Stair Climbing and High Knee Flexion Activities in Bi-Cruciate Retaining Total Knee Arthroplasty: In Vivo Kinematics and Articular Contact Analysis

Background: Bi-cruciate retaining (BCR) total knee arthroplasty (TKA) preserves both anterior and posterior cruciate ligaments with the potential to restore normal posterior femoral rollback and joint kinematics. However, there is limited information regarding articular contact behavior in the contemporary BCR TKA design during high knee flexion activities. This study aimed to investigate the articular knee contact performance in unilateral BCR TKA patients during strenuous flexion activities. Methods: Twenty-nine unilateral BCR TKA patients were evaluated for both knees during single deep lunges, step-ups, and sit-to-stand (STS) using a validated combined computer tomography and dual fluoroscopic imaging system. Medial and lateral condylar contact positions were quantified during weight-bearing flexion. Results: Contact excursions of the lateral condyle in BCR TKAs were significantly more anteriorly located than the contralateral non-operated knees during STS (-4.9 +/- 3.1 vs -9.7 +/- 4.6 mm, P < .05), single deep lunge (-5.7 +/- 3.2 vs -10.0 +/- 4.5 mm, P < .05), and step-ups (-4.8 +/- 3.6 vs -9.1 +/- 3.9 mm, P < .05). Contact points of BCR TKAs indicated reduced femoral external rotation during STS (2.1 +/- 4.8 degrees vs 7.7 +/- 5.4 degrees, P < .05), single deep lunges (1.8 +/- 4.8 degrees vs 7.0 +/- 7.1 degrees, P < .05), and step-ups (0.1 +/- 4.1 degrees vs 6.2 +/- 4.9 degrees, P < .05). Medial pivoting patterns were observed in only 59%, 56%, and 48% of the BCR TKA knees for step-ups, STS, and single deep lunge, respectively. Conclusion: The contemporary BCR TKA design demonstrated asymmetric femoral rollback, medial translation, as well as lateral pivoting in about half of the patient cohort, suggesting that in vivo tibiofemoral kinematic parameters were not fully restored in BCR patients during strenuous flexion activities. (C) 2018 Elsevier Inc. All rights reserved.