Bicruciate Retaining Designs: Where Have We Been and Where are We Going?

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Bicruciate retaining total knee arthroplasty dates back to the 1980s. The earliest of the prostheses saved all of the ligaments but included constraint in the surface design that led to a kinematic conflict and early failures. Townley and Cloutier developed successful designs that had good midterm results but they did not develop a significant following among the orthopedic surgeons of their time. With the introduction of minimally invasive surgery for total knee arthroplasty, the concept of sparing the anatomy brought surgeons back to the concept of saving all of the ligaments. In the past 5 years at least 2 new designs for the bicruciate ligament retaining TKA have been introduced. The new prostheses have improved anatomy and more sophisticated instrumentation for the surgical procedure. The clinical results are short-term, but they are encouraging. The operation can be performed routinely, the prosthesis is reliable, and patients are reporting improved KOOS scores. The future will show added technology for the operation with robotic assistance, pressure sensing devices for balancing, and smart instruments to assist in alignment. Hopefully, the more anatomic design will help the 15% of patients who are not satisfied with their TKA.

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