ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2015
Restoration of constitutional alignment in TKA leads to more physiological strains in the collateral ligaments.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
36 citing papers in PubMed, 2 syntheses or guidelines pooled it, 74 citations in OpenAlex.
- Comparison of Outcomes After Total Knee Arthroplasty Involving Postoperative Neutral or Residual Mild Varus Alignment: A Systematic Review and Meta-analysis.Orthopaedic surgery · 2022Pooled it
- What is the "safe zone" for transition of coronal alignment from systematic to a more personalised one in total knee arthroplasty? A systematic review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Pooled it
- Restoring the constitutional alignment with a restrictive kinematic protocol improves quantitative soft-tissue balance in total knee arthroplasty: a randomized controlled trial.The bone & joint journal · 2020Trial
- Short-term Outcomes of Unrestricted Kinematic Alignment: Total Knee Arthroplasty With a Medial Pivot Implant: A Japanese Multicenter Study.Arthroplasty today · 2026Article
- Ultrasound can assess soft tissue laxity in osteoarthritic knees and after total knee arthroplasty.Journal of experimental orthopaedics · 2025Article
- Does Restoration of Constitutional Alignment Improve Outcomes in Total Knee Arthroplasty?Arthroplasty today · 2025Article
- A new parameter in the era of robotic total knee arthroplasty: Coronal alignment at 90° of flexion impacts clinical outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Image-based robotic (ROSAJournal of orthopaedic surgery and research · 2025Article
- Personalized total knee arthroplasty in patients with extra-articular deformities.EFORT open reviews · 2024Review
- Review
- Pre-Planning the Surgical Target for Optimal Implant Positioning in Robotic-Assisted Total Knee Arthroplasty.Bioengineering (Basel, Switzerland) · 2023Article
- Impact of increasing total knee replacement constraint within a single implant line on coronal stability: an ex vivo investigation.Archives of orthopaedic and trauma surgery · 2023Article
- Article
- Guided-Motion Bicruciate-Stabilized Total Knee Arthroplasty Reproduces Native Medial Collateral Ligament Strain.Medicina (Kaunas, Lithuania) · 2022Article
- Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study.Bioengineering (Basel, Switzerland) · 2022Article
- Medial proximal tibial angle at the posterior tibial plateau represents the pre-arthritic constitutional medial proximal tibial angle in anterior cruciate ligament-intact, advanced osteoarthritis of the knee.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Article
- Article
- Residual varus alignment can reduce joint awareness, restore joint parallelism, and preserve the soft tissue envelope during total knee arthroplasty for varus osteoarthritis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Article
- Ethnical Differences in Knee Phenotypes Indicate the Need for a More Individualized Approach in Knee Arthroplasty: A Comparison of 80 Asian Knees with 308 Caucasian Knees.Journal of personalized medicine · 2022Article
- Probabilistic planning for ligament-balanced TKA-Identification of critical ligament properties.Frontiers in bioengineering and biotechnology · 2022Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeCurrently, controversy exists whether restoration of neutral mechanical alignment should be attempted in all patients undergoing TKA. Our hypothesis was that restoration of constitutional rather than neutral mechanical alignment may in theory lead to a more physiological strain pattern in the collateral ligaments; therefore, it could potentially be beneficial to patients. Thus, the aim of this study was to measure collateral ligament strains during three motor tasks in the native knee and compare them with the strains noted after TKA in different post-operative alignment conditions.
methodsSix cadaver specimens (approval number ML4190 from the Research Ethics Committee of University of Leuven, Belgium) were examined using a validated knee kinematics rig under physiological loading conditions. The effect of coronal malalignment was evaluated by using custom-made tibial implant inserts that induced different alignment conditions. The study of six specimens allows us to show that a difference in the mean strains in MCL and LCL of 3.6 and 5.8 %, respectively, was statistically significant with a probability (power) of 0.8.
resultsThe results indicated that after TKA insertion, the strains in the collateral ligaments closely resembled the pre-operative pattern of the native knee specimens when constitutional alignment was restored. Restoration to neutral mechanical alignment was associated with greater collateral strain deviations from the native knee.
conclusionBased upon this study, it was concluded that restoration of constitutional alignment within a "safe zone" of ±2° during TKA leads to more physiological peri-articular soft tissue strains during loaded as well as unloaded motor tasks.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.