{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T03:21:05Z","timestamp":1793762465748,"version":"4.6.1"},"reference-count":39,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T00:00:00Z","timestamp":1696377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T00:00:00Z","timestamp":1696377600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T00:00:00Z","timestamp":1696377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Key concepts in total knee arthroplasty include restoration of limb alignment and soft\u2010tissue balance. Although differences in balance have been reported amongst mechanical alignment (MA), kinematic alignment (KA) and functional alignment (FA) techniques, it remains unclear whether there are differences in gap imbalance or resection thicknesses when comparing different constitutional alignment subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MA (measured resection technique), KA (matched resections technique) and FA (technique based on the restricted KA boundaries) were compared in 116 consecutive patients undergoing 137 robotic\u2010assisted cruciate\u2010retaining total knee arthroplasties. The primary outcome was the proportion of balanced gaps (differential laxities\u2009\u2264\u20092\u00a0mm) for extension, flexion, medial and lateral gap measurements. Manual pre\u2010resection laxity measurements were obtained for MA and KA and manual post\u2010resection measurements were obtained for FA in 10\u00b0 and in 90\u00b0 of knee flexion. Secondary outcomes were resection depths and implant alignment. All outcomes were analysed per constitutional coronal alignment and joint line obliquity subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The proportions of balance in all four gap measurements were 54.7%, 66.4% and 96.5%, with MA, KA and FA, respectively. Across all constitutional alignment types, FA achieved the highest proportion of balance. MA resected the least amount of bone from the medial tibial plateau. KA had femoral components in most valgus and most internally rotated, tibial components in most varus and was the most bone\u2010preserving for the posteromedial femoral condyle. FA had the most externally rotated femoral components and was most bone\u2010preserving for the distal femoral resections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study shows that implant alignment to the mechanical axis or joint line anatomy (equal resections) alone does not guarantee a balanced total knee arthroplasty. FA resulted in the highest proportion of balanced knees across all analysed subgroups. Future research will consider whether one alignment philosophy leads to superior outcomes for different constitutional alignment subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level II.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00167-023-07567-w","type":"journal-article","created":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T19:02:25Z","timestamp":1696359745000},"page":"5118-5127","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["Functional alignment in total knee arthroplasty best achieves balanced gaps and minimal bone resections: an analysis comparing mechanical, kinematic and functional alignment strategies"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5119-8887","authenticated-orcid":false,"given":"Victor A.","family":"Van de Graaf","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Sydney Knee Specialists Suite 201, 131 Princes Highway 2217 Kogarah, Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1101-7871","authenticated-orcid":false,"given":"Darren B.","family":"Chen","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Sydney Knee Specialists Suite 201, 131 Princes Highway 2217 Kogarah, Sydney NSW Australia"},{"name":"<!--<label>2<\/label>--> CPAK Research Group Suite 201, 131 Princes Highway 2217 Kogarah, Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Allom","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Sydney Knee Specialists Suite 201, 131 Princes Highway 2217 Kogarah, Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6635-1661","authenticated-orcid":false,"given":"Jil A.","family":"Wood","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Sydney Knee Specialists Suite 201, 131 Princes Highway 2217 Kogarah, Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1578-7614","authenticated-orcid":false,"given":"Samuel J.","family":"MacDessi","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Sydney Knee Specialists Suite 201, 131 Princes Highway 2217 Kogarah, Sydney NSW Australia"},{"name":"<!--<label>2<\/label>--> CPAK Research Group Suite 201, 131 Princes Highway 2217 Kogarah, Sydney NSW Australia"},{"name":"<!--<label>3<\/label>--><!--<institution-id institution-id-type=\"ROR\">https:\/\/ror.org\/02pk13h45<\/institution-id>--> University of NSW, Medicine and Health, St George and Sutherland Campus, Clinical Sciences (WR Pitney) Building, St George Hospital Clinical School Short Street 2217 Kogarah, Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,4]]},"reference":[{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010200403000\u201000030"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1302\/2633\u20101462.211.BJO\u20102021\u20100066.R1"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2019.01.002"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010018\u20102965\u20102"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010022\u201007156\u20103"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/BTO.0000000000000567"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010014\u20103865\u20106"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2019.03.017"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2019.03.036"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010021\u201006688\u20104"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.96B10.34068"},{"key":"e_1_2_11_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978\u20101\u20104377\u20101503\u20103.00120\u20107"},{"key":"e_1_2_11_14_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20080901-15"},{"key":"e_1_2_11_15_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010197961020\u201000003"},{"key":"e_1_2_11_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/1602400305"},{"key":"e_1_2_11_17_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.101B10.BJJ\u20102018\u20101428.R2"},{"key":"e_1_2_11_18_2","doi-asserted-by":"publisher","DOI":"10.1051\/sicotj\/2021021"},{"key":"e_1_2_11_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010022\u201006872\u20100"},{"key":"e_1_2_11_20_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.103B2.BJJ\u20102020\u20101050.R1"},{"key":"e_1_2_11_21_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.105B2.BJJ\u20102022\u20101345"},{"key":"e_1_2_11_22_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058\u20105241.6.210015"},{"key":"e_1_2_11_23_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.101B3.BJJ\u20102018\u20100544.R1"},{"key":"e_1_2_11_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.21564"},{"key":"e_1_2_11_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00776\u2010006\u20101009\u2010x"},{"key":"e_1_2_11_26_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.102B3.BJJ\u20102019\u20101729"},{"key":"e_1_2_11_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2023.03.047"},{"key":"e_1_2_11_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s43465\u2010021\u201000418\u20101"},{"key":"e_1_2_11_29_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.N.01256"},{"key":"e_1_2_11_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010023\u201007351\u2010w"},{"key":"e_1_2_11_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010022\u201007209\u20107"},{"key":"e_1_2_11_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2015.03.004"},{"key":"e_1_2_11_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010022\u201007073\u20105"},{"key":"e_1_2_11_34_2","doi-asserted-by":"publisher","DOI":"10.1051\/sicotj\/2022010"},{"key":"e_1_2_11_35_2","first-page":"271","article-title":"Effects 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June 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 October 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"SM and DC report receiving research support (Stryker, Smith & Nephew, Zimmer Biomet (Research fellowship funding); Ramsay Hospital Research Fund (support for unrelated study), reimbursement for presentations (Stryker, Smith and Nephew) and paid consultations (Stryker, Amplitude SAS).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethics approval was provided by Ramsay Health Care Research Ethics and Governance (2023\/ETH\/0029).","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"}}]}}