JBJS Meta-Analysis Throws Cold Water on ‘Natural Knee’

For decades, orthopedic surgeons have debated the virtues of cruciate-retaining (CR) versus cruciate-substituting (CS) implants in total knee arthroplasty (TKA). The CR camp has long argued that preserving the posterior cruciate ligament (PCL) keeps knees feeling “natural,” while the CS camp countered with stability and simplicity.

Well, a fresh meta-analysis published August 7, 2025, in JBJS Open Access just crashed the party: when it comes to patient-perceived joint awareness, CS implants may actually have the edge.