{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:55:05Z","timestamp":1792007705027,"version":"4.4.0"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/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":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To describe a technique for flexion gap management in total knee arthroplasty (TKA) using conventional instrumentation with minimal soft tissue release, by aligning the femoral component to restore close\u2010to\u2010native posterior condylar angle (PCA). The hypothesis was that this technique renders consistent outcomes, regardless the preoperative deformity or intraoperative parameters.\n<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a consecutive series of 152 TKAs, the femoral component was rotated to restore anatomic PCA of 2\u00b0\u2009\u00b1\u20092\u00b0 and the flexion gap was balanced with a final lateral flexion laxity of 1\u20133\u00a0mm. Patients were assessed using the Knee Society Score (KSS), the Oxford Knee Score (OKS) and University of California Los Angeles (UCLA) activity score at a minimum follow\u2010up of 4 years. Uni\u2010 and multivariable analyses were performed to determine associations between clinical scores and patient demographics, PCA, laxity, pre\u2010 and postoperative hip\u2013knee\u2013ankle (HKA) angle, and preoperative femoral mechanical angle (FMA) and tibial mechanical angle (TMA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Intraoperative measurements indicated a target PCA of 2.9\u00b0\u2009\u00b1\u20091.0\u00b0 (range 0\u00b0\u20136\u00b0) with a final lateral flexion laxity of 1.5\u2009\u00b1\u20090.6\u00a0mm (range 0\u20133). The target PCA was achieved in 145\u00a0knees (95%) and the desired final lateral flexion laxity was achieved in 151\u00a0knees (99.3%). There were no significant differences in postoperative clinical outcomes between knees within the target PCA range and outliers. KSS function decreased with age and preoperative HKA angle, and was lower for women, while KSS satisfaction improved with follow\u2010up. OKS increased with target PCA and follow\u2010up, decreased with preoperative TMA, was lower for women and better for knees with resurfaced patellae. UCLA activity decreased with age, preoperative HKA angle and BMI, and was lower for women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this consecutive series of 152 TKAs performed with minimal ligament release, the target PCA and final lateral flexion laxity were simultaneously achieved in 95% of knees. At a minimum follow\u2010up of 4 years, adequate clinical scores and patient satisfaction were achieved, even in knees outside the target PCA range.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06360-3","type":"journal-article","created":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T08:03:02Z","timestamp":1605081782000},"page":"627-637","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Satisfactory mid\u2010 to long\u2010term outcomes of TKA aligned using conventional instrumentation for flexion gap balancing with minimal soft tissue release"],"prefix":"10.1002","volume":"30","author":[{"given":"Michel","family":"Bercovy","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Clinique Arago Almaviva Group 187 Rue Raymond Losserand 75014 Paris 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August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 October 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 November 2020","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":"MB reports receiving royalties and fees from ZimmerBiomet. FS reports receiving fees form Medacta. JHM has nothing to declare. MS has nothing to declare. LK reports receiving royalties and fees from ZimmerBiomet and Medacta.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was funded by Clinique Arago.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"This study was approved by the local Medical Ethics Committee and was registered on ClinicalTrials.gov (NCT02127619).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}