ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2014
Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- Mean distraction force applied in tension-controlled ligament-balanced total knee arthroplasty: A systematic review and meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Pooled it
- Can a Total Knee System Providing 1 mm Increment of Polyethylene Insert Thickness Offer a Clinical Benefit?Medicina (Kaunas, Lithuania) · 2024Trial
- Arthrofibrosis After Total Knee Arthroplasty: Biological Mechanisms, Diagnosis, and Treatment: An International Consensus Symposium.HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2026Article
- Final intraoperative gaps commonly exceed resection-based reference gaps during sequential balancing in imageless robot-assisted total knee arthroplasty.Journal of experimental orthopaedics · 2026Article
- Alignment and/or ligament balancing? Towards truly personalized total knee arthroplasty-A narrative review.Journal of experimental orthopaedics · 2026Review
- Medial soft tissue release is also related to the anterior stability of cruciate-retaining total knee arthroplasty: a cadaveric study.Knee surgery & related research · 2024Article
- Article
- The Effect of Severe Varus Deformity on Clinical and Radiographic Outcomes in Mechanical Aligned Total Knee Arthroplasty with Medial Stabilizing Technique.Journal of clinical medicine · 2024Article
- Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review.SICOT-J · 2024Article
- Effect of mediolateral gap difference on postoperative outcomes in navigation-assisted total knee arthroplasty using an ultracongruent insert and the medial stabilising technique.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Evaluation of the balance function before and after total knee arthroplasty using Berg balance scale.Archives of orthopaedic and trauma surgery · 2022Article
- Optimal intraoperative medial joint gap in extension to prevent flexion contracture following total knee arthroplasty using modified gap balancing technique.Journal of clinical orthopaedics and trauma · 2022Article
- The knee position at tourniquet inflation does not affect the gap balancing during total knee arthroplasty.Archives of orthopaedic and trauma surgery · 2022Article
- Gender-specific difference in the recurrence of flexion contracture after total knee arthroplasty.Journal of experimental orthopaedics · 2021Article
- Multi-radius posterior-stabilized mobile-bearing total knee arthroplasty partially produces in-vivo medial pivot during activity of daily living and high demanding motor task.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- Intraoperative physiological lateral laxity in extension and flexion for varus knees did not affect short-term clinical outcomes and patient satisfaction.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- Coronal and sagittal laxity affects clinical outcomes in posterior-stabilized total knee arthroplasty: assessment of well-functioning knees.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- Posterior capsular release is a biomechanically safe procedure to perform in total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2019Article
- No detrimental effect of ligament balancing on functional outcome after total knee arthroplasty: a prospective cohort study on 129 mechanically aligned knees with 3 years' follow-up.Acta orthopaedica · 2018Article
- Influence of soft tissue balancing and distal femoral resection on flexion contracture in navigated total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2017Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIn total knee arthroplasty (TKA), a high soft-tissue tension in extension at the time of operation would cause a post-operative flexion contracture. However, how tight the extension gap should be during surgery to avoid a post-operative flexion contracture remains unclear. The hypothesis is that some laxity in the intraoperative extension gap is necessary to avoid the post-operative flexion contracture.
methodsA posterior-stabilized TKA was performed for 75 osteoarthritic knees with a varus deformity. The intraoperative extension gap was measured using a tensor device that provides the gap length and the angle between the femoral component and the tibial cut surface. The medial component gap was defined as the gap calculated by subtracting the selected thickness of the tibial component, including the polyethylene liner, from the extension gap at the medial side. Then, the patients were divided into three groups according to the medial component gap, and post-operative extension angle measured 1 year after the surgery was compared between each groups.
resultsOne year post-operatively, a flexion contracture of more than 5° was found in 0/34 patients when the medial component gap was more than 1 mm, in 2/26 (8%) patients when the gap was between 0 and 1 mm, and in 3/15 (20%) patients when the gap was <0 mm. Three factors were associated significantly with the post-operative extension angle: age, preoperative extension angle, and medial component gap.
conclusionThe intraoperative extension gap is related to the post-operative extension angle. Surgeons should leave more than 1-mm laxity after the implantation to avoid the post-operative flexion contracture. As a clinical relevance, this study clarified the optimal extension gap to avoid the post-operative flexion contracture. LEVEL OF EVIDENCE: Prospective comparative study, Level II.
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