Bicruciate-retaining total knee arthroplasty: What’s new?

Table 1 Indications and relative contraindications summary

Indications	Relative contraindication
High-demand patients	Low-demand patients
End-stage bi- or tricompartmental knee OA	Severe coronal malalignment (> 15°)
Coronal malalignment < 15°	Inflammatory arthritis
ACL integrity:	ACL mucoid degeneration/absence
Clinical assessment (Lachman, anterior drawer test, pivot shift test)	Relevant preoperative reduction of ROM (> 10°)
Intraoperative assessment
Minimal ROM reduction (< 5/10°)

ACL: Anterior cruciate ligament; OA: Osteoarthritis; ROM: Range of motion.

Table 2 Second-generation bicruciate-retaining total knee arthroplasty clinical results

Ref.	Follow up in mo	BCR model (n)	Pre-op ROM flex, mean	Post-op ROM flex, mean	Pre-op KSS, mean	Post-op KSS, mean	FJS	WOMAC
Alnachoukati et al[23]	12	Vanguard XP (146)	116°	121°	48	96
Biazzo et al[49]	33.82	Vanguard XP (24)						8.68 (BCR) vs 12.81 (CR)
Baumann et al[20]	18	Vanguard XP (34)					53.4 ± 26.4
Hennessy et al[45]	12.7	Vanguard XP (29)			58.1 ± 11.8	86.6 ± 16.7
Kono et al[35]	7.7	Journey II XR	128.7 ± 6.1
Kalaai et al[33]	3.6	Vanguard XP (61)			36.2 ± 8.1	22 ± 10.1	58.4 ± 33.7
Peng et al[38]	12.7	Vanguard XP (29)			58.1 ± 11.8	87.9 ± 16.7
Pelt et al[25]	36	Vanguard XP (141)	121	123
Tsai et al[32]	12.9	Vanguard XP (30)			58.5	86.6

BCR: Bicruciate retaining; CR: Cruciate-retaining; FJS: Forgotten joint score; KSS: Knee Society score; ROM: Range of motion; WOMAC: Western Ontario and McMaster Osteoarthritis index

Table 3 Second-generation bicruciate-retaining total knee arthroplasty complications

Ref.	Year	BCR model (n)	Complication	Follow-up time in mo, mean
Alnachoukati et al[23]	2018	Vanguard XP (146)	9 intraoperative tibial island fracture; 1 cyclops lesion; 1 aseptic loosening of tibial component	12
Biazzo et al[49]	2020	Vanguard XP (24)	2 Aseptic loosening; 1 periprosthetic infection; 1 intraoperative tibial island fracture	33.82
Kalaai et al[33]	2019	Vanguard XP (61)	1 valgus thrust	3.6
Klaassen et al[51]	2017	Vanguard XP (3)	2 cyclops lesion (3 knees)
Pelt et al[25]	2019	Vanguard XP (141)	2 Intraoperative tibial island fracture; 11 arthrofibrosis; 1 hematoma; 1 chronic pain	36

BCR: Bicruciate-retaining.