Evidence map›Paper›PMID 41566837›Full record

ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2026

Excellent midterm functional and clinical outcomes of bi-cruciate retaining versus cruciate retaining total knee arthroplasty: A prospective cohort study.

Soufyan Kalaai, Bert Boonen, Emiel H van Haaren, Rob P A De Bie, Jasper Most, Martijn G M Schotanus

Abstract readComparative Study
In one paragraph

Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Soufyan KalaaiDepartment of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, location Sittard-Geleen, the Netherlands.ORCID https://orcid.org/0000-0002-3840-0718
Bert BoonenDepartment of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, location Sittard-Geleen, the Netherlands.
Emiel H van HaarenDepartment of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, location Sittard-Geleen, the Netherlands.
Rob P A De BieSchool of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences Maastricht University Medical, Maastricht, the Netherlands.
Jasper MostDepartment of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, location Sittard-Geleen, the Netherlands.
Martijn G M SchotanusDepartment of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, location Sittard-Geleen, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposebi-cruciate retaining total knee arthroplasty (BCR-TKA) is recognised as an alternative to a Cruciate Retaining Total Knee Arthroplasty (CR-TKA) in the pursuit of reducing joint awareness and approaching a 'forgotten artificial knee joint'. The aim of this retrospective cohort study was to provide a short-term comparison on functional and clinical outcomes between BCR-TKA and CR-TKA in osteoarthritis patients.

methodsThe cohort consisted of 61 BCR-TKA patients, matched for age, BMI and sex with 61 CR-TKA patients. They were operated on between 2014 and 2016. Patient-Reported Outcome Measurements, including the Forgotten Joint Score (FJS-12), Oxford Knee Score (OKS), Western Ontario and McMaster Osteoarthritis (WOMAC) and Visual Analogue Score (VAS) pain, were collected preoperatively and at 3-, 12-, 24-months and 5-years postoperatively. Additionally, domain-specific questionnaires were included, such as the FJS. Effect size for the FJS-12 was calculated at the 3-year follow-up to quantify the difference between BCR- and CR-TKA. Functional performance was additionally evaluated using a validated balance-based exergaming system, consisting of a pressure-sensitive balance platform delivering real-time visual feedback to quantify dynamic stability.

resultsAt 5-year follow-up, BCR-TKA showed significantly better patient-reported outcome measures (PROMs) than CR-TKA, including joint awareness, stiffness, function, pain and daily activity-related disabilities (FJS-12, OKS, WOMAC, VAS pain). In the subgroup completing exergaming assessment, BCR-TKA demonstrated superior dynamic stability (71.91% vs. 66.90%, p = 0.021). The 5-year survival rate was 98.4% for BCR-TKA and 95.1% for CR-TKA, with no significant difference in revision rates.

conclusionBCR-TKA resulted in superior midterm joint awareness and functional outcomes compared to the CR-TKA. Additionally, objective data collected through exergaming demonstrated a positive trend in favour of BCR-TKA, further supporting its functional benefits. This study illustrates that the bi-cruciate retaining surgical technique for TKA is a promising step toward reducing joint awareness and achieving the 'forgotten' artificial knee. As ACL preservation may enhance rotational stability and proprioception, future research should incorporate high-resolution kinematic analyses such as 3D gait analysis. LEVEL OF EVIDENCE: Level III, therapeutic, retrospective cohort study.

Indexed as

Arthroplasty, Replacement, KneeOsteoarthritis, KneeAgedFemaleHumansKnee ProsthesisMaleMiddle AgedPatient Reported Outcome MeasuresPosterior Cruciate LigamentProspective StudiesRetrospective StudiesTreatment Outcome12‐item forgotten joint scorebi‐cruciate retaining knee arthroplastycruciate retaining knee arthroplastyosteoarthritispatient reported outcome measurementstotal knee replacement

Identifiers

PMID41566837
PMCPMC13502455

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.