The function of cruciate ligaments in bi-cruciate retaining Total knee arthroplasty with asymmetrical design

Background: Bi-cruciate retaining total knee arthroplasty with an asymmetrical design may improve knee function and clinical outcomes. This study aimed to compare the kinematics, anteroposterior laxity, and in situ forces of the anterior and posterior cruciate ligaments of knees subjected to this treatment with those of healthy knees.Methods: Seven fresh-frozen cadaveric knees were tested using a robotic/universal force-moment sensor system. The kinematics during passive flexion-extension motion and anteroposterior laxity for native knee, treated knee, and treated knee with cruciate ligament transection states were investigated. The motions of the intact and treated knees during each test were repeated after anterior/posterior cruciate ligament transection to calculate the in situ force in the ligaments.Findings: The screw-home movement of normal knees disappeared after treatment. The in situ force of the anterior cruciate ligament in treated knees was higher than that in intact knees at >15 & DEG; during flexion and at 60 & DEG; and 90 & DEG; against an anterior force. The in situ force of the posterior cruciate ligament in treated knees was higher at 0 & DEG;, 15 & DEG;, and 30 & DEG; during flexion and at all flexion angles against a posterior force. Interpretation: The screw-home movement of normal knees decreased, and the in situ force of the anterior and posterior cruciate ligaments increased after treatment.