Bi-cruciate retaining total knee arthroplasty has several potential advantages including improved anteroposterior knee stability compared to contemporary posterior cruciate-retaining total knee arthroplasty. However, few studies have explored whether there is significant differences of knee biomechanics following bi-cruciate retaining total knee arthroplasty compared to posterior cruciate-retaining total knee arthroplasty. In the present study, subject-specific lower extremity musculoskeletal multi-body dynamics models for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty were developed based on the musculoskeletal modeling framework using force-dependent kinematics method and validated against in vivo telemetric data. The experiment data of two subjects who underwent total knee arthroplasty were obtained for the SimTK “Grand Challenge Competition” repository, and integrated into the musculoskeletal model. Five walking gait trials for each subject were used as partial inputs for the model to predict the knee biomechanics for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty. The results revealed significantly greater range of anterior/posterior tibiofemoral translation, and significantly more posterior tibial location during the early phase of gait and more anterior tibial location during the late phase of gait were found in bi-cruciate retaining total knee arthroplasty without anterior cruciate ligament when compared to the bi-cruciate retaining total knee arthroplasty. No significant differences in tibiofemoral contact forces, rotations, translations, and ligament forces between bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty during normal walking gait, albeit slight differences in range of tibiofemoral internal/external rotation and anterior/posterior translation were observed. The present study revealed that anterior cruciate ligament retention has a positive effect on restoring normal knee kinematics in bi-cruciate retaining total knee arthroplasty. Preservation of anterior cruciate ligament in total knee arthroplasty and knee implant designs interplay each other and both contribute to restoring normal knee kinematics in different types of total knee arthroplasty. Further evaluation of more demanding activities and subject data from patients with bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty via musculoskeletal modeling may better highlight the role of the anterior cruciate ligament and its stabilizing influence.

与现代后交叉保留全膝关节置换术相比，双交叉保留全膝关节置换术具有几个潜在的优势，包括改善膝关节前后稳定性。然而，很少有研究探讨双交叉保留全膝关节置换术与后交叉保留全膝关节置换术相比，膝关节生物力学是否存在显着差异。在本研究中，基于肌肉骨骼建模框架，基于肌肉骨骼建模框架，开发了双交叉保留、双交叉保留无前交叉韧带和后交叉保留全膝关节置换术的特定主题下肢肌肉骨骼多体动力学模型。相关运动学方法并针对体内遥测数据进行验证。两名接受全膝关节置换术的受试者的实验数据是为 SimTK“大挑战赛”存储库获取的，并集成到肌肉骨骼模型中。每个受试者的五次步行步态试验用作模型的部分输入，以预测双交叉保留、双交叉保留无前交叉韧带和后交叉保留全膝关节置换术的膝关节生物力学。结果表明，在没有前交叉韧带的双交叉保留全膝关节置换术中，发现胫股前/后平移范围明显更大，步态早期胫骨后定位显着更多，步态晚期胫骨前定位更多。与双交叉保留全膝关节置换术相比。在正常步行步态期间，双交叉保留和后交叉保留全膝关节置换术之间的胫股接触力、旋转、平移和韧带力没有显着差异，尽管胫股内/外旋转和前/后平移的范围略有不同。观察到。本研究表明，前交叉韧带保留对双交叉保留全膝关节置换术中恢复正常膝关节运动学具有积极作用。在全膝关节置换术中保留前交叉韧带和膝关节植入物设计相互影响，两者都有助于在不同类型的全膝关节置换术中恢复正常的膝关节运动学。