Bicruciate-Retaining Total Knee Arthroplasty: State of the Art for the Younger and Active Population? A Systematic Review and Future Prospective
Peter S. Walker
Round 1
Reviewer 1 Report
Line 18. Mechanic, kinematic and kinematic clinical outcome. This is an unusual terminology, not clear what it means. Line 52. ‘As TKA was primarily designed for the elderly patient’ I do not think this is true at all. Today’s total knees are designed in the best possible way for patients of all ages and conditions. Line 84. ‘kinematic laboratory/ cadaveric studies. Make this more clear.Overall there needs to more description of the shape of the bearing surfaces in the different designs, and their effect on kinematics. The bearing surfaces have as much if not more influence on AP stability and 3D kinematics, than retention of the ACL. Particularly under the weight-bearing loads of function.
Author Response
Thanks to the reviewer for the important remarks.
Response to reviewer:
Comment 1: Line 18. Mechanic, kinematic and kinematic clinical outcome. This is an unusual terminology, not clear what it means
Response: Line 18, correct, this was an error in the text. The sentence has been changed to : “A systematic review of the literature was performed to assess the best available preclinical and clinical literature on BCR-TKA for kinematics and mechanic, kinematic and kinematic clinical outcome and adverse events such as implant loosening.”
Comment 2: Line 52. ‘As TKA was primarily designed for the elderly patient’ I do not think this is true at all. Today’s total knees are designed in the best possible way for patients of all ages and conditions.
Response: Line 52. We agree with the reviewer that at present, TKA is designed for all ages. This statement referred to the past. The sentence in the manuscript has been identified for clarity to: “As early TKA designs were primarily aimed at the elderly patient, new challenges for improvement in function and kinematics have arisen.
Comment 3: Line 84. ‘kinematic laboratory/ cadaveric studies. Make this more clear.
Response: Changed to "preclinical kinematic laboratory/ cadaveric studies"
Comment 4: Overall there needs to more description of the shape of the bearing surfaces in the different designs, and their effect on kinematics. The bearing surfaces have as much if not more influence on AP stability and 3D kinematics, than retention of the ACL. Particularly under the weight-bearing loads of function.
Response: Regarding the design of the bearing, we agree that this may have a major impact on stability and kinematics. We have now described all bearing designs for the different BCR-TKA designs. In addition, we have added the following sentence to the discussion: “What’s more, newer anatomical bearing designs with more constrained (concave) medial and convex lateral surfaces may be as important for anterior-posterior stability and kinematics. Unfortunately, while such designs have been described, their exact influence on kinematics are yet to be determined. [25] “
Reviewer 2 Report
The review provide a systematic description of the broad available 27 preclinical, and clinical literature on BCR-TKA, which underlines the current interest in improving kinematics and clinical outcome based on a more anatomical TKA design.There is some concern on this review which is needed to revise furtherly as follow.
The clinical results of LCS and third generation BCR-TKA are needed to summarised into tables.
Author Response
Comment:
The review provide a systematic description of the broad available 27 preclinical, and clinical literature on BCR-TKA, which underlines the current interest in improving kinematics and clinical outcome based on a more anatomical TKA design.There is some concern on this review which is needed to revise furtherly as follow.
The clinical results of LCS and third generation BCR-TKA are needed to summarised into tables.
Response: A table has been added to include the LCS design. The third generation only includes one study, therefore we have chosen not to include a table for the third generation.
