Hip and Knee Reconstructive Surgery Department, Humanitas Gavazzeni, Bergamo, Italy.
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Eur J Orthop Surg Traumatol. 2021 May;31(4):785-790. doi: 10.1007/s00590-020-02834-9. Epub 2020 Nov 19.
The aim of this study is to compare 2 groups of total knee arthroplasties (TKAs): the bicruciate-retaining (BCR-group) and cruciate-retaining total knee arthroplasty (CR-group), evaluating the functional results in the short-term follow-up.
24 BCR were included in the study and were compared with a group of 24 TKAs performed with the same implant, but with sacrifice of the ACL and retention of the posterior cruciate ligament. For preoperative and postoperative clinical evaluation, the visual analogue score (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used. Radiological evaluation included weight-bearing long-leg view, a Rosemberg view, lateral view of the knee and tangential view of the patella. Hip-knee-ankle angle (HKA) was recorded pre and postoperatively. Radiolucent lines (RLLs) were evaluated according the Knee Society Roentgenographic Evaluation System (KSRES).
At last follow-up the mean VAS score was 1.81 for BCR group and 1.43 for CR group (p = 0.61). The mean WOMAC score was 8.68 for BCR group and 12.81 for CR group (p = 0.33). As for the radiological evaluation, preoperative HKA angle was 0.53° varus for BCR group and 3.14° varus for CR group (p = 0.24); postoperative HKA was 0.72° valgus for BCR group and 0.38° valgus for CR group (p = 0.75). The percentage of RLLs was similar between the two groups (12% versus 15%).
BCR-TKA has showed to give similar functional and radiographic outcomes compared to conventional CR-TKA in a similar cohort of patients. An higher operative times and higher number of complications respect were found in BCR group. These results can be explained by the early learning curve experiences. Future randomized controlled trials should be performed to support new implant designs such as BCR.
Level of evidence Case-control study, level III.
本研究旨在比较两组全膝关节置换术（TKA）：保留双交叉韧带（BCR 组）和保留交叉韧带的全膝关节置换术（CR 组），评估短期随访中的功能结果。
研究纳入 24 例 BCR，并与一组采用相同植入物但牺牲前交叉韧带并保留后交叉韧带的 24 例 TKA 进行比较。术前和术后临床评估采用视觉模拟评分（VAS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）。影像学评估包括负重全长位片、罗森伯格位片、膝关节侧位片和髌骨切线位片。记录术前和术后髋关节-膝关节-踝关节角（HKA）。根据膝关节协会 X 线评估系统（KSRES）评估透亮线（RLL）。
末次随访时，BCR 组 VAS 评分平均为 1.81，CR 组为 1.43（p=0.61）。BCR 组 WOMAC 评分平均为 8.68，CR 组为 12.81（p=0.33）。影像学评估方面，BCR 组术前 HKA 角为 0.53° 内翻，CR 组为 3.14° 内翻（p=0.24）；BCR 组术后 HKA 角为 0.72° 外翻，CR 组为 0.38° 外翻（p=0.75）。两组 RLL 比例相似（12%对 15%）。
在相似的患者队列中，BCR-TKA 与传统的 CR-TKA 相比，在功能和影像学结果方面相似。BCR 组手术时间较长，并发症较多。这些结果可以通过早期学习曲线经验来解释。未来应进行随机对照试验，以支持 BCR 等新型植入物设计。
病例对照研究，III 级。
