{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T05:26:14Z","timestamp":1793683574038,"version":"4.5.1"},"reference-count":41,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>No systematic review has compared the clinical outcome of anterior stabilized ultra\u2010congruent and standard cruciate\u2010retaining inserts in fixed\u2010bearing primary total knee arthroplasty. This study aimed to compare the outcomes and establish the superiority or equivalence of these inserts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pubmed, EMBASE, Medline, AMED, ERIC, and Proquest databases were searched electronically. PRISMA guidelines were followed in the conduct of the study. The clinical outcomes compared in the meta\u2010analysis were overall knee score, WOMAC, score for knee function, score for knee pain, SF\u201012\u00a0PCS, knee flexion, manipulation under anaesthesia for postoperative knee stiffness, revision total knee arthroplasty or change of polyethylene insert for post\u2010operative instability (relative risk [RR]) and survivorship. Study quality was evaluated using the Newcastle Ottawa Scale and the Modified Jadad scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fourteen studies comprising 9989\u00a0knees (three RCTs and 11 comparative case\u2010cohort studies) were included for qualitative and quantitative analysis. The pooled analysis of the ultracongruent insert and the standard cruciate retaining insert was based on a cohort of 2860 and 7129 TKA, respectively. Knee pain was significantly better in patients that had standard inserts (<jats:italic>p<\/jats:italic>\u2009=\u20090.02; 95% CI \u2212 1.06 to \u2212 0.10), and the physical component of health\u2010related quality of life was also significantly better in patients that had standard inserts (<jats:italic>p<\/jats:italic>\u2009=\u20090.02; 95% CI \u2212 6.43 to \u2212 0.64). There was a 72% lesser chance of revision TKA or change of insert for postoperative instability in knees that had been implanted with ultracongruent inserts (RR\u2009=\u20090.28; <jats:italic>p<\/jats:italic>\u2009=\u20090.0002; 95% CI 0.15\u20130.55). There was no difference in the otheroutcome measures. There was no significant difference between the two inserts, considering the minimal clinically important difference or absolute ratio.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Differences observed between the two types of inserts were not clinically significant. Therefore, based on current evidence, arthroplasty surgeons can use either of these inserts with cruciate\u2010retaining knee prosthesis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Therapeutic study, Level II.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06833-z","type":"journal-article","created":{"date-parts":[[2022,1,10]],"date-time":"2022-01-10T19:03:06Z","timestamp":1641841386000},"page":"3076-3091","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Equivalent outcomes of ultra\u2010congruent and standard cruciate\u2010retaining inserts in total knee arthroplasty"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7099-941X","authenticated-orcid":false,"given":"Karthik","family":"Vishwanathan","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics Parul Institute of Medical Sciences and Research, Parul University Limda, Waghodia 391760 Vadodara Gujarat India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4978-3590","authenticated-orcid":false,"given":"Srinivas B. S.","family":"Kambhampati","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Sri Dhaatri Orthopaedic, Maternity &amp; Gynaecology Center, SKDGOC 531127 Vijayawada Andhra Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9577-9533","authenticated-orcid":false,"given":"Raju","family":"Vaishya","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Indraprastha Apollo Hospitals New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2013.03.014"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010018\u20104872\u2010z"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.95B11.32835"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.sart.2016.06.006"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2019.04.034"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010013\u20102523\u2010y"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2011.04.001"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.02.029"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010012\u20101997\u20103"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104427\u20108"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058\u20105241.5.190015"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005827\u20102"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2000.6633"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u20105\u201013"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010198911000\u201000004"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2005.08.019"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2019.12.033"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2020.0024"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.01.021"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.09.053"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2019.06.001"},{"key":"e_1_2_10_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005543\u2010x"},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010014\u20102892\u2010x"},{"key":"e_1_2_10_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s43019\u2010020\u201000038\u20103"},{"issue":"1","key":"e_1_2_10_26_2","first-page":"2","article-title":"Cruciate retaining and cruciate substituting ultra\u2010congruent insert","volume":"4","author":"Mazzucchelli L","year":"2016","journal-title":"Ann Transl Med"},{"key":"e_1_2_10_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.08.016"},{"key":"e_1_2_10_28_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447\u201020121217\u201004"},{"key":"e_1_2_10_29_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058\u20105241.4.180083"},{"key":"e_1_2_10_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2021.01.017"},{"key":"e_1_2_10_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010013\u20103068\u20106"},{"key":"e_1_2_10_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2016.06.012"},{"key":"e_1_2_10_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010014\u20103648\u20100"},{"key":"e_1_2_10_34_2","first-page":"146","article-title":"Posterior cruciate supplementing total knee arthroplasty using conforming inserts and cruciate recession. Effect on range of motion and radiolucent lines","volume":"309","author":"Scott RD","year":"1994","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_10_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104553\u20103"},{"key":"e_1_2_10_36_2","doi-asserted-by":"publisher","DOI":"10.1186\/s43019\u2010019\u20100001\u20107"},{"key":"e_1_2_10_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.10.006"},{"key":"e_1_2_10_38_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010016\u20104144\u20108"},{"key":"e_1_2_10_39_2","doi-asserted-by":"publisher","DOI":"10.1080\/00016470152846583"},{"key":"e_1_2_10_40_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u201014\u2010135"},{"key":"e_1_2_10_41_2","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8503963"},{"key":"e_1_2_10_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.09.008"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-021-06833-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-021-06833-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-021-06833-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-021-06833-z","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T08:56:37Z","timestamp":1760864197000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-021-06833-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,11]]},"references-count":41,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1007\/s00167-021-06833-z"],"URL":"https:\/\/doi.org\/10.1007\/s00167-021-06833-z","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,11]]},"assertion":[{"value":"31 August 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts of interest to declare that are relevant to the content of this article","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study protocol was reviewed by the Institutional Ethics Committee of Parul University, Vadodara (PUIECHR \/ PIMSR\/ 00\/ 081734\/ 3913). It was granted exempt review since the study involved pooling and analysis of data that already exists in the public domain. There is no patient identifying information in the present manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}