While the majority of the total knees used today are of the cruciate retaining (CR) and cruciate substituting (PS) types, the results are not ideal in terms of satisfaction, function, and biomechanical parameters. It is proposed that a design which specifically substituted for the structures which provided stability could produce normal laxity behavior, which may be a path forward to improved outcomes. Stabilizing structures of the anatomic knee were identified under conditions of low and high axial loading. The upward slope of the anterior medial tibial plateau and the anterior cruciate was particularly important under all loading conditions. A guided motion design was formulated based on this data, and then tested in a simulating machine which performed an enhanced ASTM constraint test to determine stability and laxity. The guided motion design showed much closer neutral path of motion and laxity in anterior–posterior (AP) and internal–external rotation, compared with the PS design. Particular features included absence of paradoxical anterior sliding in early flexion, and lateral rollback in higher flexion. A total knee design which replicated the stabilizing structures of the anatomical knee is likely to provide more anatomical motion and may result in improved clinical outcomes.

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