ArticleOrthopadie (Heidelberg, Germany)2026
Intraoperative balance in total knee arthroplasty : Development and internal validation of the Knee Balancing Score.
Article in Orthopadie (Heidelberg, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Bridging postural biomechanics and knee arthroplasty success.Arthroplasty (London, England) · 2026Review
- The coronal plane alignment of the knee classification cannot ignore the joint line convergence angle.BMC musculoskeletal disorders · 2026Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAchieving an accurate mediolateral soft tissue balance is essential for stability, kinematics and long-term outcomes in total knee arthroplasty (TKA); however, existing classification systems are often complex and lack intraoperative usability. This study introduces and internally validates the Knee Balancing Score (KBS), a simplified and reproducible method based solely on mediolateral gap asymmetry measured at full extension (when achievable) and 90° flexion using a robotic-assisted platform.
methodsA prospective series of 285 robotic-assisted TKAs performed between 2022 and 2025 was analyzed. Medial and lateral joint gaps were recorded at full extension (when achievable) and 90° flexion under standardized varus-valgus stress. The KBS was derived from the absolute gap difference (∆Gap = |L - M|, mm) and classified separately for extension (E1-E4) and flexion (F1-F4). Correlations between ∆Gap and alignment parameters, including the hip-knee-ankle angle (HKA), arithmetic HKA, medial proximal tibial angle (mPTA), lateral distal femoral angle (LDFA), and joint line orientation (JLO), were calculated (P < 0.05).
resultsThe mean ∆Gap was 3.02 ± 2.25 mm in extension and 3.47 ± 2.63 mm in flexion (P = 0.021). Symmetry (E1) was observed in 21.8% of knees, while mild lateral opening (E2) occurred in 36.1%. In flexion, physiological lateral laxity (F2) was observed in 29.5% and pathological imbalance (F3-F4) in 51.6%. Valgus morphotypes showed greater asymmetry in both planes (P < 0.01). The ∆Gap correlated inversely with the HKA angle (r = -0.28 to -0.40) and mPTA (r = -0.34 to -0.39), confirming construct validity.
conclusionThe KBS offers a practical, physiological and objective system to quantify intraoperative balance, transforming subjective perception into a standardized and reproducible assessment applicable in modern TKA practice.
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