{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T03:21:22Z","timestamp":1793762482178,"version":"4.6.1"},"reference-count":168,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Proper 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\u2010controlled ligament\u2010balanced TKA at 0\u00b0 and 90\u00b0 of knee flexion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A 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\u2010controlled ligament\u2010balanced TKA. Mean distraction force at 0\u00b0 and 90\u00b0 of knee flexion were calculated for the native knee, cadaver knee, and computer model\/artificial knee groups. Differences between groups were calculated using Kruskal\u2013Wallis and Mann\u2013Whitney <jats:italic>U<\/jats:italic> tests, with <jats:italic>p<\/jats:italic>\u2009\u2264\u20090.05 considered significant. A frequentist meta\u2010analysis of subgroup analysis between native and cadaver knee studies was performed using a random effects model with inverse variance and the Sidik\u2013Jonkman heterogeneity estimator with Hartung\u2013Knapp adjustment to calculate participant age and sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of 116 included primary studies involved, a total of 6869 participants had distraction force measurements during TKA. The mean distraction force was 149.9\u2009N (35.0\u2013320.0\u2009N) at 0\u00b0 knee extension and 139.5\u2009N (14.7\u2013244.7\u2009N) at 90\u00b0 of flexion. Using the Kruskal\u2013Wallis test or the Mann\u2013Whitney <jats:italic>U<\/jats:italic> test, there were no significant differences in distraction force between native knee, cadaver knee, computer model\/artificial knee studies at extension (<jats:italic>p<\/jats:italic>\u2009=\u20090.2480 and <jats:italic>p<\/jats:italic>\u2009=\u20090.1130) and at 90\u00b0 of knee flexion (<jats:italic>p<\/jats:italic>\u2009=\u20090.8439 and <jats:italic>p<\/jats:italic>\u2009=\u20090.6241).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This meta\u2010analysis is the first to quantify distraction force in TKA, providing essential reference values of 149.9\u2009N at 0\u00b0 extension and 139.5\u2009N at 90\u00b0 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12629","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T11:14:42Z","timestamp":1741605282000},"page":"2498-2526","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Mean distraction force applied in tension\u2010controlled ligament\u2010balanced total knee arthroplasty: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1833-7608","authenticated-orcid":false,"given":"Roland","family":"Becker","sequence":"first","affiliation":[{"name":"Center of Orthopaedics and Traumatology, Brandenburg Medical School University Hospital Brandenburg an der Havel Brandenburg an der Havel Germany"},{"name":"Faculty of Health Science Brandenburg Brandenburg Medical School Theodor Fontane Brandenburg an der Havel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilan","family":"Voss","sequence":"additional","affiliation":[{"name":"Center of Orthopaedics and Traumatology, Brandenburg Medical School University Hospital Brandenburg an der Havel Brandenburg an der Havel Germany"},{"name":"Faculty of Health Science Brandenburg Brandenburg Medical School Theodor Fontane Brandenburg an der Havel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Lettner","sequence":"additional","affiliation":[{"name":"Center of Orthopaedics and Traumatology, Brandenburg Medical School University Hospital Brandenburg an der Havel Brandenburg an der Havel Germany"},{"name":"Faculty of Health Science Brandenburg Brandenburg Medical School Theodor Fontane Brandenburg an der Havel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Hable","sequence":"additional","affiliation":[{"name":"Faculty of Applied Computer Science Deggendorf Institute of Technology Deggendorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmut Enes","family":"Kayaalp","sequence":"additional","affiliation":[{"name":"Istanbul Fatih Sultan Mehmet Training and Research Hospital University of Health Sciences Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reha","family":"Tandogan","sequence":"additional","affiliation":[{"name":"Ortoklinik &amp; 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