Evidence map›Paper›PMID 40012264›Full record

SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025

Mean distraction force applied in tension-controlled ligament-balanced total knee arthroplasty: A systematic review and meta-analysis.

Roland Becker, Maximilan Voss, Jonathan Lettner, Robert Hable, Mahmut Enes Kayaalp, Reha Tandogan, Pier Indelli, Nikolai Ramadanov

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Article
  6. Article
  7. Review
  8. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Roland BeckerCenter of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany.ORCID http://orcid.org/0000-0003-1833-7608
Maximilan VossCenter of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany.
Jonathan LettnerCenter of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany.
Robert HableFaculty of Applied Computer Science, Deggendorf Institute of Technology, Deggendorf, Germany.
Mahmut Enes KayaalpIstanbul Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Reha TandoganOrtoklinik & Çankaya Hospital, Ankara, Turkey.
Pier IndelliDepartment Orthopaedic Surgery, Südtiroler Sanitätsbetrieb, Brixen, Italy.
Nikolai RamadanovCenter of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeProper tension of the collateral ligaments is the key to success in total knee arthroplasty (TKA). The study aimed to identify the distraction force for the medial and lateral femorotibial compartments in tension-controlled ligament-balanced TKA at 0° and 90° of knee flexion.

methodsA literature search was conducted in PubMed up to 31 December 2024 to identify studies that reported exact values of the distraction force applied in tension-controlled ligament-balanced TKA. Mean distraction force at 0° and 90° of knee flexion were calculated for the native knee, cadaver knee, and computer model/artificial knee groups. Differences between groups were calculated using Kruskal-Wallis and Mann-Whitney U tests, with p ≤ 0.05 considered significant. A frequentist meta-analysis of subgroup analysis between native and cadaver knee studies was performed using a random effects model with inverse variance and the Sidik-Jonkman heterogeneity estimator with Hartung-Knapp adjustment to calculate participant age and sex.

resultsOut of 116 included primary studies involved, a total of 6869 participants had distraction force measurements during TKA. The mean distraction force was 149.9 N (35.0-320.0 N) at 0° knee extension and 139.5 N (14.7-244.7 N) at 90° of flexion. Using the Kruskal-Wallis test or the Mann-Whitney U test, there were no significant differences in distraction force between native knee, cadaver knee, computer model/artificial knee studies at extension (p = 0.2480 and p = 0.1130) and at 90° of knee flexion (p = 0.8439 and p = 0.6241).

conclusionThis meta-analysis is the first to quantify distraction force in TKA, providing essential reference values of 149.9 N at 0° extension and 139.5 N at 90° flexion. These findings offer valuable guidelines for intraoperative soft tissue management during TKA procedures. The consistency of distraction force across different experimental models suggests that these values are broadly applicable. However, it remains unclear whether a more personalized distraction force should be considered for gap preparation. LEVEL OF EVIDENCE: Level IV.

Indexed as

Arthroplasty, Replacement, KneeCollateral LigamentsKnee JointBiomechanical PhenomenaCadaverHumansRange of Motion, Articulardistraction forceligament tensionreplacementtotal knee arthroplasty

Identifiers

PMID40012264
PMCPMC12205427

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Registered trials

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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.