###### Abstract  
(1) Background: Total knee arthroplasty (TKA) is a well-established surgical treatment for end-stage osteoarthritis. While no leading factor can be identified, the high frequency of patient dissatisfaction (20%) pertains to several key features such as preoperative expectations and postoperative improvement in knee function. Bicruicate-retaining total knee arthroplasty (BCR-TKA) may improve kinematics and lead to improved clinical outcome in the higher-demanding patients.  
(2) Methods: A systematic review of the literature was performed to assess the best available preclinical and clinical literature on BCR-TKA for kinematics and clinical outcome and adverse events such as implant loosening. Articles were screened using predefined in- and exclusion criteria. The guidelines for Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were used.  
(3) Results: The literature search resulted in 352 articles which were screened for title and abstract. After application of the in- and exclusion criteria, 13 preclinical and 30 clinical articles were included. The methodological quality of studies was low, including mainly level IV studies. (4) Conclusions: This is the first report that provides a systematic description of the broad available preclinical and clinical literature on BCR-TKA. It underlines the current interest in improving kinematics and clinical outcome based on a more anatomical TKA design. The current review demonstrates the low methodological quality of clinical trials that have investigated BCR-TKA. Currently, there are insufficient data to support broad (\"state of the art\") implantation of BCR-TKA. Preclinical and clinical research suggest, however, that the design has a potential benefit to achieve improved kinematics in the young and active arthroplasty patient and warrants future research for new-generation designs with optimal (tibial) fixation and reproducible (robot or navigated) surgical placement.  
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for improvement in function and kinematics have arisen [3]. Primary TKA was designed to sacrifice the anterior cruciate ligament (ACL) and gain anteroposterior (AP) stability from the implant design in either posterior-cruciate-retaining (CR) or posterior-stabilized (PS) knee arrhythmias. The resulting loss of propriocepsis, along with the paradoxical anterior femoral translation commonly observed in mid- and terminal flexion, may lead to suboptimal kinematics and eventually to patient dissatisfaction [4; 5; 6; 7; 8]. Thus, in retaining the cruciate ligaments, bicruxiate (BCR)-TKA may improve kinematics and lead to improved clinical outcome in the higher-demanding patients. Although BCR-TKA is expected to improve the performance of these patients as a result of the preserved ACL function, its clinical result remains controversial. The initial bicruxiate design was introduced in the 1960s by [PERSON] [9]. Over the past decades, several newer designs have been introduced, which aim at better (tibial) fixation and range of motion. To date, the lack of improved clinical outcome and implant survival after BCR-TKA along with the low methodological quality of clinical trials have restricted broad implementation. Still, the proposed clinical and kinematic improvement that may be achieved by retaining the ACL has been supported by different kinematic and laboratory studies, along with early results of clinical trials [4]. The increase in the use of robotic-assisted TKA may further improve optimal implant placement, ligament balancing and alignment that may prove to be key factors in its possible success. The purpose of this review is to provide a comprehensive systematic overview of the literature on BCR-TKA to provide an in-depth view on available results and provide a basis for a future prospective.