Bicruciate-retaining versus cruciate-retaining total knee arthroplasty in implant fixation: a 10-year follow-up of a randomized RSA trial
In brief
Bicruciate-retaining knee matches stability yet has double revision rate
After ten years, tibial component migration was virtually identical between bicruciate-retaining and standard cruciate-retaining total knee arthroplasties (about 0.9 mm vs 0.6 mm). Patient-reported scores were also similar, but the bicruciate group experienced two revisions while the cruciate group had none, suggesting higher complication risk despite comparable fixation.
- Journal
- Acta orthopaedica (Q1)
- Published
- 17 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Tomofumi Kinoshita, Kristian R L Mortensen, Lina H Ingelsrud, Omar Muharemovic, Kirill Gromov, Anders Troelsen
- PMID
- 42770474
- DOI
- 10.2340/17453674.2026.46805
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (paper of the day, 23 September 2026): 10‑year RSA trial comparing BCR‑TKA vs CR‑TKA
Abstract
BACKGROUND AND PURPOSE: Bicruciate-retaining (BCR) total knee arthroplasty (TKA) aims to restore physiological knee kinematics and joint stability by preserving both cruciate ligaments, potentially improving patient satisfaction. However, long-term clinical outcomes and tibial component migration remain insufficiently understood. We therefore aimed to evaluate long-term implant fixation and clinical outcome after BCR-TKA compared with cruciate-retaining (CR) TKA. METHODS: We performed a long-term follow-up of a randomized controlled trial using radiostereometric analysis (RSA) to compare tibial implant migration between BCR-TKA and CR-TKA. The primary outcome was maximum total point motion (MTPM) of the tibial component, measured with model-based RSA at 3 months, 1, 2, 5, and 10 years. Secondary outcomes included the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS) at identical time points. Mortality, reoperations, and revisions were recorded. RESULTS: 25 patients were included in each group. At 10 years, the estimated mean MTPM was 0.88 mm (95% confidence interval [CI] 0.64-1.12) in the BCR group and 0.64 mm (CI 0.40-0.88) in the CR group (between-group difference -0.23 mm, CI -0.57 to 0.10). Estimated changes in OKS and FJS showed no evidence of differing longitudinal trajectories between groups. 2 revisions occurred in the BCR group, whereas none occurred in the CR group. CONCLUSION: No significant differences were detected between BCR-TKA and CR-TKA in tibial implant migration or patient-reported outcomes over the 10-year follow-up. In contrast, the incidence of complications was higher in the BCR group, indicating that careful patient selection and optimization of surgical strategies remain important for BCR-TKA.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.