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Area of Science:

  • Orthopedic surgery
  • Biomechanics
  • Biomedical engineering

Background:

  • Bicruciate-retaining total knee arthroplasty (BCR-TKA) preserves the anterior cruciate ligament (ACL), aiming for improved functional outcomes.
  • Limited biomechanical data exists on ACL function after BCR-TKA compared to intact knees.

Purpose of the Study:

  • To biomechanically investigate the function of the preserved ACL in BCR-TKA.
  • To compare knee kinematics and ACL forces in intact knees, BCR-TKA, and BCR-TKA with ACL transection (ACLT).

Main Methods:

  • Utilized 8 human cadaveric knees with a 6-degrees-of-freedom robotic system.
  • Evaluated three states: intact knee, BCR-TKA, and BCR-TKA + ACLT.
  • Measured kinematics during passive flexion-extension and anteroposterior (AP) laxity under load.

Main Results:

  • Femoral translation and rotation differed in BCR-TKA compared to intact knees during passive flexion.
  • AP laxity was comparable between intact and BCR-TKA knees but significantly increased after ACLT.
  • ACL in situ forces were higher in BCR-TKA during passive motion but equivalent to intact knees under anterior loading.

Conclusions:

  • The ACL in BCR-TKA is functional under anterior tibial load, contributing to AP stability.
  • Kinematics and ACL forces during passive motion differ between intact and BCR-TKA knees.
  • Potential for ACL overtensioning during BCR-TKA may limit range of motion.