Abstract

Total knee arthroplasty is a widely accepted surgical intervention for end-stage knee osteoarthritis. The restoration of knee stability is a crucial goal in achieving successful outcomes post-TKA. Traditionally, the posterior cruciate ligament has been sacrificed during TKA, resulting in altered kinematics and potential instability in the knee joint. Recent advancements have led to the development of implants that aim to replace the cruciate ligament during primary TKA, offering improved functional outcomes and patient satisfaction.

This article provides a comprehensive review of the current state of implants that replace the cruciate ligament in primary TKA. It begins by discussing the anatomical and biomechanical importance of the cruciate ligaments in knee stability and function. The drawbacks associated with sacrificing the PCL during TKA are then highlighted, including compromised stability, altered kinematics, and potential long-term complications.

The review subsequently explores various types of cruciate ligament-preserving implants, including posterior stabilized and cruciate-retaining designs. The characteristics, indications, surgical techniques, and clinical outcomes of each implant are thoroughly examined, incorporating evidence from clinical studies, systematic reviews, and metaanalyses. Additionally, implant-related complications, such as implant loosening, wear, and failure, are addressed to provide a comprehensive overview.

Furthermore, the review delves into emerging technologies and advancements in implant designs, such as anatomical implants, patient-specific instrumentation, and computer-assisted navigation. The potential benefits and limitations of these innovative approaches are discussed, along with the evolving evidence base supporting their use.