ReviewSICOT-J2015
Midflexion instability in primary total knee replacement: a review.
Review in SICOT-J, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed.
- Balanced Medial Collateral Ligament (MCL) Length, Not Intrinsic Laxity, Governs Load Sharing and Kinematics in Mechanically Aligned Posterior-Stabilized TKA.Annals of biomedical engineering · 2026Article
- The influence of CPAK classification on the pivot motion between kinematic and mechanical alignment total knee arthroplasty.Journal of orthopaedics · 2025Article
- Mid-Flexion Sagittal Stability of Total Knee Arthroplasty Implanted With Kinematic Alignment: A Quantitative Radiographic Laxity Study With Single-Radius Posterior-Stabilized and Condylar-Stabilized Implants.Arthroplasty today · 2025Article
- Estimation of adductor ratio in the Indian population: Is it a reliable indicator for recreating joint line of the knee?Journal of clinical orthopaedics and trauma · 2025Article
- The ROSA knee robotic system demonstrates superior precision in restoring joint line height and posterior condylar offset compared to conventional manual TKA: a retrospective case-control study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- Comparison of postoperative clinical outcome in medial-pivotal and gradually reducing radius design cruciate-retaining total knee arthroplasty-A multicenter analysis of propensity-matched cohorts.Journal of experimental orthopaedics · 2024Article
- Medial stability and lateral flexibility of the collateral ligaments during mid-range flexion in medial-pivot total knee arthroplasty patients demonstrates favorable postoperative outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- 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
- Fixed Flexion Contracture Can Successfully Be Addressed with Exact Preservation of the Femoral Joint Line and Only Minimal Increase of Tibia Resection in the Concept of Kinematically Aligned Total Knee Arthroplasty.Journal of personalized medicine · 2023Article
- Effects of Severe Varus Deformity on Soft Tissue Balancing in Total Knee Arthroplasty.Journal of clinical medicine · 2022Article
- Total Knee Arthroplasty Violates the Law of Burmester-A Biomechanical Investigation.Journal of personalized medicine · 2022Article
- Functional stability: an experimental knee joint cadaveric study on collateral ligaments tension.Archives of orthopaedic and trauma surgery · 2022Article
- Intraoperative Load Sensing in Total Knee Arthroplasty Leads to a Functional but Not Clinical Difference: A Comparative, Gait Analysis Evaluation.Journal of functional morphology and kinesiology · 2022Article
- Management of instability after primary total knee arthroplasty: an evidence-based review.Journal of orthopaedic surgery and research · 2021Review
- Anatomical evaluation of the femoral attachment of the posterior oblique ligament.Archives of orthopaedic and trauma surgery · 2021Article
- Variation and trends in reasons for knee replacement revision: a multi-registry study of revision burden.Acta orthopaedica · 2021Article
- Mid-flexion stability in the anteroposterior plane is achieved with a medial congruent insert in cruciate-retaining total knee arthroplasty for varus osteoarthritis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Article
- No difference in patient preference for medial pivot versus posterior-stabilized design in staged bilateral total knee arthroplasty: a prospective study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- Effect of additional distal femoral resection on flexion deformity in posterior-stabilized total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- Does the medial pivot knee improve the clinical and radiographic outcome of total knee arthroplasty? A single centre study on two hundred and ninety seven patients.International orthopaedics · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionMidflexion instability in primary total knee replacement (TKR) is an evolving concept. Successful treatment of instability requires an understanding of the different types of instability.
methodsA literature review was performed to identify information pertinent to midflexion instability in primary total knee replacement, utilising PRISMA guidelines. Databases searched included Embase, Medline, All of the Cochrane Library, PubMed and cross references.
resultsThree factors, i.e., elevated joint line, multiradii femoral component and medial collateral ligament (MCL) laxity, were identified to influence midflexion instability. Literature suggested mediolateral instability at 30-60° of flexion as diagnostic of midflexion instability. Literature search also revealed paucity in clinical studies analysing midflexion instability. Most of the evidence was obtained from cadaveric studies for elevated joint line and MCL laxity. Clinical studies on multiradii femoral component were limited by their small study size and early followup period.
conclusionElevated joint line, multiradii femoral component and MCL laxity have been suggested to cause midflexion laxity in primary TKR. Due to limitations in available evidence, this review was unable to raise the strength of overall evidence. Future well-designed clinical studies are essential to make definitive conclusions. This review serves as a baseline for future researchers and creates awareness for routine assessment of midflexion instability in primary total knee replacement.
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