title: The utility of bicruciate-retaining total knee arthroplasty.
abstract: BACKGROUND
  We describe the features of modern and historical bicruciate-retaining (BCR) total knee arthroplasty (TKA) implants compared with other TKA implant designs, reviewing kinematics, proprioception, operative technique, and clinical results.
  
  
  METHODS
  We performed a review based on PubMed, Embase, CINAHL Plus, and Cochrane databases from January 1990 to April 2016 using combinations of the following keywords: "bicruciate-retaining arthroplasty," "bicruciate-retaining total knee arthroplasty," "bicruciate-retaining TKA," "kinematics," "knee kinematics," and "TKA kinematics."
  
  
  RESULTS
  Four studies have supported the notion that preservation of both cruciate ligaments in TKA preserves more "normal" knee kinematics. BCR implants provide greater proprioceptive performance when compared with posterior cruciate-retaining (CR) TKA implants. However, the operative implantation is more challenging with BCR TKAs, requiring the surgeon to take additional precautions. Overall, there did not seem to be a significant difference in short-term clinical outcomes between the BCR and CR implants.
  
  
  CONCLUSIONS
  The utility of BCR TKA is still debatable. The literature has not shown clear indications and guidelines for the value and use of this implant. Although kinematics have been shown to mirror the native knee more closely, the clinical outcomes of BCR vs CR TKAs do not differ significantly. Moreover, additional care must be taken when inserting a BCR implant. The anterior cruciate ligament exploration and preservation is more challenging and certain preparation and precautions must take place. Overall, we have not found that BCR implants are significantly superior to CR implants with regards to short term clinical outcomes despite the BCR TKA having improved kinematics and proprioception.
authors.affiliation: Department of Orthopaedics, NYUMC Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Feroz A
authors.initials: FA
authors.lastname: Osmani
authors.affiliation: Department of Orthopaedics, NYUMC Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Savyasachi C
authors.initials: SC
authors.lastname: Thakkar
authors.affiliation: Department of Orthopaedics, NYUMC Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Collins
authors.affiliation: Department of Orthopaedics, NYUMC Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
keywords: BCR; Bicruciate-retaining; CR; Implant; Knee; TKA