Bicruciate retaining total knee arthroplasty: current state and future promise

Abstract

Total knee arthroplasty (TKA) is a well-known surgical procedure performed to address end stage osteoarthritis. The main goal is to relieve pain, recover articular function and return to normal function as soon as possible. Over the years it is frequently performed in the elderly, but lately there is an increased demand in a younger and more active population. Up to 25% of patients feel dissatisfied about their TKA. The anterior cruciate ligament (ACL) is considered the main anteroposterior stabilizer of the knee; nevertheless the ACL is usually sacrificed during conventional TKA. Research shows this might be an unnecessary sacrifice in certain cases. The considerable dissatisfaction rate in mainly high-demanding patients, together with the literature reports on the importance of the ACL function, were the two main reasons for the development of bicruciate retaining (BCR) total knee arthroplasty. BCR TKA may offer superior knee kinematics and proprioception, through anterior cruciate ligament preservation, but requires a higher level of attention to obtain an accurate and precise component orientation to reach proper ligamentous balancing and restore the native knee biomechanics. Many surgeons abandoned its use due to its challenging technique and inconsistent results. Recent new BCR implant designs are promising. This systematic literature review aims to summarize the current state of BCR TKA and what to expect in the future.

Effect of Posterior Tibial Slope on Knee Kinematics After Bicruciate-Retaining Total Knee Arthroplasty

“…Considerable variability in rotational motion during knee flexion has been observed after both cruciate retaining and posterior stabilized TKA. BCR designs have been shown to have more normal femoral posterior rollback and external rotation during knee flexion than ACL-sacrificing designs [ 13 , 21 , 22 ]. However, variability in kinematic patterns has also been reported after BCR TKA [ 22 ].…”

“…BCR designs have been shown to have more normal femoral posterior rollback and external rotation during knee flexion than ACL-sacrificing designs [ 13 , 21 , 22 ]. However, variability in kinematic patterns has also been reported after BCR TKA [ 22 ]. This suggests that factors other than ligament integrity may affect kinematics after BCR TKA such as PTS, articular congruity of the medial and lateral articular surfaces, joint line orientation, limb alignment, and muscle function.…”