ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2023
Independent of the preoperative coronal deformity, adjusted mechanical alignment leads in a high percentage to non-anatomical tibial and femoral bone cuts.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Robotic-assisted mechanically aligned total knee arthroplasty does not lead to better clinical and radiological outcomes when compared to conventional TKA: a systematic review and meta-analysis of randomized controlled trials.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Pooled it
- Total Knee Arthroplasty and the Evolution of Coronal Alignment: From Mechanical to Personalized Strategies.Journal of personalized medicine · 2025Review
- Influencing factors of flexion contracture among patients with knee osteoarthritis: a multi-center retrospective cross-sectional study.Scientific reports · 2025Article
- Simulation of osteotomy in total knee arthroplasty with femoral extra-articular deformity assisted by artificial intelligence: a study based on three-dimensional models.Journal of orthopaedic surgery and research · 2024Article
- No difference in postoperative patient satisfaction rates between mechanical and kinematic alignment total knee arthroplasty: A systematic review.Journal of experimental orthopaedics · 2024Review
- Constitutional alignment predicts medial ligament balancing in mechanically aligned total knee arthroplasty for varus knees.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Effect of posteromedial vertical capsulotomy with medial collateral ligament liberation on intraoperative medial component gap mismatch between extension and mid-flexion during total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA) - there is no winner yet.Journal of experimental orthopaedics · 2023Review
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Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe technique of adjusted mechanical alignment (AMA) in total knee arthroplasty (TKA) has been described to achieve alignment and balancing goals in varus knees in a high percentage, albeit at the price of non-anatomical bone cuts. The purpose of this study was to analyze (1) whether AMA achieves similar alignment and balancing results in different types of deformity and (2) whether they can be achieved without altering the native anatomy.
methodsA series of 1000 patients with hip-knee-ankle (HKA) angles from 165° to 195° were analyzed. All patients were operated using AMA technique. According to the preoperative HKA angle, three groups of knee phenotypes (varus, straight, valgus) were defined. The bone cuts were analyzed for being anatomic (< 2 mm deviation of individual joint surface) or non-anatomic (> 4 mm deviation of individual joint surface).
resultsAMA reached the goals for postoperative HKA in over 93% in every group (varus: 636 cases, 94%, straight: 191 cases, 98%, valgus: 123 cases, 98%). In 0° extension, the gaps were balanced in varus knees in 654 cases (96%), in straight knees in 189 cases (97%) and in valgus knees in 117 cases (94%). A balanced flexion gap was found in a similar number of cases (varus: 657 cases, 97%, straight: 191 cases, 98%, valgus: 119 cases, 95%). In the varus group, non-anatomical cuts were performed at the medial tibia (89%) and the lateral posterior femur (59%). The straight group showed similar values and distribution for non-anatomical cuts (medial tibia: 73%; lateral posterior femur 58%). Valgus knees showed a different distribution of values, being non-anatomical at the lateral tibia (74%), distal lateral femur (67%) and posterior lateral femur (43%).
conclusionIn all knee phenotypes, the AMA goals were achieved in a high percentage by altering the patients' native anatomy. In varus knees, the alignment was corrected by non-anatomical cuts at the medial tibia, and in valgus knees at the lateral tibia and the lateral distal femur. All phenotypes showed non-anatomical resections on the posterior lateral condyle in approximately 50% of cases. LEVEL OF EVIDENCE: III.
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