Bicruciate total knee arthroplasty

Abstract

The history of total knee arthroplasty (TKA) design has been rooted in the balance of forces that guide normal knee motion. The tibiofemoral articular geometry, ligamentous tension, and surrounding muscles together control the rotation for the medial and lateral femoral condyles as the knee moves from extension to full flexion. Progress in TKA design over the past decades is based on utilizing emerging technology to restore the balance of these forces to create a prosthesis that is both long-lasting and natural feeling. There is increasing evidence to suggest that these goals are wholly complementary. The bicruciate ligament retaining (BCR) design aims to further improve patient satisfaction and implant survivorship by addressing knee kinematics and proprioception. The early results reported by the designers of the BCR knees were comparable to those of the posterior stabilized and cruciate-retaining total knees. However, the results were not reproduced by non-designing surgeons and the concept fell out of favor. Recent advances in instrumentation and prosthetic design have led to increased interest in the BCR knee.