Abstract
The bi-cruciate retaining (BCR) total knee arthroplasty (TKA) is based on sound biomechanics to produce kinematics close to normal, which is the goal of BCR TKA. This assumes that the joint line is maintained and both cruciates are functional with a range of motion greater than 125 degrees.
The technical difficulties of implanting such a knee in correct anatomical position with preservation of both cruciate ligaments with proper tension is challenging and may not be possible in the hands of most surgeons.
Patient selection for consideration of BCR TKA assumes that both ligaments are normal and ROM is greater than 125 degrees. If this assumption is correct, why does one need a knee replacement in such a patient? If we assume that the patient has normal cruciate ligaments, there is no scientific evidence to suggest that they will remain normal in the environment of a TKA with longer follow-up. Lastly, fixation with cement may be compromised because of the lack of a stem and less surface area. This can be argued both ways, but the long-term data on this matter favors stemmed designs. Moreover, insertion of cruciate ligaments (ACL) limits the robustness of the connecting bar for bicruciate knees. Lastly over 30 years, surgeons have tried BCR TKA without significant market share. Remember “all good things in life should ultimately prevail”.
