C/O LEFT TKA TYPE-2 DM 0-100 5 55 53 58 46.4 GRADE I 4 DEGNERATIVE CHANGES LAX R 12 9 PS 108 90 91 96 82.7 93 92 5 82

SHANTI 64/F AIIMS/JDH/2023/08/000643 9414590208 4/9/2023 BILATERAL ARTHRITIC KNEE IN K/C/O RA RA,HTN,DM-2 0-90 5 50 38 48 36.9 GRADE I 3.2 DEGNERATIVE CHANGES LAX R 10 5 PS 50 70 86 87 74.4 97 90 5 85
5-90 5 36 43 35.7 GRADE I 4.8 DEGNERATIVE CHANGES LAX L 9 6 PS 54 86 86 75.6 97 90 6 84
OCHAB KANWAR 55/F 9.89262E+14 8209998303 26/09/2023 BILATERAL OA KNEE HTN 0-90 5 30 41 63 48.8 NO LAXITY 3 SHINY TENSE R 16 10 CR 160 death 95 86 7 83
10-100 5 31 61 47 NO LAXITY 4 SHINY TENSE L 15 11 CR 165 96 86 4 84
SARASWATI 75/F 9.89262E+14 9879681008 29/09/2023 BILATERAL OA KNEE NONE
0-90 5 40 43 57 36.9 GRADE I 3 DEGNERATIVE CHANGES LAX L 12 9 PS 108 70 85 86 76.2 97 88 6 83
KELI DEVI 69/F 9.89262E+14 9116958368 29/09/2023 BILATERAL OA KNEE none 0-90 5 55 39 63 49.4 GRADE I 2 SHINY TENSE R 15 10 CR 150 80 90 91 79.2 95 86 7 84
20-90 5 37 59 46.4 GRADE I 3 SHINY LAX L 12 8 PS 96 89 91 80.4 94 86 4 85
MOHINI 50/F 9.89262E+14 7339752398 17/10/2023 BILATERAL OA KNEE (KL GRADE IV) NONE 10-90 10 40 35 65 49.4 GRADE I 3 SHINY TENSE R 14 10 CR 140 70 84 86 75 96 89 6 86

RATNI KOTHARI 66/F 9.89262E+14 7014568600 19/10/2023 BILATERAL OA KNEE ( KL GRADE IV) HTN , CABG 0-100 ABSENT 55 42 65 53.6 NO LAXITY 1 SHINY TENSE R 15 9 CR 135 60 78 77 72 96 86 6 82
0-100 ABSENT 42 63 51.8 NO LAXITY 1 SHINY TENSE L 13 8 CR 104 79 77 73.2 97 90 7 83
SHANTI DEVI 80/F 9.89262E+14 9414590208 17/10/2023 LEFT OA KNEE IN E/O/C/O RIGHT TKA NONE
0-90 ABSENT 30 36 57 47.6 GRADE I 4.8 SHINY TENSE L 14 9 CR 126 60 80 81 72 97 87 5 86
LAXMI 37/F 9.89262E+14 9413520127 17/10/2023 BILATERAL IMFLAMMATORY ARHTRITIS RA 0-90 10 40 36 47 41.1 GRADE I 8 DEGENERATIVE CHANGES LAX R 11 8 PS 88 70 85 86 75.6 95 86 4 85
5-90 5 38 52 44.6 GRADE I 4 DEGENERATIVE CHANGES LAX L 9 7 PS 63 85 86 75 97 87 6 83
PAPPU LAL 46/M 9.89262E+14 9828231389 17/10/2023 BILATERAL OA KNEE (KL GRADE IV) NONE 10-90 5 35 32 52 42.3 NO LAXITY 3 SHINY TENSE R 15 8 CR 120 80 90 91 78.6 95 90 4 73
10-90 15 32 52 39.9 NO LAXITY 4 SHINY TENSE L 14 9 CR 126 91 91 79.2 94 92 5 82
MANJU SEN 63/F 9.89262E+14 8209363565 19/10/2023 BILATERAL OA KNEE (KL GRADE IV) NONE 0-100 5 40 46 64 46.4 GRADE I 2 SHINY TENSE R 15 8 CR 120 70 85 86 74.4 96 88 6 86
0-100 5 46 62 44.6 GRADE I 1 SHINY TENSE L 12 7 CR 84 86 86 74.4 97 90 5 86
KAMLA DEVI 65/F 9.89262E+14 9413395615 26/10/23 BILATERAL OA KNEE ( KL GRADE IV) DM TPYE II 5-100 5 50 38 62 42.3 GRADE I 1.6 SHINY TENSE R 12 10 CR 120 60 78 77 69.6 99 90 4 82
 MASTER CHART
POSTERIOR CROSS
DATE OF KNEE LYSHOLM STRESS INTRAOPERATIVE CR VS LYHOLM ALPHA BETA GAMMA DELTA
NAME AGE AIIMS ID CONTACT NO DIAGNOSIS COMORBIDITIES VARUS KFS KSS KOOS DRAWER SECTION KFS KSS KOOS
SURGERY ROM SCORE RADIOGRAPH FINDINGS PS SCORE ANGLE ANGLE A NGLE ANGLE
TEST AREA
5-100 5 36 60 41.1 GRADE I 2 SHINY TENSE L 13 9 CR 117 79 77 70.8 94 90 6 83
KRISHNA 68/F 9.89262E+14 7891633731 31/10/2023 BILATERAL OA KNEE HTN 20-90 15 40 36 56 47.6 GRADE I 2 SHINY TENSE R 16 9 CR 144 70 85 82 76.8 96 90 4 83
20-100 20 35 56 45.8 GRADE I 4 SHINY TENSE L 15 10 CR 150 85 82 76.2 96 86 5 86
MOHAN LAL 56/M 9.89262E+14 94175 89450 1/11/2023 BILATERAL OA KNEE DM 60
0-100 5 39 58 41.7 GRADE I 4 SHINY TENSE L 11 8 CR 88 70 86 86 75 97 86 5 83
GAMGADHAR 72/M 9.89262E+14 95107 83450 7/11/2023 BILATERAL OA KNEE HTN 0-130 5 50 41 55 48.8 GRADE I 6.4 SHINY TENSE R 16 11 CR 176 70 85 86 74.4 94 87 4 83
5-130 5 41 55 46.4 GRADE I 4.8 SHINY TENSE L 15 10 CR 150 85 86 75.6 94 86 5 83
MOHAMMAD SADIK 32/M 9.89262E+14 8433557808 15/11/2023 POST TRAUMATIC OA KNEE NIL 0-100 ABSENT 50 46 55 53 GRADE I 4.8 DEGERATIVE CHANGES LAXITY R 8 7 PS 56 80 90 91 79.2 96 86 6 87

USHA 63/F 9.89262E+14 9828200112 15/11/2023 BILATERAL OA KNEE( KL GRADE IV) HYPOTHYROIDISM 10-100 10 30 42 59 45.8 GRADE I 2.4 DEGNERATIVE CHANGES LAX R 12 8 PS 96 70 85 86 75 95 86 5 85
5-90 5 43 59 47.6 GRADE I 2.4 DEGNERATIVE CHANGES LAX L 11 7 PS 77 84 86 74.4 96 89 4 83
VS BHATI 68/M 9.89262E+14 9001789250 30/11/2023 BILATERAL OA KNEE ( KL GRADE IV) HTN /DM II 0-120 5-10 50 38 55 51.8 GRADE 0 4 SHINY TENSE R 15 11 CR 165 70 86 86 75.6 96 88 6 85
0-120 0-5 38 55 48.8 GRADE 0 3 SHINY TENSE L 14 10 CR 140 86 86 75 98 89 7 86
SHAKUNTALA 60/F 9.89262E+14 8696920097 20/11/2023 BILATERAL OA KNEE ( KL GRADE IV) HYPOTHYROIDISM 0-120 10-15 40 53 57 47 GRADE I 2 SHINY TENSE R 12 8 PS 96 70 84 82 74.4 94 88 5 85
0-120 15-20 53 61 48.2 GRADE I 2 SHINY TENSE L 11 9 PS 99 84 86 76.2 95 87 4 84
KANCHAN 72/f 9.89262E+14 7742998087 30/11/2023 BILATERAL OA KNEE ( KL GRADE IV) NIL 20-100 0-10 10 39 53 47 GRADE 1 6 DEGNERATIVE CHANGES LAX R 10 8 PS 80 80 90 91 78.6 94 89 6 86
10-100 0-20(VALGUS) 38 49 45.8 GRADE 1 9 DEGNERATIVE CHANGES LAX L 10 9 PS 90 91 91 79.2 95 93 6 84
KAMLA DEVI 65/F 9.89262E+14 9314025071 30/11/2023 BILATERAL OA KNEE( KL GRADE IV) HUPOTHYRIDISM 5-100 0-5 55 35 61 48.8 GRADE I 3 SHINY TENSE R 13 11 CR 143 70 85 86 75.6 96 89 6 80
10-100 0-5 35 55 47.6 GRADE I 2 SHINY TENSE L 14 10 CR 140 84 86 74.4 95 90 5 87
PUSHPA BHOOTRA 65/F 9.89262E+14 9414477871 8/12/2023 BILATERAL OA KNEE ( KL GRADE IV) DM 5-100 0-5 60 43 53 47 GRADE I 6.4 SHINY TENSE R 11 9 PS 99 80 90 91 79.2 95 90 6 85
10-90 0-5 38 53 46.4 GRADE I 4.8 SHINY TENSE L 13 11 CR 143 91 91 79.8 93 89 5 84
NEETU MEHTA 45/F 9.89262E+14 9460551446 13/12/2023 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-120 0-5 50 38 61 50 GRADE I 4.8 SHINY TENSE R 14 11 CR 154 70 84 81 74.5 93 86 5 85

SEEMA GEHLOT 55/F 9.89262E+14 7790868987 5/1/2024 BILATERAL OA KNEE ( KL GRADE IV) HTN 5-100 0-5 25 48 65 48.2 NO LAXITY 1.6 SHINY TENSE R 13 10 CR 130 70 86 86 75 96 86 6 82
0-90 0-5 39 62 48.8 NO LAXITY 1.6 SHINY TENSE L 14 12 CR 168 86 86 75 95 91 5 84
SANGEETA CHOUHAN 57/F 9.89262E+14 8764402487 8/1/2024 BILATERAL OA KNEE( KL GRADE IV) NIL 10-120 5-10 35 40 55 47 GRADE I 4 DEGNERATIVE CHANGES TENSE R 12 9 PS 108 60 85 86 74.4 96 86 7 86

REKHA DEVI 41/F 9.89262E+14 6377231223 14/1/2024 BILATERAL OA KNEE( KL GRADE IV) RA 20-100 5 20 7 45 38.1 GRADE I 4.8 DEGNERTIVE CHANGES LAX R 11 8 PS 88 80 86 91 79.8 96 89 8 81
10-110 5-10 30 45 40.2 GRADE I 6.4 DEGNERTIVE CHANGES LAX L 12 9 PS 108 85 91 80.4 95 90 5 82
VIMLA KAUR 65/F 9892622300289353 9414382650 14/1/2024 BILATERAL OA KNEE( KL GRADE IV) HTN/CVA/CAD/HYPOTHYRIDISM 0-100 5-10 56 52 58 44 GRADE 0 7 DEGNERTIVE CHANGES TENSE R 10 8 PS 80 70 84 86 75.6 91 90 5 82
0-110 5-10
SANGEETA 60/F 9.89262E+14 8852857378 10/1/2024 BILATERAL OA KNEE( KL GRADE IV) HTN 0-90 20 35 18 56 42.9 GRADE I 4 SHINY LAX R 11 9 PS 99 80 90 91 79.2 93 89 4 84
10-90 15-20 17 54 41.1 GRADE I 3 SHINY LAX L 10 7 PS 70 91 91 79.8 95 87 5 85
RADHA 60/F 9.89262E+14 9116753112 22/1/2023 BILATERAL OA KNEE ( KL GRADE IV) BIPOLAR DISORDER 5-120 0-5 60 40 62 44 GRADE 1 3 DEGNERATIVE CHANGES LAX R 11 8 PS 88 60 80 81 70.2 95 87 6 82
5-120 0-5 35 58 45.2 GRADE 0 1 DEGNERATIVE CHANGES LAX L 12 9 PS 108 81 81 70.8 97 87 6 83
JAN KANWAR 46/F 9.89262E+14 9413137504 22/1/2024 BILATERAL OA KNEE (KL GRADE IV) RA 10-110 5 35 40 63 42.9 GRADE 0 2 SHINY TENSE R 11 8 CR 88 80 89 91 80.4 97 89 4 83
15-110 5 37 56 41.7 GRADE 1 6 SHINY TENSE L 10 7 PS 70 89 91 79.2 95 88 5 84
MANJU SINGHWI 56/F 9.89262E+14 7822811998 29/1/2024 BILATERAL OA KNEE IN O/C/O HTO RIGHT SIDE NIL 0-100 10 45 46 60 49.4 GRADE I 4 DEGNERATIVE CHANGES LAX R 9 6 PS 54 70 85 86 74.4 95 88 4 85
0-100 15 46 60 48.2 GRADE I 2 SHINY TENSE L 11 7 PS 77 85 86 75 94 87 5 85
GOMI 63/F 9.89262E+14 9460309996 31/1/2024 BILATERAL OA KNEE NIL 5-100 5-10 45 42 59 41.1 GRADE I 4 DEGNERATIVE CHANGES TENSE R 8 8 PS 64 80 89 91 71.4 93 86 7 84

FATIMA BIBI 37/F 9.89262E+14 9352769546 31/1/2024 BILATERAL RA KNEE NIL 15-90 15 VALGUS 35 16 47 39.9 GRADE II 8 DEGNERATIVE CHANGES LAX R 8 7 PS 56 80 89 91 79.2 96 86 5 85

UMRAV SHARMA 57/F 9.89262E+14 7737739039 19/2/2024 BILATERAL OA KNEE ( KL GRADE IV) HYPOTHYROIDISM 0-100 5-10 25 42 65 48.8 GRADE I 3 SHINY LAX R 8 7 PS 56 70 81 81 70.2 94 87 4 86
0-100 5-10 46 63 47 GRADE I 4 SHINY LAX L 8 8 PS 64 82 81 70.8 95 86 6 84
PREMRAM LOHAR 66/M 9.89262E+14 9079835945 19/2/2024 BILATERAL OA KNEE ( KL GRADE IV) DM 5-100 5-10 35 48 56 48.8 GRADE I 4 SHINY TENSE R 9 7 CR 63 70 85 85 75 90 88 5 86
5-100 5-10 39 56 47 GRADE I 7 SHINY TENSE L 10 8 CR 80 86 85 75.6 90 90 5 85
SUSHILA METHA 53/F 9.89262E+14 9829021437 05-03-2024 BILATERAL OA KNEE( KL GRADE IV) HTN DM 5-90 5-10 60 41 46 39.9 GRADE I 5 SHINY TENSE R 10 9 PS 90 70 84 86 74.4 94 87 4 83
5-100 5-10 41 46 42.9 GRADE I 3 SHINY TENSE L 9 8 PS 72 84 86 75 95 86 7 84
BASANT KUMAR DHOOT 63/M 9.89262E+14 9414134638 05-03-2024 BILATERAL OA KNEE ( KL GRADE IV) NIL 5-110 5-10 56 30 52 41.7 GRADE I 3.2 SHINY TENSE R 11 7 CR 77 80 90 91 79.2 90 89 6 83
5-110 5-10 52 50 42.9 GRADE I 3 SHINY TENSE L 12 8 CR 96 91 91 79.8 97 88 6 83
PUSHPA SARAWGI 64/F 9.89262E+14 7297045478 11-03-2024 BILATERAL OA KNEE KL GRADE IV HTN AND HYPOTHYROIDISM 5-110 0-5 35 52 63 48.8 GRADE I 2 SHINY TENSE R 11 8 CR 88 70 84 86 74.4 94 90 5 85
5-110 0-5 48 63 50 GRADE I 1.8 SHINY TENSE L 10 8 CR 80 84 86 75.6 91 88 6 84
SURESH KANWAR 47/F 9.89262E+14 9001342417 11-03-2024 BILATERAL OA KNEE( KL GRADE IV) NIL 0-110 0-5 35 46 59 51.2 NO LAXITY 2 SHINY TENSE R 9 7 CR 63 60 80 81 70.8 92 89 6 84
0-110 0-5 41 57 50 NO LAXITY 2 SHINY TENSE L 9 7 CR 63 79 81 70.2 93 88 7 85
SRINIVASAN 78/M 9.89262E+14 9489325306 12-03-2024 BILATERAL OA KNEE KL GRADE IV DM
10-120 5-10 55 39 61 48.2 GRADE I 3 DEGENERATIVE CHANGES LAX L 8 6 PS 48 70 85 86 74.4 93 88 6 86
SURESH CHAND 62/M 9.89262E+14 7597264326 12-03-2024 BILATERAL OA KNEE ( KL GRADE IV) HTN 0-120 5-10 50 46 65 50 NO LAXITY 1 SHINY TENSE R 12 9 CR 108 70 84 85 75 92 89 4 83

HTN, HYPOTHYROIDSIM,
SHARDA 70/F 9.89262E+14 9314722899 18-03-2024 BILATERAL OA KNEE ( KL GRADE IV) 0-110 5-10 45 40 58 47 GRADE I 2 DEGENERATIVE CHANGES LAX R 8 6 PS 48 70 86 85 75 90 87 4 81
DYSSLIPIDEMIA
0-110 5-10 35 57 44 GRADE I 2 SHINY LAX L 8 6 PS 48 86 86 75.6 95 88 6 84
PAPPU DEVI 69/F 9.89262E+14 8160136866 20-3-2024 BILATERAL OA KNEE ( KL GRADE IV) NIL 5-100 5-10 35 42 60 46.4 NO LAXITY 1 SHINY TENSE R 9 7 PS 63 80 89 90 79.8 95 88 5 85

GEETA 55/f 9.89262E+14 9877551890 27-3-2024 LEFT OA KNEE ( KL GRADE IV) NIL
10-100 5-10 45 45 60 47 GRADE I 4 SHINY TENSE L 11 8 PS 88 70 84 85 74.4 94 89 5 81
MAHIRAM 65/m 9.89262E+14 9413572154 1-4-2024 BILATERAL OA KNEE( KL GRADE IV) HTN 0-100 5-10 70 55 62 48.8 GRADE I 3 SHINY TENSE R 16 10 CR 160 80 89 90 78.6 94 86 6 83
0-100 5-10 50 62 49.4 GRADE I 2 SHINY TESNE L 15 10 CR 150 90 91 79.2 94 87 7 84
KHALI 72/M 9.89262E+14 7847932120 1-4-2024 RIGHT OA KNEE HTN 0-110 5-10 60 49 55 47.6 NO LAXITY 2 SHINY TESNE R 14 12 CR 168 70 85 86 75.6 92 87 5 84

SHANTI DEVI 69/F 9.89262E+14 8764268884 1-4-2024 BILATERAL OA KNEE( KL GRADE IV) NIL 10-110 5-10 15 44 55 45.8 NO LAXITY 6 DEGENERATIVE CHANGES LAX R 10 8 PS 80 80 89 90 80.4 94 88 4 85
10-110 5-10 53 55 44.6 NO LAXITY 3 SHINY LAX L 12 9 PS 108 89 90 79.8 95 89 5 86
RADHESHYAM 67/M 9.89262E+14 9782153182 10-4-24 BILATERAL OA KNEE ( KL GRADE IV) CAD 0-120 5-10 45 47 57 46.4 GRADE I 2 SHINY LAX R 12 8 PS 96 70 86 85 74.4 93 90 5 84
0-120 5-10 47 61 47.6 GRADE I 2 SHINY LAX L 10 8 PS 80 85 85 73.8 94 87 4 85
NATHI 60/F 9.89262E+14 8209581414 15-4-24 BILATERAL OA KNEE(KL GRADE IV) HTN 0-110 5-10 45 45 59 44 GRADE I 4 DULL DEGENERATIVE LAX R 9 7 PS 63 80 89 90 80.4 94 87 5 86
0-110 5-10 45 59 42.9 GRADE I 3 DULL DEGENERATIVE LAX L 8 7 PS 56 89 91 81 95 88 6 84
SAANGA RAM 71/M 9.89262E+14 9783871783 17-4-24 RIGHT OA KNEE (KL GRADE IV) DM/HTN 5-120 5-10 60 48 63 48.8 NO LAXITY 1 DULL TENSE R 10 10 CR 100 70 85 86 75 93 89 5 86

MANJU 50/F 9.89262E+14 9414205500 22-4-24 LEFT OA KNEE ( KL GRADE IV) NIL
0-110 5-10 35 47 59 45.8 NO LAXITY 4 SHINY TENSE L 11 9 PS 99 80 89 90 79.8 92 88 4 83
BHANWARI DEVI 56/F 9.89262E+14 8949772893 22-4-24 BILATERAL OA KNEE( KL GRADE IV) NIL 0-110 5-10 30 52 59 48.2 NO LAXITY 5 SHINY TENSE R 13 10 CR 130 80 90 91 80.4 93 88 5 85
0-110 5-10 51 57 50.6 NO LAXITY 4 DULL TENSE L 11 10 PS 110 89 91 81 94 89 6 85
AMRIT LAL 72/M 9.89262E+14 9251400905 23-4-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 0-110 5-10 60 60 63 52 NO LAXITY 4 SHINY TENSE R 15 12 CR 180 70 90 91 79.2 90 89 5 84
0-110 5-10 60 57 50.6 NO LAXITY 5 DULL TENSE L 12 10 CR 120 90 91 79.8 92 87 6 85
SHANTI JAIN 54/F 9.89262E+14 9392840949 23-4-24 BILATERAL OA KNEE(KL GRADE IV) NIL 5-100 5-10 60
5-100 5-10 47 65 48.8 NO LAXITY 3 SHINY TENSE L 13 9 CR 117 60 80 81 70.8 91 89 4 83
PUSHPA BOHRA 69/F 9.89262E+14 7737427183 24-4-24 BILATERAL OA KNEE(KL GRADE IV) HTN 0-110 5-10 25 37 65 50.6 GRADE I 1.6 SHINY TENSE R 14 10 CR 140 70 84 85 74.4 91 86 4 81
0-110 5-10 36 61 50 GRADE I 4 SHINY TENSE L 13 10 CR 130 85 86 75 92 88 4 84
HARI SINGH 62/M 9.89262E+14 9717923539 29-4-24 BILATERAL OA KNEE(KL GRADE IV) asthma 10-110 5-10 55 68 69 53 NO LAXITY 3 DULL TENSE R 14 12 CR 168 80 89 90 79.8 93 87 7 89

CHAMUNDRAI SINGH 68/M 9.89262E+14 9414615014 3-5-24 BILATERAL OA KNEE (KL GRADE IV) DM 5-100 5-10 60 53 63 50 GRADE I 4.8 SHINY TENSE R 15 10 CR 150 70 84 85 75 92 90 7 84
0-100 5-10 55 59 50.6 NO LAXITY 4.8 SHINY TENSE L 14 11 CR 154 85 86 75.6 93 87 6 85
GHANKI DEVI 57/F 9.89262E+14 9413581840 3-5-24 BILATERAL OA KNEE( KL GRADE IV) NIL 0-110 5-10 60 50 61 48 NO LAXITY 1.6 DULL TENSE R 13 10 CR 130 70 85 85 76.2 95 88 4 83
0-110 5-10 50 61 48.2 GRADE I 3 DULL TENSE L 12 8 PS 96 86 86 76.2 96 94 5 84
MOHAN LAL 77/M 9.89262E+14 9460179998 30-4-2-24 BILATERAL OA KNEE( KL GRADE IV) DM/HTN 10-90 5-10 60 36 65 54.8 NO LAXITY 3.2 SHINY TENSE R 15 10 CR 150 70 84 85 74.4 93 88 5 84

LEELA DEVI 61/F 9.89262E+14 9462420015 6-5-24 BILATERAL OA KNEE( KL GRADE IV) ASTHMA 0-110 5-10 60 50 63 51 GRADE I 1 SHINY TENSE R 11 9 CR 99 60 80 80 70.8 93 89 6 82
 MASTER CHART
POSTERIOR CROSS
DATE OF KNEE LYSHOLM STRESS INTRAOPERATIVE CR VS LYHOLM ALPHA BETA GAMMA DELTA
NAME AGE AIIMS ID CONTACT NO DIAGNOSIS COMORBIDITIES VARUS KFS KSS KOOS DRAWER SECTION KFS KSS KOOS
SURGERY ROM SCORE RADIOGRAPH FINDINGS PS SCORE ANGLE ANGLE A NGLE ANGLE
TEST AREA
0-110 5-10 44 61 49.4 GRADE I 4.8 SHINY TENSE L 10 7 CR 70 79 80 70.2 90 89 5 84
BHANWARI 48/F 9.89262E+14 9521002405 8-5-24 BILATERAL OA KNEE( KL GRADE IV) RA 0-130 5-10 50 49 69 55 GRADE I 1 DEGNERTIVE CHANGES LAX R 10 6 PS 60 70 85 86 75 93 86 7 84
0-130 5-10 49 65 51.8 GRADE I 2 DEGENERATIVE CHANGES LAX L 10 6 PS 60 86 86 76.2 94 87 6 83
SURESH KUMAR BHATTAR 58/M 9.89262E+14 9414704346 9-5-24 BILATERAL OA KNEE( KL GRADE IV) HTN/DM 0-120 5-10 35 47 63 54 GRADE I 4.8 SHINY TENSE R 15 10 CR 150 70 84 85 74.4 90 90 4 84
0-120 5-10 47 59 51.2 GRADE I 3.2 SHINY TENSE L 12 9 PS 108 84 86 75.6 92 88 5 85
NATHI 73/F 9.89262E+14 9413710760 9-5-24 BILATERAL OA KNEE( KL GRADE IV) NIL 0-120 5-10 60 57 52 48 GRADE I 2 SHINY TENSE R 10 7 PS 70 70 85 86 76.2 94 90 5 83
0-120 5-10 57 54 47 NO LAXITY 1 SHINY TENSE L 13 10 CR 130 86 86 76.8 93 89 4 84
SANTOSH 61/F 9.89262E+14 9414288853 10-5-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 0-110 5-10 50 34 69 55 NO LAXITY 2.4 SHINY TENSE R 14 11 CR 154 60 80 80 70.8 95 87 6 87
0-110 5-10 34 65 50.6 NO LAXITY 4 SHINY TENSE L 14 9 CR 126 79 80 70.2 94 86 5 84
MADHU CHAJJER 53/F 9.89262E+14 7014862944 10-5-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 0-90 5-10 60 41 61 50 NO LAXITY 4 SHINY TENSE R 13 10 CR 130 80 89 90 79.8 94 87 6 84
0-90 5-10 41 61 52.4 NO LAXITY 7 SHINY TENSE L 15 9 CR 135 89 90 80.4 92 88 5 83
SAJJAN DEVI 67/F 9.89262E+14 7976736442 14-5-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 20-120 5-10 50 47 59 45.8 NO LAXITY 1 SHINY TENSE R 13 10 CR 130 70 84 86 74.4 94 86 6 85
20-120 5-10 47 61 47 NO LAXITY 1 SHINY TENSE L 14 9 CR 126 85 86 75 93 87 4 86
HEMA KHANCHANDANI 50/F 9.89262E+14 9828808995 15-5-24 BILATERAL OA KNEE ( KL GRADE IV) DM/SLE/HTN 0-110 5-10 60 46 54 44.6 GRADE I 3.2 SHINY TENSE R 14 10 PS 140 60 79 81 70.2 100 80 5 84
0-110 5-10 46 59 45.2 GRADE I 2.4 DULL DEGENRATIVE LAX L 9 6 PS 54 79 80 69.6 98 82 4 86
GANGA DEVI 63/F 9.89262E+14 9602014990 15-5-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 5-120 5-10 60 47 65 50.6 NO LAXITY 4 SHINY TENSE R 12 8 CR 96 80 89 90 80.4 96 89 5 86
5-120 5-10 47 65 48.2 NO LAXITY 2.4 SHINY TENSE L 15 9 CR 135 89 90 81 91 87 7 85
BABUI 50/F 9.89262E+14 9257807227 15-5-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-130 5-10 45 39 61 50 GRADE I 2 DEGENERATIVE SHINY TENSE R 15 10 PS 150 80 90 91 81 94 88 6 83
0-130 5-10
CHUKA DEVI 60/F 9.89262E+14 9967167353 15-5-24 BILATERAL OA KNEE ( KL GRADEI V) NIL 15-90 5-10 20 34 54 47 NO LAXITY 4 DEGERATIVE DULL LAX R 8 5 PS 45 70 84 85 75 97 82 6 86
15-90 5-10 34 52 46.4 GRADE I 5.6 DEGERATIVE DULL LAX L 7 6 PS 42 85 86 75.6 96 85 5 84
MOHINI DEVI 72/F 9.89262E+14 9414135296 20-5-24 BILATERAL OA KNEE( KL GRADE IV) NIL 0-130 5-10 60 60 59 48.2 NO LAXITY 3.2 SHINY TENSE R 13 9 CR 117 80 89 90 81.6 91 88 5 85

HEERA JAIN 71/F 9.89262E+14 9829311474 20-5-24 BILATERAL OA KNEE (KL GRADE IV) NIL 0-90 5-10 60 31 54 47 GRADE I 3.2 SHINY TENSE R 14 10 CR 140 70 84 85 73.8 95 87 5 85
0-100 5-10 33 54 45.2 GRADE I 3.2 SHINY TENSE L 13 8 PS 104 86 86 75 94 86 6 84
RAJA RAM 50/M 9.89262E+14 9252194559 22-5-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-110 5-10 45 39 65 52.4 GRADE I 8 SHINY TENSE R 12 9 CR 108 80 89 90 79.8 94 90 4 75
0-110 5-10 39 65 51.2 GRADE I 8 SHINY TENSE L 11 8 CR 88 91 91 81 96 89 5 81
PAPU DEVI 45/F 9.89262E+14 9950078856 24-5-24 BILATERAL OA KNEE ( KL GRADE IV) HTN/DM 0-120 5-10 60 53 65 53 NO LAXITY 1.6 SHINY TENSEE R 12 8 CR 108 80 88 90 79.2 98 86 6 75
0-120 5-10 53 63 53.6 NO LAXITY 1.6 SHINY TENSE L 13 9 CR 117 90 90 81 92 89 4 80
VIJAY LAXMI 52/F 9.89262E+14 7878025083 27-5-24 BILATERAL OA KNEE ( KL GRADE IV) nil 0-110 5-10 60 37 60 48.8 GRADE I 1.6 DEGNERATIVE CHANGES LAX R 11 8 PS 88 70 85 86 75.6 92 90 5 82
0-110 5-10 37 60 50 GRADE I 0.8 DEGNERATIVE CHANGES LAX L 10 7 PS 70 85 86 74.4 93 87 6 84
LADU DEVI 60/F 9.89262E+14 8302012299 29-5-24 BILATERAL OA KNEE ( KL GRADE IV) nil 5-110 5-10 60 37 65 51.8 NO LAXITY 1.6 SHINY TENSE R 12 9 CR 108 70 84 86 73.8 96 87 4 83
5-110 5-10 37 65 54.2 NO LAXITY 2.4 SHINY TENSE L 13 10 CR 130 86 86 75.6 94 86 5 84
SUSHILA 57/F 9.89262E+14 7976369242 29-5-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-110 5-10 45 58 61 48 GRADE I 0.8 DULL TENSE R 11 7 PS 77 80 89 90 79.8 95 85 4 77
0-110 5-10 58 59 48.2 GRADE I 0.8 DULL DEGENERATIVE CHANGES TENSE L 10 7 PS 70 89 90 81 94 87 5 81
KAILASH CHANDRA 54/M 9.89262E+14 9414838249 29-5-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 10-90 5-10 45 26 65 46.4 NO LAXITY 4 SHINY TENSE R 12 8 CR 96 80 88 90 79.2 94 88 6 83
10-110 5-10 39 59 45.8 NO LAXITY 2.4 SHINY TENSE L 14 9 CR 126 90 91 81 93 90 6 77
PUSHPA 70/F 9.89262E+14 7297841568 29-5-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 20-90 5-10 50
10-100 5-10 40 54 48 GRADE I 3.2 SHINY TENSE L 13 7 CR 91 80 90 91 81.6 94 86 4 83
KAMLA DEVI 48/F 9.89262E+14 9057259310 4-6-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 5-110 5-10 60 37
5-110 5-10 37 69 53 GRADE I 2.4 SHINY TENSEL L 12 10 CR 120 70 84 85 75 87 89 5 92
PRITI 37/F 9.89262E+14 6375833605 5-6-24 BILATERAL OA KNEE ( KL GRADE IV) RA /HYPOTHYROIDISM 10-100 5-10 60 45 52 42.9 GRADE II 10 DEGENRATIVE LAX R 10 8 PS 80 60 79 80 70.2 92 87 4 85
30-100 5-10 44 52 41.7 GRADE II 11 DEGENRATIVE LAX L 9 7 PS 63 78 80 69.6 93 86 6 83
LAL SINGH 71/M 9.89262E+14 8209222971 5-6-24 BILATERAL OA KNEE ( KL GRADE IV) HTN/IHD 10-120 5-10 55 36 65 52 NO LAXITY 1.6 SHINY TENSEL R 13 8 CR 104 70 84 86 75.6 95 87 5 84

BHANWARI 58/F 9.89262E+14 9680081971 10-6-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-110 5-10 60 37 69 48.8 NO LAXITY 2.4 SHINY TENSE R 12 8 CR 96 70 84 86 74.4 96 90 6 87
0-110 5-10 37 69 50.6 NO LAXITY 3.2 SHINY TENSE L 13 9 CR 117 85 86 75.6 91 89 6 86
SRIKANT GUPTA 51/M 9.89262E+14 6354062295 10-6-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-120 5-10 70 51 65 51.2 NO LAXITY 1.6 DULL TENSE R 14 8 CR 112 70 83 85 73.8 92 88 7 80

ASHOK PRAJAPAT 54/F 9.89262E+14 9587123971 12-6-24 BILATERAL OA KNEE ( KL GRADE IV) NIL
0-110 5-10 60 57 61 49.4 GRADE I 3.2 SHINY LAX L 11 7 PS 77 80 89 90 79.8 94 87 5 86
OM PRAKASH 64/M 9.89262E+14 9799687505 12-6-24 BILATERALOA KNEE ( KL GRADE IV) NIL 10-110 10-15 25 22 54 45.8 GRADE I 4.8 SHINY TENSE R 12 8 PS 96 80 90 91 81 93 86 5 83

TARA 66/F 9.89262E+14 8209808499 18-6-24 BILATERAL OA KNEE( KL GRADE IV) HYPOTHYROIDISM 5-110 5-10 60 37 62 51.2 GRADE I 1.6 SHINY TENSE R 14 9 CR 126 80 88 90 79.2 96 90 6 82
5-110 5-10 37 62 50 GRADE I 1.6 SHINY TENSE L 13 10 CR 130 89 90 81.6 96 87 5 83
HUKAMCHAND 77/M 9.89262E+14 8764130770 18-6-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 10-110 15 20 18 58 48.8 NO LAXITY 2 DULL TENSE R 12 8 CR 96 80 90 91 80.4 95 90 4 87

KAMLA DEVI 60/F 9.89262E+14 9829949063 19-6-24 BILATERAL OA KNEE ( KL GRADE IV) DM/HTN 5-110 5-10 60 36 61 48 NO LAXITY 1.6 SHINY TENSE R 12 9 PS 108 70 84 85 75 92 86 6 86
5-110 5-10 36 58 47 NO LAXITY 1.6 SHINY TENSE L 12 8 PS 96 86 85 76.2 91 90 4 86
SNEHLATA BHANDARI 67/F 9.89262E+14 7976979751 18-6-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 5-110 5-10 60 35 65 50 NO LAXITY 4 SHINY TENSE R 12 7 CR 84 70 85 86 74.4 90 89 5 87
5-110 5-10 35 61 45.8 GRADE I 2.4 DULL DEGE LAX L 11 9 PS 99 85 86 75.6 93 88 4 85
PUSHPA KANWAR 52/F 9.89262E+14 9461119647 21-6-24 BILATERAL OA KNEE ( KL GRADE IV) dm/HYPOTHYROIDISM 0-110 5-10 50 23 54 47 GRADE I 4 SHINY TENSE R 13 9 PS 117 60 79 80 70.2 94 87 5 84
0-110 5-10 23 58 44 NO LAXITY 4 SHINY TENSE L 12 9 PS 108 79 80 70.8 95 86 6 83
MANJU GAHLOT 58/F 9.89262E+14 6376923082 21-6-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-120 0-5 50 37 54 44 NO LAXITY 3.2 DEGENETAIVE TENSE R 9 7 PS 63 70 84 85 74.4 95 87 4 85
0-120 0-5 37 49 45.8 NO LAXITY 4 DEGENRATIVE TENSE L 10 8 PS 80 85 86 75 94 86 5 85
BHAGWATI DEVI 57/F 9.89262E+14 9680347842 24-6-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-110 5-10 60 36 67 53 GRADE I 2.4 SHINY TENSE R 12 8 CR 96 70 84 85 73.8 93 92 6 75
0-110 5-10 36 69 52.4 GRADE I 2.4 SHINY TENSE L 11 7 CR 77 86 86 75 94 87 5 85
SHARDA 67/F 9.89262E+14 9409208888 25-6-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-120 5-10 55 24 67 49 GRADE I 3.2 SHINY TENSE R 10 8 PS 80 70 85 86 75 94 86 6 83
0-120 5-10 24 69 49.4 GRADE I 2.4 SHINY TENSE L 11 9 PS 99 85 86 76.2 95 87 5 84
SENAKI 60/F 9.89262E+14 8005588627 25-6-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 5-120 5 60 36 65 45.8 GRADE I 4 SHINY TENSE R 13 9 PS 117 70 80 81 73.8 92 87 7 81
5-120 5 36 65 47.6 GRADE I 4 SHINY TENSE L 12 8 PS 96 79 80 74.4 93 86 6 84
SAJJAN KANWAR 72/F 9.89262E+14 9928348448 1-7-24 BILATERAL OA KNEE ( KL GRADE IV) HTN/HYPOTHYROIDISM/DM 10-90 5-10 45 18 59 46 GRADE I 4 SHINY LAX R 10 8 PS 80 70 84 86 75.6 96 87 5 81
10-90 5-10
ASHA DEVI 56/F 9.89262E+14 7838472344 1-7-24 BILATERAL OA KNEE ( KL GRADE IV) HTN/DM 5-120 5-10 45 18 63 50 GRADE I 1.6 SHINY TENSE R 10 7 CR 70 70 85 86 73.8 91 89 6 84
5-120 5-10 18 59 47 GRADE I 4.8 SHINY LAX L 9 6 PS 54 86 86 76.2 92 88 4 83
SAROJ DAVE 56/F 9.89262E+14 9460525800 11-7-24 BILATERAL OA KNEE(KL GRADE IV) HTN 0-100 5-10 60 30 63 48 NO LAXITY 1.6 SHINY TENSE R 13 9 CR 117 70 84 85 75 96 87 6 85
0-100 5-10 30 61 45.2 GRADE I 2.4 SHINY LAX L 12 8 PS 96 84 85 76.2 92 89 4 85
VIBHA LODHA 56/F 9.89262E+14 8949147918 11-7-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-120 5-10 50 37 69 50 NO LAXITY 0.8 SHINY TENSE R 13 9 CR 117 70 79 80 69.6 95 88 4 84
0-120 5-10 37 67 53 NO LAXITY 3.2 SHINY TENSE L 14 8 CR 112 84 85 75 94 92 7 84
RAMESHWAR 72/M 9.89262E+14 8619519404 18-7-24 LEFT OA IN O/C/O RIGHT TKA HTN/IHD
0-110 5-10 30 40 65 54 NO LAXITY 3.2 SHINY TENSE L 12 9 CR 108 70 85 86 76.2 92 89 6 84
SUNITA 50/F 9.89262E+14 6376075962 22-7-24 BILATERAL OA KNEE (KL GRADE IV) HYPOTHYROIDISM 0-120 5-10 45 47 61 46.4 NO LAXITY 0.8 SHINY TENSE R 14 8 CR 112 70 86 85 74.4 97 87 6 84
0-120 5-10 47 63 48.8 NO LAXITY 0.8 SHINY TESNE L 15 9 CR 135 85 85 73.2 95 90 6 85
SHYAM LAL 46/M 9.89262E+14 9887380156 22-7-24 LEFT OA KNEE ( KL GRADE IV) NIL
0-120 5-10 35 47 63 50.6 NO LAXITY 1.6 SHINY TENSE L 16 9 CR 144 70 85 86 74.4 92 87 5 82
PUSHPA PARMAR 62/M 9.89262E+14 9413077820 22-7-24 RIGHT OA KNEE (KL GRADE IV) DM/HTN 0-110 5-10 50 38 65 53 GRADE I 0.8 SHINY TENSE R 13 8 CR 104 70 79 80 69.6 94 90 5 84

PAKIYA DEVI 59/F 9.89262E+14 7425027655 22-7-24 BILATERAL OA KNEE (KL GRADE IV) DM/HTN 5-110 5-10 15 40 61 47.6 GRADE I 3.2 SHINY TENSE R 12 7 CR 84 80 89 90 81 94 87 5 85
0-110
SHRINIVASAN 72/M 9.89262E+14 9783957838 24-7-24 BILATERAL OA KNEE ( KL GRADE IV) HTN/DM 5-110 5-10 50 40 61 48.8 GRADE I 2.4 DULL TENSE R 13 9 CR 117 80 89 90 79.8 95 87 6 86
5-110 5-10 40 61 50 GRADE I 2.4 DULL TENSE L 13 8 CR 104 90 90 80.4 94 86 5 84
RAMESH KUMAR 46/M 9.89262E+14 9829611289 26-7-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 0-120 5-10 45 29 65 49.4 NO LAXITY 1.6 SHINY TENSE R 12 12 CR 144 80 89 90 79.2 93 88 6 83
0-120 5-10 29 65 51.2 NO LAXITY 1.6 SHINY TENSE L 12 10 CR 120 89 91 79.8 95 89 4 84
ASHOKA SARASWAT 54/F 9.89262E+14 9587123971 26-7-24 BILATERAL OA KNEE ( KL GRADE IV) nil 15-100 5-10 25 57 59 48.8 GRADE I 2.4 DEGENERATIVE LAX R 12 7 PS 84 80 90 91 81 95 89 5 85

RAM SINGH 74/M 9.89262E+14 9461217090 5-8-24 BILATERAL OA KNEE (KLGRADEIV) HTN 0-100 5-10 40 30 61 44 GRADE I 2.4 SHINY TENSE R 11 8 CR 88 80 89 90 80.4 94 89 5 90
0-100 5-10 23 61 45.2 GRADE I 2.4 SHINY TENSE L 12 8 CR 96 90 90 81.6 94 89 6 88
 MASTER CHART
POSTERIOR CROSS
DATE OF KNEE LYSHOLM STRESS INTRAOPERATIVE CR VS LYHOLM ALPHA BETA GAMMA DELTA
NAME AGE AIIMS ID CONTACT NO DIAGNOSIS COMORBIDITIES VARUS KFS KSS KOOS DRAWER SECTION KFS KSS KOOS
SURGERY ROM SCORE RADIOGRAPH FINDINGS PS SCORE ANGLE ANGLE A NGLE ANGLE
TEST AREA
JIVRAJ MAHESHWARI 65/M 9.89262E+14 8949691136 5-8-24 RIGHT OA KNEE IN O/C/O L TKA HTN/DM 0-110 5-10 60 36 65 53 NO LAXITY 3.2 DEGENRATIVE CHANGES TENSE R 13 9 CR 117 70 84 85 75 92 93 5 85

PYARI DEVI 41/F 9.89262E+14 9660800821 5-8-24 RA KNEE HTN 10-100 5-10 10 16 52 43.5 GRADE I 4.8 DEGENRATIVE LAX R 11 7 PS 77 80 89 90 80.4 94 90 5 81
5-100 5-10 28 47 42.3 GRADE I 4.8 DEGENRATIVE DULL LAX L 10 9 PS 90 90 90 81 98 86 6 84
MOHAN SINGH RAJPUROHIT 73/M 9.89262E+14 9079273386 8-8-24 BILATERAL OA KNEE (KL GRADE IV) HTN 0-110 5-10 60 47 69 51.2 NO LAXITY 4.8 SHINY TENSE R 11 10 CR 110 70 84 85 74.4 97 87 5 83
0-110 5-10 47 67 50 NO LAXITY 3.2 SHINY TENSE L 13 8 CR 104 84 86 75.6 92 88 5 82
BILATERAL OA KNEE ( KL GRADE IV) WITH LEFT SIDE
KAMLA 59/F 9.89262E+14 8302498509 12-8-24 nil 0-120 5-10 0 48 57 43.5 NO LAXITY 4.8 SHINY TENSE R 10 8 PS 80 60 79 80 69.6 95 88 5 82
STRESS FRACTURE
0-120 5-10 20 59 45.2 GRADE II 3.2 DEGENERATIVE LAX L 9 7 PS 63 79 80 70.2 94 86 6 83
DEVI 44/F 9.89262E+14 9413638470 12-8-24 BILATERAL OA KNEE (KLGRADE IV) NIL
0-120 5-10 70 79 69 54.2 NO LAXITY 1.6 SHINY TENSE L 13 8 CR 104 80 89 90 79.2 93 87 5 84
MAHESHWARI KALWANI 68/F 9.89262E+14 9509431901 23-8-24 BILATERAL OA KNEE (KL GRADE IV) DM/HTN/OBESITY 5-110 5-10 20 35 59 50 NO LAXITY 2.4 SHINY TENSE R 10 7 CR 70 70 85 86 76.2 98 90 4 83
0-110 5-10 33 59 51.2 NO LAXITY 1.6 SHINY TENSE L 9 8 CR 72 83 85 75 96 89 6 82
ACHAL DAS 63/M 9.89262E+14 9898717671 28-8-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 10-110 5-10 45 15 52 46.4 GRADE I 4 SHINY TENSE R 13 9 CR 117 70 85 86 74.4 93 86 4 83
10-110 5-10 21 52 45.8 GRADE I 4 SHINY TENSE L 12 8 CR 96 84 86 73.2 93 86 6 85
MODU RAM 73/M 9.89262E+14 9829373201 28-8-24 BILATERAL OA KNEE (KL GRADE IV) NIL 0-120 5-10 60 34 65 47.6 NO LAXITY 3.2 SHINY TENSE R 11 7 CR 77 70 84 85 75 92 90 6 84
0-120 5-10 40 65 46.4 NO LAXITY 2.4 SHINY TENSE L 10 8 CR 80 84 85 75.6 93 87 5 85
KELI DEVI 54/F 9.89262E+14 9829523789 30-8-24 BILATERAL OA KNEE (KL GRADE IV) NIL 0-120 5-10 60 40 69 51.8 NO ALXITY 1.6 SHINY TENSE R 13 8 CR 104 70 85 86 73.2 96 89 4 82
0-120 5-10
PARMESHWARI 63/F 9.89262E+14 9413960297 30-8-24 BILATERAL OA KNEE ( KL GRADE IV) DM/HTN/HYPOTHYROIDISM 15-110 5-10 20 27 55 41 NO LAXITY 4 DEGENERATIVE TENSE R 8 5 PS 40 70 83 85 73.2 94 89 4 89
10-110 5-10 46 59 42.3 GRADE I 4 DEGENRATIVE TENSE L 9 6 PS 54 85 86 75 94 90 5 89
JASODHA DEVI 52/F 9.89262E+14 9828429721 2-9-2024 BILATERAL OA KNEE (KLGRADE IV) HTN 0-120 5-10 45 54 59 44.6 GARDE I 4 DEGNERATIVE LAX R 10 8 PS 80 80 88 90 79.8 95 86 5 84
0-120 5-10 53 54 43.5 GRADE I 3.2 DEGENRATIVE LAX L 11 9 PS 99 89 90 81 93 87 6 85
DHAPU DEVI 47/F 9.89262E+14 8104207337 2-9-24 BILATERAL OA KNEE (KL GRADE IV NIL 0-120 5-10 45 43 69 53 NO LAXITY 1.6 SHINY TENSE R 10 8 CR 80 70 84 85 74.4 94 87 4 86
0-120 5-10 39 65 51 NO LAXITY 2.4 SHINY TENSE L 11 7 CR 77 84 85 76.2 93 89 4 84
SUSHILA 65/F 9.89262E+14 9636790033 3-9-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 0-120 5-10 60 79 65 47.6 NO LAXITY 2.4 SHINY TENSE R 12 9 CR 108 80 89 90 79.8 98 86 5 86
0-110 5-10 79 69 47 NO LAXITY 3.2 SHINY TENSE L 13 8 CR 104 90 90 80.4 94 89 6 83
DHAGALAI 64/F 9.89262E+14 9785112955 3-9-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 10-100 5-10 45 35 60 49 GRADE I 2.4 DULL TENSE R 10 8 CR 80 70 84 86 74.4 99 96 4 85
10-100 5-10 33 65 53 GRADE I 1.6 DULL TENSE L 11 7 CR 77 86 86 75 95 88 6 84
SUKHI 69/F 9.89262E+14 9414151976 5-9-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 5-120 5-10 50 47 69 55 NO LAXITY 1.6 SHINY TENSE R 12 9 CR 108 70 84 85 74.4 93 90 6 82
5-120 5-10 46 69 57 NO LAXITY 2.4 SHINY TENSE L 13 8 CR 104 84 85 76.2 95 87 6 86
JHAMUDI DEVI 59/F 9.89262E+14 8005846768 9-9-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 5-120 5-10 50 40 59 48 NO LAXITY 3.2 DULL TENSE R 11 7 PS 77 70 88 90 79.2 95 87 5 81
10-120 5-10 39 59 47 NO LAXITY 4 DULL TENSE L 12 8 PS 96 89 91 81 93 89 5 88
KIRAN MAHESHWARI 68/F 9.89262E+14 9828027888 18-9-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 5-100 5-10 45 26 53 47 GRADE I 2.4 DEGENEARTIVE LAX R 9 7 PS 63 60 78 80 70.2 92 88 4 81
5-100 5-10 25 55 44.6 GRADE I 3.2 DEGENERTAIVE LAX L 10 8 PS 80 79 80 71.4 94 87 5 83
TAMUDI 59/F 9.89262E+14 9660227096 9-9-24 BILATERAL OA KNEE ( KL GRADE IV) RA 0-110 5-10 40 49 64 45.8 GRADE I 4 SHINY TENSE R 10 8 PS 80 70 85 86 74.4 94 90 5 89
0-110 5-10 48 63 46.4 GRADE I 1.6 SHINY TENSE L 11 7 PS 77 85 86 75 90 89 6 85
KUSUM JAIN 62/F 9.89262E+14 9414131134 10-9-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 50
0-100 5-10 40 66 50 NO LAXITY 1.6 SHINY TENSE L 13 10 CR 130 70 86 85 76.2 93 87 7 84
MANJU 51/F 9.89262E+14 9829231483 12-9-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 0-90 5-10 45 30 62 50 NO LAXITY 2.4 SHINY TENSE R 12 8 CR 96 70 83 85 75 94 86 5 83
0-100 5-10 33 67 48 NO LAXITY 2.4 SHINY TENSE L 13 9 CR 117 85 86 76.2 94 87 7 85
KAPUR RAM 62/M 9.89262E+14 9829087445 17-9-24 OA KNEE RIGHT SIDE RA 15-90 5-10 50 28 57 45 GRADE I 4 DEGENERATIVE CHANGES LAX R 10 7 PS 70 80 89 90 81 95 86 4 84

SUMAN 59/F 9.89262E+14 8000071526 17-9-24 BILAGTEAL OA KNEE ( KL GRADE IV) NIL 5-110 5-10 45 45 61 52 GRADE I 0.8 SHINY TENSE R 12 7 CR 84 60 79 80 69 92 88 6 86
5-110 5-10 44 61 52 GRADE I 1.6 SHINY TENSE L 12 8 CR 96 80 81 70.2 94 87 5 87
BHAGWATI JAJOO 61/F 9892624015966907 9950155991 18-9-24 BILATERAL OA KNEE ( KL GARDE IV) NIL 5-120 5-10 35 22 65 51 NO LAXITY 0.8 SHINY TENSE R 11 9 CR 99 70 84 85 74.4 92 86 4 86
0-120 5-10 22 64 50 NO LAXITY 1.6 SHINY TENSE L 10 9 CR 90 85 86 75 95 88 5 83
SHAKUNTALA 54/F 9.89262E+14 9355387157 18-9-24 BILATERAL OA KNEE (KL GRADE IV) HTN/DM 0-120 5-10 60 50 62 54 NO LAXITY 2.4 SHINY TENSE R 13 9 CR 117 70 83 85 76.2 94 86 7 84

SITA DEVI 65/F 9.89262E+14 9352565406 23-9-24 BILATERAL OA KNEE ( KL GRADE IV) IHD/DM/HTN 5-130 5-10 35 48 55 48 GRADE I 3.2 SHINY LAX R 10 8 PS 80 70 83 85 73.8 96 89 4 83
0-120 5-10 50 55 49 GRADE I 2.4 SHINY LAX L 11 7 PS 77 85 86 75 95 88 5 84
HEMLATA 52/F 9.89262E+14 7597177771 22-9-24 BILATERAL OA KNEE ( KL GRADE IV) HTN/DM/CAD 0-120 5-10 60 50 65 56 NO LAXITYT 2.4 SHINY TENSE R 13 8 CR 104 70 86 86 76.2 96 87 6 85

PREMLATA BOHRA 73/F 9.89262E+14 9983194100 25-9-24 BILATERAL OA KNEE ( KL GRADE IV) HYPOTHYROIDISM 5-100 5-10 50 40 63 49 GRADE I 4 SHINY LAX R 12 9 PS 108 70 84 85 74.4 92 89 7 87

AABIDA BANO 63/F 9.89262E+14 9414849733 26-9-24 BILATERAL OA KNEE ( KL GRADE IV) HTN/DM II 5-120 5-10 60 48 58 52 NO LAXITY 4.8 DEGNERATIVE CHANGES TENSE R 13 8 PS 104 70 86 86 76.2 96 86 5 83

DEVI SINGH 62/M 9.89262E+14 9799708615 26-9-24 BILATERAL OA KNEE ( KL GRADE IV ) HTN/DM 15-110 5-10 35 45 58 48 GRADE I 4 DEGENRATIVE CHANGES LAX R 11 7 PS 77 70 83 85 76.8 94 88 7 82
10-110 5-10 44 53 49 GRADE I 3.2 DEGENRATIVE CHANGES LAX L 10 7 PS 70 83 86 77.4 96 89 5 85
BHANWARI DEVI 75/F 9.89262E+14 9414475578 26-9-24 BILATERAL OA KNEE ( KL GRADE IV) HTN 5-120 5-10 35 38 53 51 GRADE I 2.4 DEGENRATIVE CHANGES TENSE R 11 7 CR 77 70 84 85 73.8 92 86 7 86
5-120 5-10 38 53 52 GRADE I 2.4 DEGENRATIVE CHANGES TENSE L 10 8 CR 80 85 86 74.4 95 90 5 83
PUKHRAJ 71/M 9.89262E+14 9588093559 26-9-24 BILATERAL OA KNEE ( KL GRADE IV) NIL 25-90 5-10 20 24 44 41 GRADE I 2.4 DEGENRATIVE CHANGES LAX R 9 6 PS 54 60 79 80 70.2 94 88 6 84
30-90 5-10 23 44 40 GRADE I 3.2 DEGENRATIVE CHANGES LAX L 10 7 PS 70 78 80 71.4 92 86 7 83
KARUNA VERMA 53/F 9892624009455185 9460007684 30-9-24 RIGHT RHEUMATOID KNEE RA 20-90 5-10 50 34 58 50 GRADE I 4 DEGENRATIVE CHANGES LAX R 9 6 PS 54 60 79 81 69 94 86 4 84