Bicruciate Retaining Total Knee Arthroplasty

Early total knee arthroplasties were designed to retain both of the cruciate ligaments (bicruciate retaining total knee arthroplasty). Unfortunately, the results of these implants were compromised with early implant loosening as the primary mode of failure. Subsequent prosthetic designs included resection of both cruciates with surface modifications of the implants (medial pivot total knee arthroplasty, posterior stabilized total knee arthroplasty) or retention of just the posterior cruciate ligament. These designs provided excellent clinical results with long-term follow-up studies. However, the kinematics of the total knee arthroplasties often failed to mimic the motion of the native knee. In the early 2000s, designers began to look more critically at the kinematics and returned to bicruciate ligament retaining designs. The chapter reviews the past, present, and future of the bicruciate retaining total knee arthroplasties.