{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:58:35Z","timestamp":1785347915334,"version":"3.55.0"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Traditional management of hyperextension deformity in total knee arthroplasty (TKA) involves routine under\u2010resection of distal femoral bone to lower the joint line and close the extension gap. This study aimed to assess how a robotic functional alignment (FA) workflow with pre\u2010resection gap assessment managed hyperextending knees to achieve balance compared to controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of a prospective registry was performed using a single implant\/robotic platform, two surgeons, between 2016 and 2023. 100 hyperextending TKA patients with hyperextension of 5\u00b0 or more were compared to a control group of 1881 patients with 0\u00b0\u201310\u00b0 of fixed flexion contracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The hyperextension group had a greater maximum flexion ROM (137\u00b0 vs. 132\u00b0) compared to controls. All four mean start\u2010of\u2010case gaps (medial and lateral in flexion and extension) were larger for the hyperextension patients by 0.7\u20131.2\u2009mm. The femoral joint line was not routinely distalised by a clinically significant amount in the hyperextension patients (0.3\u2009mm difference in means; 0.6\u2009mm vs. 0.3\u2009mm. The hyperextension cohort had relative tibial under\u2010resection (4.8\u2009mm vs. 5.4\u2009mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and additional insert thickness (11.2 vs. 10.3\u2009mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) resulting in an overall mean tibial joint line elevation of 1.5\u2009mm greater than controls. At the 1\u2010year mark, there was no difference between groups when assessing range of motion (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05) and forgotten joint score (FJS,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Two patients had hyperextension recurrence at 1\u2010year review, measured at \u20132\u00b0 and \u20135\u00b0.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hyperextending arthritic knees may not require routine distalisation of the femoral joint line to achieve balance and close the extension gap. These knees have a global laxity that can often be effectively managed with predominantly tibial sided changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, therapeutic retrospective comparative study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70203","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T14:43:35Z","timestamp":1764600215000},"page":"2906-2915","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knee hyperextension is a sign of through\u2010range laxity and may be effectively managed without routine joint line distalisation in a robotic functional alignment workflow"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7796-6047","authenticated-orcid":false,"given":"Anton","family":"Lambers","sequence":"first","affiliation":[{"name":"Medical School The University of Western Australia Perth Western Australia Australia"},{"name":"Department of Orthopaedics Northeast Health Wangaratta Wangaratta Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4425-4529","authenticated-orcid":false,"given":"Serene","family":"Lee","sequence":"additional","affiliation":[{"name":"Perth Hip and Knee Clinic Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Langton","sequence":"additional","affiliation":[{"name":"Perth Hip and Knee Clinic Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0554-4106","authenticated-orcid":false,"given":"Dermot","family":"Collopy","sequence":"additional","affiliation":[{"name":"Perth Hip and Knee Clinic Perth Australia"},{"name":"St John of God Subiaco Murdoch and Midland Hospitals Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3967-1613","authenticated-orcid":false,"given":"Gavin","family":"Clark","sequence":"additional","affiliation":[{"name":"Perth Hip and Knee Clinic Perth Australia"},{"name":"St John of God Subiaco Murdoch and Midland Hospitals Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2011.06.035"},{"key":"e_1_2_12_3_1","article-title":"Does relative femoral and tibial component size influence revision risk following primary total knee arthroplasty","volume":"1","author":"Brown ZG","year":"2025","journal-title":"J Arthroplasty"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/BTO.0000000000000567"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2023.04.004"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.103B5.BJJ-2020-0396.R1"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2024.10.008"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12408"},{"key":"e_1_2_12_9_1","volume-title":"Surgical Techniques and Instrumentation in Total Knee Arthroplasty","author":"Insall 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recurrence rates of hyperextension after total knee arthroplasty in asian patients with preoperative knee hyperextension: a prospective observational study","volume":"15","author":"Thippanna RK","year":"2023","journal-title":"Cureus"}],"container-title":["Knee Surgery, Sports Traumatology, 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