{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T10:43:54Z","timestamp":1793357034896,"version":"4.5.0"},"reference-count":40,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"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":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Modern personalised total knee arthroplasty (TKA) techniques aim to mimic natural knee kinematics by focusing on soft\u2010tissue dynamics rather than static alignment. However, a consistent definition of the optimal ligamentous balance has not yet been established. This study had three aims: to assess intraoperative collateral ligament tension and the overall balance between the medial and lateral compartments; to evaluate postoperative gait analysis parameters and compare them with the healthy contralateral knee; and to determine whether the achieved intercompartmental balance affects the final coronal alignment of the knee.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective single\u2010cohort study was conducted to evaluate 102 primary AR\u2010assisted TKAs performed for end\u2010stage unilateral knee osteoarthritis between September 2021 and June 2024. A total of 17 patients out of 102 were ultimately included following the application of the study's inclusion and exclusion criteria. Intraoperative data were collected on MCL and LCL elongation patterns during passive ROM both before and after trial component placement. Additionally, the study examined differences in intercompartmental ligament balancing. Postoperative coronal alignment was radiographically evaluated using the hip\u2010knee\u2010ankle (HKA) angle. Functional outcomes were measured using 3D markerless gait analysis at least 9 months after surgery. A repeated\u2010measures analysis of variance (ANOVA) and a Pearson correlation were employed to examine trends in ligament asymmetry and their relationship with alignment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The medial collateral ligament (MCL) exhibited nearly isometric behaviour throughout the range of motion (0.3\u2009\u00b1\u20091.11 at 0\u00b0, \u22122.4\u2009\u00b1\u20092.71 at 20\u00b0, \u22122.3\u2009\u00b1\u20093.96 at 40\u00b0, \u22122.3\u2009\u00b1\u20094.16 at 60\u00b0, \u22121.5\u2009\u00b1\u20094.03 at 80\u00b0, \u22120.7\u2009\u00b1\u20094.52 at 100\u00b0, \u22120.2\u2009\u00b1\u20094.97 at 120\u00b0 preoperatively; 2.2\u2009\u00b1\u20092.98 at 0\u00b0, 2.1\u2009\u00b1\u20093.40 at 20\u00b0, 1.4\u2009\u00b1\u20094.02 at 40\u00b0, 1.2\u2009\u00b1\u20094.41 at 60\u00b0, 0.8\u2009\u00b1\u20094.48 at 80\u00b0, 1.5\u2009\u00b1\u20094.42 at 100\u00b0, 1.6\u2009\u00b1\u20095.09 at 120\u00b0 postoperatively). Conversely, the LCL showed progressive detensioning (0.0\u2009\u00b1\u20092.03 at 0\u00b0, \u22123.1\u2009\u00b1\u20092.07 at 20\u00b0, \u22123.9\u2009\u00b1\u20092.72 at 40\u00b0, \u22124.9\u2009\u00b1\u20093.34 at 60\u00b0, \u22126.6\u2009\u00b1\u20093.63 at 80\u00b0, \u22128.5\u2009\u00b1\u20094.13 at 100\u00b0, \u22129.6\u2009\u00b1\u20094.40 at 120\u00b0 preoperatively; \u22122.1\u2009\u00b1\u20095.16 at 0\u00b0, \u22123.1\u2009\u00b1\u20094.03 at 20\u00b0, \u22124.7\u2009\u00b1\u20093.80 at 40\u00b0, \u22125.8\u2009\u00b1\u20093.19 at 60\u00b0, \u22127.0\u2009\u00b1\u20093.86 at 80\u00b0, \u22126.6\u2009\u00b1\u20094.55 at 100\u00b0, \u22127.0\u2009\u00b1\u20095.08 at 120\u00b0 postoperatively), leading to asymmetric ligament balancing with the opening of the lateral compartment. This trapezoidal soft\u2010tissue configuration persisted postoperatively. No significant differences were observed in gait parameters between the operated and contralateral limbs, all\n                      <jats:italic>p<\/jats:italic>\n                      \u2010values being\u2009&gt;\u20090.05. A notable negative correlation was seen between postoperative HKA and ligament asymmetry at early flexion angles (0\u00b0, 20\u00b0, 40\u00b0;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.63,\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.67,\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.48, respectively), indicating that soft\u2010tissue balancing affects coronal alignment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Focusing on dynamic soft\u2010tissue boundaries rather than static alignment targets may preserve knee kinematics after TKA. Augmented reality\u2010assisted balancing techniques provide real\u2010time, personalised ligament management, which aligns with the patient's native kinematics and could be an encouraging direction in modern knee arthroplasty. More research is needed to confirm these findings across larger groups and different technologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70312","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T13:16:15Z","timestamp":1769606175000},"page":"3664-3674","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Targeting ligament boundaries rather than alignment boundaries in augmented\u2010reality\u2010assisted total knee arthroplasty ensures comparable gait patterns between operated and contralateral limbs"],"prefix":"10.1002","volume":"34","author":[{"given":"Michael","family":"Engl","sequence":"first","affiliation":[{"name":"Department Orthopaedic Surgery S\u00fcdtiroler 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