ArticleThe Journal of bone and joint surgery. American volume2013
Lessons learned from selective soft-tissue release for gap balancing in primary total knee arthroplasty: an analysis of 1216 consecutive total knee arthroplasties: AAOS exhibit selection.
Article in The Journal of bone and joint surgery. American volume, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed.
- Modified Macroscopic Soft Tissue Injury (Modified MASTI) Classification for Bone and Soft Tissue Integrity in Cruciate Retaining Total Knee Arthroplasty.Indian journal of orthopaedics · 2025Article
- Medial Deviation of a 6° Prosthetic Trochlear Groove After Kinematically Aligned Total Knee Arthroplasty Occurs in Four Types of Coronal Plane Alignment of the Knee (CPAK) and Decreases the Forgotten Joint Score.Arthroplasty today · 2024Article
- Variability in Alignment and Bone Resections in Robotically Balanced Total Knee Arthroplasties.Bioengineering (Basel, Switzerland) · 2024Article
- Phenotype-considered kinematically aligned total knee arthroplasty for windswept-deformity-associated osteoarthritis: surgical strategy and clinical outcomes.Knee surgery & related research · 2024Article
- Complete Release of the Superficial Medial Collateral Ligament in Total Knee Arthroplasty.Arthroplasty today · 2024Article
- Shear wave tensiometry tracks reductions in collateral ligament tension due to incremental releases.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2023Article
- Analysis of Gait Ability and Patient Reported Outcome Measurements after Robotic-assisted Total Knee Arthroplasty for Osteoarthritis of the Knee with Windswept Deformity.Journal of orthopaedic case reports · 2023Article
- Restricted Inverse Kinematic Alignment Better Restores the Native Joint Line Orientation While Achieving Similar Balance, Laxity, and Arithmetic Hip-Knee-Ankle Angle to Gap Balancing Total Knee Arthroplasty.Arthroplasty today · 2023Article
- Bilateral Knee Arthroplasty in Patients Affected by Windswept Deformity: A Systematic Review.Journal of clinical medicine · 2022Review
- Predictive Gap-balancing Reduces the Extent of Soft-tissue Adjustment Required After Bony Resection in Robot-assisted Total Knee Arthroplasty-A Comparison With Simulated Measured Resection.Arthroplasty today · 2022Article
- Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021?Musculoskeletal surgery · 2022Review
- Influence of Patella Position on Soft Tissue Balance and Clinical Outcomes in Patients Undergoing Minimally Invasive Total Knee Arthroplasty, a Randomized Clinical Trial.Frontiers in surgery · 2022Article
- An insert with less than spherical medial conformity causes a loss of passive internal rotation after calipered kinematically aligned TKA.Archives of orthopaedic and trauma surgery · 2021Article
- Improved femoral component rotation in total knee arthroplasty: an anatomical study with optimized gap balancing.Archives of orthopaedic and trauma surgery · 2021Article
- Restoring the Patient's Pre-Arthritic Posterior Slope Is the Correct Target for Maximizing Internal Tibial Rotation When Implanting a PCL Retaining TKA with Calipered Kinematic Alignment.Journal of personalized medicine · 2021Article
- Higher revision rate for posterior cruciate-retaining than posterior-stabilized total knee arthroplasty for the treatment of valgus osteoarthritis.Archives of orthopaedic and trauma surgery · 2021Article
- A cruciate-retaining implant can treat both knees of most windswept deformities when performed with calipered kinematically aligned TKA.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Article
- [Adjusted mechanical alignment: operative technique-Tips and tricks].Der Orthopade · 2020Review
- [Calipered technique for kinematic alignment].Der Orthopade · 2020Review
- Bone resection for mechanically aligned total knee arthroplasty creates frequent gap modifications and imbalances.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundSoft-tissue releases are commonly necessary to achieve symmetrical flexion and extension gaps in primary total knee arthroplasty performed with a measured resection technique. We reviewed the frequency of required releases according to preoperative alignment and the clinical and radiographic results; associations with failure, reoperations, and complications are presented.
methodsWe reviewed 1216 knees that underwent primary total knee arthroplasty from 2004 to 2009; 774 (64%) were in female patients and 442 (36%), in male patients. In the coronal plane, 855 knees had preoperative varus deformity, 123 were neutral, and 238 had valgus deformity. The mean age at the time of the index procedure was 62.7 years (range, twenty-three to ninety-four years), and the mean body mass index was 32.7 kg/m² (range, 17.4 to 87.9 kg/m²). Clinical outcomes included the Knee Society Score (KSS), implant failure, reoperation, and complications. Radiographs were analyzed for component alignment.
resultsThe only difference in the total KSS was found at the time of final follow-up between valgus knees with zero releases (total KSS = 178) and those with one or two releases (KSS = 160, p = 0.026). Overall, 407 knees (33.5%) required zero releases, 686 (56.4%) required one or two releases, and 123 (10.1%) required three or more releases. Among varus knees, 37% required zero releases, 55% required one or two releases, and 7.5% required three or more releases. Among neutral knees, 39% required zero releases, 55% required one or two releases, and 5.7% required three or more releases. Only 17% of valgus knees required zero releases whereas 61% required one or two releases and 21.8% required three or more releases. Valgus knees required more releases than neutral or varus knees did (p < 0.001).
conclusionsSelective soft-tissue release for gap balancing in primary total knee arthroplasty is an effective technique that produced excellent clinical and radiographic results regardless of preoperative alignment. Consistent anatomic coronal-plane alignment and soft-tissue balance could be achieved without bone cut modification by using measured bone resection and selective soft-tissue release.
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