{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T22:20:50Z","timestamp":1789856450330,"version":"4.0.1"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,11,7]],"date-time":"2018-11-07T00:00:00Z","timestamp":1541548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,11,7]],"date-time":"2018-11-07T00:00:00Z","timestamp":1541548800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate preoperative soft tissue balance for total knee arthroplasty (TKA), varus\/valgus stress radiographs has been used in previous studies. While the joint line of femur and tibia is almost parallel in healthy and postoperative knees, osteoarthritis (OA) knees exhibit articular cartilage wear that causes the joint line tilting even in a non\u2010stress condition. Therefore, the exact angle of the joint line might mislead to understand the joint laxity in OA knees. The purpose of this study was to evaluate soft tissue balance in varus OA knees using preoperative stress radiographs under three different constant loads, taking the articular cartilage wear into consideration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>One hundred and eighteen varus\u2010deformed OA knees in 102 patients were investigated before primary TKA. Preoperative knee radiographs were obtained in the anteroposterior view with no stress (defined as the neutral condition) and with varus and valgus stresses (5, 10, and 15\u00a0kg) in extension. Two different types of joint line angle (JLA), the absolute JLA (an exact angle of joint line) and the relative JLA (the absolute JLA minus the JLA in the neutral condition), were compared for the same load with the paired <jats:italic>t<\/jats:italic> test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The absolute JLA was 7.9\u2009\u00b1\u20091.2\u00b0\/\u2212\u20091.5\u2009\u00b1\u20092.2\u00b0 under varus\/valgus 15\u00a0kg stress, 6.7\u2009\u00b1\u20092.4\u00b0\/\u2212\u20090.3\u2009\u00b1\u20092.1\u00b0 under varus\/valgus 10\u00a0kg stress, and 4.7\u2009\u00b1\u20092.4\u00b0\/1.1\u2009\u00b1\u20092.2\u00b0 under varus\/valgus 5\u00a0kg stress. Significant differences in the numerical values of the absolute JLA were observed between varus and valgus stresses for each load. The neutral JLA was 3.2\u2009\u00b1\u20092.0\u00b0. The relative JLA was 4.8\u2009\u00b1\u20092.1\u00b0\/\u2212\u20094.7\u2009\u00b1\u20091.8\u00b0 under varus\/valgus 15\u00a0kg stress, 3.5\u2009\u00b1\u20092.0\u00b0\/\u2212\u20093.5\u2009\u00b1\u20091.8\u00b0 under varus\/valgus 10\u00a0kg stress, and 1.5\u2009\u00b1\u20091.9\u00b0\/\u2212\u20092.1\u2009\u00b1\u20091.8\u00b0 under varus\/valgus 5\u00a0kg stress. No significant differences in the numerical values of the relative JLA were observed between varus and valgus stresses for each load.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Consideration of cartilage wear allowed knee laxity to be evaluated more precisely in this study than in previous reports. It was shown that medial soft tissue contracture did not always exist, even in varus OA knees. Regarding clinical relevance, surgeons should be aware that underestimating medial soft tissue laxity due to reliance on the absolute JLA might lead to excessive medial tissue release and result in postoperative instability and lower patient satisfaction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-018-5276-9","type":"journal-article","created":{"date-parts":[[2018,11,6]],"date-time":"2018-11-06T22:30:43Z","timestamp":1541543443000},"page":"1642-1650","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Medial soft tissue contracture does not always exist in varus osteoarthritis knees in total knee arthroplasty"],"prefix":"10.1002","volume":"27","author":[{"given":"Tetsuro","family":"Ushio","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka City Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Mizu\u2010uchi","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka City Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Okazaki","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Tokyo Women\u2019s Medical University 8\u20101, Kawada\u2010cho, Shinjuku\u2010ku 162\u20108666 Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Miyama","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka City Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukio","family":"Akasaki","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka City Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Ma","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka City Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuharu","family":"Nakashima","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka City Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11,7]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2006.11.009"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010009\u20100903\u20100"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010198365020\u201000016"},{"key":"e_1_2_10_5_2","first-page":"1","article-title":"Functional knee phenotypes: a call for a more personalised and individualised approach to total knee arthroplasty?","volume":"0","author":"Hirschmann MT","year":"2018","journal-title":"Knee Surg Sports Traumatol 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June 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2018","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 November 2018","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"HM: Zimmer Biomet, paid presenter or speaker. KO: Zimmer Biomet, paid presenter or speaker; Smith & Nephew, paid presenter or speaker.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study protocol was approved by the Institutional Review Board of Kyushu University (IRB number 28-366).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}