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World J Orthop. Oct 18, 2021; 12(10): 732-742
Published online Oct 18, 2021. doi: 10.5312/wjo.v12.i10.732
Bicruciate-retaining total knee arthroplasty: What’s new?
Luigi Sabatini, Luca Barberis, Daniele Camazzola, Michele Centola, Marcello Capella, Alessandro Bistolfi, Marco Schiraldi, Alessandro Massè
Luigi Sabatini, Luca Barberis, Michele Centola, Alessandro Bistolfi, Orthopaedics and Traumatology Department, Presidio CTO, Torino 10126, Italy
Daniele Camazzola, Marcello Capella, Alessandro Massè, Orthopaedics and Traumatology Department, CTO Hospital, Torino 10126, Italy
Marco Schiraldi, Orthopedics and Traumaology Department, Michele e Pietro Ferrero Hospital, Verduno 12060, Italy
Author contributions: Sabatini L provided input for writing of the paper; Bistolfi A and Capella M collected the literature for review; Barberis L, Camazzola D and Centola M wrote the paper; Massè A and Schiraldi M coordinated the writing of the paper.
Conflict-of-interest statement: The authors declare having no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luigi Sabatini, MD, Doctor, Senior Researcher, Surgeon, Orthopaedics and Traumatology Department, Presidio CTO, Via Zuretti 26, Torino 10126, Italy. luigisabatini.ort@gmail.com
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: May 13, 2021
Revised: May 23, 2021
Accepted: August 6, 2021
Article in press: August 6, 2021
Published online: October 18, 2021
Processing time: 230 Days and 11.7 Hours
Abstract

Primary total knee arthroplasty (TKA) is a widespread procedure to address end stage osteoarthritis with good results, clinical outcomes, and long-term survivorship. Although it is frequently performed in elderly, an increased demand in young and active people is expected in the next years. However, a considerable dissatisfaction rate has been reported by highly demanding patients due to the intrinsic limitations provided by the TKA. Bicruciate-retaining (BCR) TKA was developed to mimic knee biomechanics, through anterior cruciate ligament preservation. First-generation BCR TKA has not gained popularity due to its being a challenging technique and having poor survival outcomes. Thanks to implant design improvement and surgeon-friendly instrumentation, second-generation BCR TKA has seen renewed interest. This review will focus on surgical indications, kinematical basis, clinical results and latest developments of second-generation BCR TKA.

Keywords: Total knee arthroplasty; Anterior cruciate ligament; Bicruciate retaining; Knee kinematics; Second generation design; Knee osteoarthritis treatment

Core Tip: Second-generation bicruciate-retaining total knee arthroplasty (BCR TKA) is designed to overcome the historical durability issues of this implant. Recent kinematics studies point out the advantage of this design in mimicking normal knee motion. Second-generation BCR TKA is generally associated with a more restrictive indication range in terms of coronal alignment, anterior cruciate ligament integrity, and preoperative range of motion. Available clinical results demonstrate variable outcomes with short-term follow-up.