ArticleArchives of orthopaedic and trauma surgery2025
A navigation-based analysis of native knee collateral ligament length change patterns in function of CPAK classification.
Article in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Targeting ligament boundaries rather than alignment boundaries in augmented-reality-assisted total knee arthroplasty ensures comparable gait patterns between operated and contralateral limbs.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Intraoperative Analysis of Collateral Ligament Elongation Patterns by Coronal Plane Alignment of the Knee Classification Using Augmented Reality Navigation in Japanese Osteoarthritic Knees.Arthroplasty today · 2026Article
- Radiolucent lines after robotic-assisted surface-matching kinematically aligned UKA: short-term incidence and lack of association with tibial alignment.Archives of orthopaedic and trauma surgery · 2026Article
- Clinical technique for augmented reality-guided tibial resection in kinematic alignment total knee arthroplasty: Real-time ligament elongation enables personalised soft tissue balance.Journal of experimental orthopaedics · 2026Article
- Coronal plane alignment changes do not affect in vivo kinematics for robotically performed total knee arthroplasty.Journal of experimental orthopaedics · 2026Article
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Authors and funding
7 authors.
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Abstract
introductionIntroduction This study investigates the elongation patterns of native knee collateral ligaments across various coronal plane alignment phenotypes (CPAK classification), aiming to refine soft tissue balancing in Total Knee Arthroplasty (TKA). MATERIALS AND
methodsMaterials and methods In this cross-sectional study, 84 patients were analyzed prior to undergoing TKA using a computer-assisted surgery (CAS) system. CPAK types were determined using pre-operative standing full-leg radiographs. The CAS system facilitated real-time tracking of the native medial (MCL) and lateral (LCL) collateral ligament elongation throughout passive knee motion. Data were normalized and analyzed using a linear mixed model to assess the impact of knee alignment on ligament elongation, with ANOVA and Fisher's LSD method applied at a 95% confidence level.
resultsResults A significant correlation was observed between aHKA and MCL length changes during deep flexion (90°-110°), with the MCL shortening in valgus-aligned knees and lengthening in varus/neutral knees. CPAK III (valgus knees with high JLO) showed significantly more MCL shortening than CPAK I, II, and IV at 90° flexion (p < 0.05). Knees with similar aHKA values exhibited comparable MCL behavior. Across all CPAK types, the LCL displayed a consistent pattern of progressive loosening with flexion. Valgus knees, particularly CPAK III, demonstrated a significantly tighter LCL in full extension compared to other types (p < 0.05). No significant effect of aHKA or JLO on LCL behavior was found.
conclusionConclusion This study demonstrates that MCL and LCL elongation patterns are phenotype-dependent. While the LCL consistently loosens with flexion across types, MCL behavior varies significantly with coronal alignment. These findings suggest that alignment-based ligament behavior must be considered for optimal soft tissue balance and support a shift toward personalized TKA strategies aimed at replicating native knee kinematics.
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