ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Functional alignment in total knee arthroplasty is an umbrella term-A call for better definition and reporting quality!
Article 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 10 papers.
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Who cites it
10 citing papers in PubMed.
- Robotic-assisted total knee arthroplasty: accuracy, clinical outcomes, complications, learning curve and cost-effectiveness: a critical clinical review.Journal of robotic surgery · 2026Review
- Functional alignment: Defined personalized alignment strategy with promising outcomes and room for improvement.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Accuracy and Precision of Femoral and Tibial Bone Resections Using Manual Unrestricted Kinematic Alignment in Total Knee Arthroplasty: A Retrospective Digital Caliper Study.Journal of clinical medicine · 2026Article
- Reduced spinopelvic mobility does not correlate with knee flexion deformity in patients undergoing total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Alignment and/or ligament balancing? Towards truly personalized total knee arthroplasty-A narrative review.Journal of experimental orthopaedics · 2026Review
- Patient-Specific Restoration of Constitutional Alignment Within Predefined Safety Boundaries Using Three-Dimensional Navigation in Primary Total Knee Arthroplasty: One-Year Clinical and Radiographic Outcomes.Journal of clinical medicine · 2026Article
- Analysis of CPAK change in robotic functional alignment TKA: a new simplified classification.Archives of orthopaedic and trauma surgery · 2026Article
- Evolving Philosophies of Alignment in TKA: From Mechanical Uniformity to Personalised Harmony.Medicina (Kaunas, Lithuania) · 2026Review
- Functional versus mechanical alignment in robotic primary total knee arthroplasty: A meta-analysis.SICOT-J · 2026Article
- Functional alignment in total knee arthroplasty is an umbrella term-A call for better definition and reporting quality!Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
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Authors and funding
5 authors.
Funding
Abstract
purposeFunctional alignment (FA) aims to achieve a symmetric, rectangular extension gap and a rectangular or trapezoidal flexion gap, positioning the components in a manner that reduces the compromises to the soft tissue envelope. Because the FA surgeon can accomplish this goal with a multitude of adjustments to the components' position or soft tissue balance, the purpose of the present study was to analyze the possible paths for achieving FA.
methodsTen knees undergoing robotic total knee arthroplasty (TKA) were analyzed. Based on the intraoperatively acquired data, a macro was created to perform a post hoc analysis of the 10 possible paths to align a TKA functionally: (1) starting from mechanical alignment (MA) or kinematic alignment (KA), (2) preserving either the position of the femoral or tibial component and (3) with equal, 1 mm gaps or with increased 90° lateral flexion laxity.
resultsTen different knee phenotypes were analyzed (Var-Neu-Neu 2x; Neu-Neu-Val; Val-Val-Val; Neu-Val-Neu; Var-Neu-Var 3x; Var-Var-Var; Var-Var-Val). On average, 3.5 different paths resulted in FA for each TKA (range: 0-8). Two TKAs (Val-Val-Val; Var-Var-Val) could not be functionally aligned using any of the ten evaluated paths. One TKA could be functionally aligned using eight different paths.
conclusionFunctionally aligning a TKA can be achieved through multiple adjustments, resulting in various implant positions and soft tissue balances. To better understand the different combinations behind FA, a more detailed nomenclature is needed, including which initial alignment (MA or KA) was utilized, which component's position (femoral or tibial) was preserved, and whether a rectangular or trapezoidal flexion space was targeted. LEVEL OF EVIDENCE: Level IV, therapeutic study.
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