{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T03:21:03Z","timestamp":1793762463846,"version":"4.6.1"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T00:00:00Z","timestamp":1637798400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T00:00:00Z","timestamp":1637798400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T00:00:00Z","timestamp":1637798400000},"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":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Valgus knees have inferior outcomes compared to varus knees. There is little data regarding soft\u2010tissue balance in flexion which may influence outcome in valgus knees undergoing TKA. The purpose of this study was to evaluate whether there is imbalance between medial and lateral flexion gaps in valgus deformity. A secondary aim was to compare soft\u2010tissue balance in knees with valgus deformity less than 10\u00b0 with those exceeding 10\u00b0. The null hypothesis was that there was no soft\u2010tissue imbalance in 90\u00b0 of flexion irrespective of magnitude of deformity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>64 valgus knees (52 female and 12\u00a0male) with deformity from 0.5 to 27.5\u00b0 (mean 188.77, SD 6.21) were studied in 54 patients (mean age 67.81 y, SD 8.69) undergoing navigated TKA. Medial and lateral gaps in extension and at 90\u00b0 of flexion were compared (using Independent\u2010samples <jats:italic>t<\/jats:italic> test) between knees with valgus\u2009&lt;\u200910\u00b0 with those\u2009&gt;\u200910\u00b0 using a validated dynamic method after resection of cruciates, menisci and osteophytes, and then after final trialling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean initial medial\u2013lateral (ML) gap difference in extension was 2.63\u00a0mm (SD 2.63) and 2.09\u00a0mm (SD 3.78) in flexion, being tighter laterally. Initial ML gap differences in extension and flexion correlated with valgus deformity (<jats:italic>R<\/jats:italic>\u2009=\u2009\u2009\u2212\u20090.514; <jats:italic>p<\/jats:italic>\u2009=\u20090.00001; <jats:italic>R<\/jats:italic>\u2009=\u2009\u2009\u2212\u20090.325; <jats:italic>p<\/jats:italic>\u2009=\u20090.01, respectively). Initial ML gap differences in extension correlated with those in flexion (<jats:italic>R<\/jats:italic>\u2009=\u20090.42; <jats:italic>p<\/jats:italic>\u2009=\u20090.0005). Mean ML flexion and extension gap differences were 1.30\u00a0mm (SD 3.67) and 1.26\u00a0mm (SD 1.92) in knees with\u2009&lt;\u200910\u00b0 valgus, and 3.17\u00a0mm (SD 3.71) and 4.29\u00a0mm (SD 2.45) in those\u2009&gt;\u200910\u00b0 valgus; <jats:italic>p<\/jats:italic> values were 0.026 and\u2009&lt;\u20090.001 respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The lateral flexion gap in valgus knees may be narrower than the medial flexion gap, especially in knees with\u2009&gt;\u200910\u00b0 deformity. This contrasts with native and varus knees, in which it exceeds the medial gap. This novel study indicates the need to identify valgus knees with lateral flexion gap tightness by distracting the posterior femoral condyles from the proximal tibia by dynamic stressing of the soft\u2010tissues after resection of cruciates, menisci, and osteophytes, with the knee flexed to 90\u00b0. These findings, highlighting the need for restoring flexion gap balance, may improve the inferior outcomes in valgus knees.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06798-z","type":"journal-article","created":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T08:02:51Z","timestamp":1637827371000},"page":"2905-2914","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Arthritic knees with more than 10\u00b0 valgus can have soft\u2010tissue imbalance in flexion"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6622-7860","authenticated-orcid":false,"given":"Arun","family":"Mullaji","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Breach Candy Hospital Bhulabhai Desai Road 400036 Mumbai India"},{"name":"<!--<label>2<\/label>--> Mullaji Knee Clinic 400036 Mumbai 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