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- •Foreword
- •Preface
- •Contents
- •Contributors
- •Introduction
- •Posterior Stabilized
- •Cruciate Retaining
- •Bi-cruciate Retaining Designs
- •Conclusion
- •References
- •Introduction
- •The Cruciate Ligaments
- •Polyethylene Advancements
- •Surface Anatomy
- •References
- •Introduction
- •Cruciate Function Provided by Total Knee Bearing Surfaces
- •References
- •Introduction
- •Prosthesis Design
- •Intraoperative Considerations
- •Clinical Results
- •Conclusions
- •References
- •Introduction
- •Relevant Anatomy
- •Implant Design
- •Surgical Technique
- •Conclusions
- •References
- •Introduction
- •History
- •Surgical Technique
- •Complications
- •Outcomes
- •Conclusion
- •References
- •Introduction
- •Native Knee Kinematics
- •BCS TKA Design Features
- •Clinical Results
- •Conclusion
- •References
- •Introduction
- •Prosthetic Designs
- •Newer Designs
- •Surgical Technique
- •Results
- •Complications
- •Summary
- •References
- •Historical Perspective
- •Pathoanatomy
- •Prosthetic Design
- •Surgical Technique
- •Clinical Outcomes
- •Summary
- •References
- •Introduction
- •PCL Retention Promotes Internal Tibial Rotation During Flexion
- •Conclusions
- •References
- •Introduction
- •Extension First Technique
- •Flexion-First Technique
- •Disadvantages
- •Various Alignment Philosophies
- •Various Gap Philosophies
- •ACL Preserving Knee Systems
- •Joint Distraction Variability
- •Robotics
- •Conclusion
- •References
- •Background
- •Indications
- •System Features
- •Active, Semi-Active, Passive
- •Image-Based Versus Imageless
- •Open Versus Closed
- •Technique
- •Intraoperative Planning
- •Clinical Studies
- •Soft-Tissue Protection
- •Clinical Outcomes
- •Limitations
- •References
- •Introduction
- •Data Captured During Robotic Surgery
- •Conclusion
- •References
- •Bicruciate Retaining TKA
- •Bicruciate Stabilized TKA
- •Medial Pivot TKA Design
- •Summary
- •References
- •Introduction
- •Rehabilitation Overview
- •Surgical Approaches
- •Rehabilitation Guidelines
- •Implants
- •Fixation
- •Partial Knee Replacement
- •PCL Substituting/Stabilized TKA
- •PCL Retaining TKA
- •Introduction
- •Healthy, Nonimplanted Knee Kinematics
- •AP Translation
- •Axial Rotation
- •Femoral Condylar Liftoff
- •AP Translation
- •Axial Rotation
- •Femoral Condylar Liftoff
- •PCL Sparing TKA Kinematics
- •AP Translation
- •Axial Rotation
- •Femoral Condylar Liftoff
- •PCL Substituting TKA Kinematics
- •AP Translation
- •Axial Rotation
- •Femoral Condylar Liftoff
- •Bicruciate Substituting TKA Kinematics
- •AP Translation
- •Axial Rotation
- •Bicruciate Retaining TKA Kinematics
- •AP Translation
- •Axial Rotation
- •Medial Pivot TKA Kinematics
- •AP Translation
- •Axial Rotation
- •Mobile Bearing TKA Kinematics
- •Summary
- •References
- •Introduction
- •Implant Design
- •Instrumentation
- •Augmented Reality
- •Smart Implants
- •Summary
- •References
- •Index

TheCruciate
Ligaments in Total
Knee Arthroplasty
Design, Function and
Rehabilitation
AlfredJ.TriaJr.
GilesR.Scuderi
Editors
123

The Cruciate Ligaments in Total Knee Arthroplasty

Alfred J. TriaJr. • Giles R. Scuderi
Editors
The Cruciate Ligaments
in Total Knee Arthroplasty
Design, Function andRehabilitation

Editors
Alfred J. TriaJr.
Orthopedic Surgery (Emeritus)
Rutgers-Robert Wood Johnson
Medical School
New Brunswick, NJ, USA
Giles R. Scuderi
Orthopaedic Surgery
Zucker School of Medicine at Hofstra/
Northwell
Hempstead, NY, USA
ISBN 978-3-031-75991-8 ISBN 978-3-031-75992-5 (eBook)
https://doi.org/10.1007/978-3-031-75992-5
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland
AG 2024
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.

Through our academic pursuits for over four
decades, we have had the opportunity to
train and mentor numerous residents, fellows
and surgeons. As our legacy, we are hopeful
that they will pickup the baton and continue
to inuence the world of knee surgery. This
book is dedicated to all of them.
Giles R.Scuderi, MD, Alfred J.Tria, Jr., MD

Foreword
It gives me great pleasure to be asked to write a foreword for the upcoming textbook
entitled The Cruciate Ligaments in Total Knee Arthroplasty: Design, Function, and
Rehabilitation to be edited by my good friends Gil Scuderi and Fred Tria.
This book has brought together many of my friends and colleagues from around
the world of Knee Arthroplasty and I am proud to see them here, especially my dear
old friend Peter Walker whose seminal engineering work allowed John Insall and
me to implant the rst Total Condylar Prosthesis (TCP) at HSS in 1974. The TCP
(which of course sacriced both cruciate ligaments) became the basis of the modern
total knee design.
Indeed, I see the guiding inuence of John Insall himself in the organization and
authorship of this book. I daresay John would be pleased if not a little skeptical with
how things have evolved in knee arthroplasty.
I will keep my opinions on these new designs to myself.
I am quite sure this textbook will become the foundational knowledge of knee
design in years to come.
Hospital for Special Surgery ChitranjanS.Ranawat
New York, NY, USA
vii

Preface
This text represents our fteenth passage together. Our fellowships with Dr. John
N.Insall were our initial common bond and fostered a lifelong friendship. We have
been fortunate to have honed our academic careers in The Knee Society and cultivated so many wonderful relationships with many of the authors who have contributed to this text. Our colleague, mentor, and friend, Dr. Chitranjan Ranawat, was
kind enough to author the foreword to this text. As an internationally acclaimed
surgeon, we are extremely grateful to him for his time and thoughts.
The text is centered on the cruciate ligaments that have challenged knee designers from the very beginning. With contributions from numerous expert authors, the
history is reviewed, and the basics of anatomy and kinematics are presented. The
total knee designs section discusses all the present-day prostheses with historical
background. The surgical techniques consider the varying approaches with their
advantages and limitations. The rehabilitation section ties the postoperative recovery program to each knee design. The results section compares the different prostheses and concludes with some considerations for the future.
The nal answer for the cruciates and total knee arthroplasty is not yet completed; but, we do hope that this text will provide further insight into the direction
of the changing paradigm.
New Brunswick, NJ, USA AlfredJ.Tria Jr
Hempstead, NY, USA GilesR.Scuderi
ix

Contents
Part I Background
1 The Evolution of Total Knee Replacements . . . . . . . . . . . . . . . . . . . . . . 3
Mohamed F. Albana and Giles R. Scuderi
Part II Basics
2 Anatomy: Cruciate Ligaments and Knee Surfaces . . . . . . . . . . . . . . . . 19
Alfred J. Tria Jr and Giles R. Scuderi
3 Kinematics of the Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Peter S. Walker
Part III Total Knee Designs with Respect to the Cruciate Ligaments
4 The PCL-Sparing Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . . . . . 51
Jonathan R. Franco and Antonia F. Chen
5 Medial Pivot Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Seper Ekhtiari, Emilio D. Hernandez, Jesse I. Wolfstadt,
and David Backstein
6 PCL Substituting Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . . . . . 73
Zuhdi E. Abdo, Giles R. Scuderi, and Alfred J. Tria Jr
7 Bicruciate Substituting Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . 81
Peter P. Hsiue, Ryan Cheng, Jeffrey A. O’Donnell,
and Steven B. Haas
8 Bicruciate Retaining Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . . . 89
Alfred J. Tria Jr and Giles R. Scuderi
9 Partial Knee Arthroplasties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Todd E. Bertrand, Patricia R. Melvin, and Adolph V. Lombardi Jr
xi

xii
Contents
Part IV Surgical Techniques
10 Kinematic Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Alexander J. Nedopil, Sahil A. Sanghavi, Stephen M. Howell,
and Maury L. Hull
11 Ligament Gap Balancing Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Martin Roche, Tsun Law, Gabriella Dituri, and Ebony James
12 Robotic Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Gabrielle N. Swartz, Reza Katanbaf, Sandeep S. Bains,
Ronald E. Delanois, and Michael A. Mont
13 Artificial Intelligence Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Ryan Cheng, Tony S. Shen, and David J. Mayman
Part V Rehabilitation Programs
14 Variations in Protocols: Physical Therapy, Bracing,
Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Lauren Sacco, Faraz Jamal, and Tony K. George
Part VI Results
15 Comparisons of All Designs with Respect
to the Cruciate Ligaments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Douglas A. Dennis, Jason A. Bryman, and Richard D. Komistek
16 Future Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Giles R. Scuderi and Alfred J. Tria Jr
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

Contributors
ZuhdiE.Abdo Lenox Hill Hospital/Northwell Health, New Hyde Park, NY, USA
Mohamed F. Albana Zucker School of Medicine at Hofstra/Northwell, Hemp-
stead, NY, USA
David Backstein, MD, MEd, FRCSC Hospital for Special Surgery at NCH,
Naples, FL, USA
SandeepS.Bains LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute
for Advanced Orthopedics, Baltimore, MD, USA
ToddE.Bertrand JIS Orthopedics, LLC, New Albany, OH, USA
Jason A. Bryman Colorado Joint Replacement, AdventHealth Porter, Den-
ver, CO, USA
AntoniaF.Chen Department of Orthopedic Surgery, Brigham and Women’s Hos-
pital, Harvard Medical School, Boston, MA, USA
RyanCheng Hospital for Special Surgery, New York, NY, USA
Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery,
New York, NY, USA
Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
RonaldE.Delanois LifeBridge Health, Sinai Hospital of Baltimore, Rubin Insti-
tute for Advanced Orthopedics, Baltimore, MD, USA
Douglas A. Dennis Colorado Joint Replacement, AdventHealth Porter, Den-
ver, CO, USA
Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
Department of Biomedical Engineering, University of Denver, Denver, CO, USA
Department of Orthopaedics, University of Colorado Health School of Medicine,
Aurora, CO, USA
xiii
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