Bicruciate-retaining (BCR) knee replacement is an advanced prosthesis design that preserves both the anterior and posterior cruciate ligaments during total knee replacement. It aims to restore more natural knee kinematics than conventional cruciate-sacrificing or posterior-stabilised designs.
The surgical technique is similar to standard TKR but more demanding — both cruciate ligaments must be carefully preserved while the bone is cut and the implants are positioned. Specialised implant designs accommodate the retained ligaments. The tibial component has a unique geometry that works with the natural cruciates. Precise ligament balancing and component positioning are critical. The operation takes one and a half to two hours.
BCR knee replacement may be offered to patients with intact cruciate ligaments who wish to maximise natural knee feeling and kinematics after TKR. It may provide better proprioception, more natural stair descent, and improved deep flexion compared to conventional designs.
All standard non-operative knee arthritis treatments. Conventional TKR (cruciate-sacrificing or posterior-stabilised), partial knee replacement, and osteotomy are surgical alternatives.
MRI to confirm both cruciate ligaments are intact and functional. Standard TKR pre-assessment. Surgeon must have specific training and experience with BCR designs.
Potentially more natural knee kinematics — better proprioception, more normal stair descent, and improved 'knee feeling.' Early clinical results are promising but long-term data is still maturing compared to conventional TKR designs with forty years of follow-up.
Infection, blood clots, stiffness, ongoing pain.
Cruciate preservation requires precise surgical technique.
Compared to conventional designs with decades of follow-up.
Despite intent to preserve, one or both cruciates may be damaged during surgery requiring conversion to a conventional design.
If ligament balancing is imprecise.
Revision may be more complex than conventional TKR.
General or spinal anaesthesia — same as conventional TKR.
Similar to conventional TKR. Hospital one to three days. Physiotherapy from day one. Potentially faster return of natural knee function due to preserved proprioception. Full recovery six to twelve months.
Same as conventional TKR. X-rays at six weeks, one year, then every two to five years.
Early results are very promising — patients may experience more natural knee feeling and kinematics. However, conventional TKR designs have forty years of proven long-term data. BCR designs are newer and long-term survivorship data is still maturing. Both are excellent options.
No — both cruciate ligaments must be intact and functional. Patients with ACL-deficient knees, severe deformity, or inflammatory arthritis are generally not suitable.