{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T16:13:26Z","timestamp":1760890406826,"version":"3.37.3"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:00:00Z","timestamp":1637712000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:00:00Z","timestamp":1637712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI12\/01098"],"award-info":[{"award-number":["PI12\/01098"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006382","name":"Universidad de Oviedo","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006382","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract\n<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>In complex and deformed knees, soft tissue release (STR) is required to obtain symmetry in the femorotibial gap. The objective of this study was to attempt to predict the need for soft tissue release using surgical navigation in total knee replacement (TKR).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Prospective and non-randomized study. One hundred thirty knees. At the start of navigation, an attempt was made to correct the femorotibial mechanical axis by applying force to the medial or lateral side of the knee (varus-valgus stress angle test). A gap balanced technique with computer-assisted surgery (CAS) was performed in all cases. The ligaments were tensioned, and using CAS visualization and control, progressive STR was performed in the medial or lateral side until a symmetry of the femorotibial gap was achieved.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Eighty-two patients had a varus axis\u2009\u2265\u20093\u00b0 and 38 had a valgus axis (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). STR was performed under navigation control in 38.5% of cases, lateral release (LR) in 12 cases, and medial release (MR) in 38 cases. After performing the varus-valgus stress angle test (VVSAT), the axis of 0\u00b0 could be restored at some point during the manoeuvre in 28 cases. STR was required in 44.6% of varus cases and 27% of valgus cases (<jats:italic>P<\/jats:italic>\u2009=\u20090.05). A significant relationship was found between the previous deformity and the need for MR (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) or LR (<jats:italic>P<\/jats:italic>\u2009=\u20090.001). STR was more common in male patients (<jats:italic>P<\/jats:italic>\u2009=\u20090.002) and as obesity increased.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This study shows that pre-operative factors favouring the need to perform STR in a TKR implant can be defined.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00264-021-05263-3","type":"journal-article","created":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T08:02:55Z","timestamp":1637740975000},"page":"815-821","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6536-8186","authenticated-orcid":false,"given":"Daniel","family":"Hernandez-Vaquero","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfonso","family":"Noriega-Fernandez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio","family":"Roncero-Gonzalez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gorka Luis","family":"Ruete-Gil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Manuel","family":"Fernandez-Carreira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,11,24]]},"reference":[{"issue":"3","key":"5263_CR1","doi-asserted-by":"publisher","first-page":"e2","DOI":"10.2106\/JBJS.RVW.18.00026","volume":"7","author":"JJ Mercuri","year":"2019","unstructured":"Mercuri JJ, Pepper AM, Werner JA, Vigdorchik JM (2019) Gap balancing, measured resection, and kinematic alignment. How, when, and why? JBJS Rev 7(3):e2. https:\/\/doi.org\/10.2106\/JBJS.RVW.18.00026","journal-title":"JBJS Rev"},{"issue":"7","key":"5263_CR2","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1002\/jor.24289","volume":"37","author":"M Viceconti","year":"2019","unstructured":"Viceconti M, Ascani D, Mazza C (2019) Operative prediction of soft tissue balancing in knee arthroplasty. Part 1: Effect of surgical parameters during level walking. J Orthop Res 37(7):1537\u20131545. https:\/\/doi.org\/10.1002\/jor.24289","journal-title":"J Orthop Res"},{"issue":"1","key":"5263_CR3","doi-asserted-by":"publisher","first-page":"12","DOI":"10.5792\/ksrr.18.033","volume":"31","author":"O-S Lee","year":"2019","unstructured":"Lee O-S, Elazab A, Lee YS (2019) Preoperative varus-valgus stress difference is valuable for predicting the extent of medial release in varus deformity during total knee arthroplasty. Knee Surg Relat Res 31(1):12\u201318. https:\/\/doi.org\/10.5792\/ksrr.18.033","journal-title":"Knee Surg Relat Res"},{"issue":"1","key":"5263_CR4","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1007\/s00264-011-1294-7","volume":"36","author":"G Matziolis","year":"2012","unstructured":"Matziolis G, Matziolis D, Perka C (2012) Pre-operative frontal plane malalignment predicts the extension gap asymmetry in knee osteoarthritis. Int Orthop 36(1):79\u201382. https:\/\/doi.org\/10.1007\/s00264-011-1294-7","journal-title":"Int Orthop"},{"key":"5263_CR5","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1007\/s11999-009-1175-1","volume":"468","author":"D Hernandez-Vaquero","year":"2010","unstructured":"Hernandez-Vaquero D, Suarez-Vazquez A, Sandoval-Garcia MA, Noriega-Fernandez A (2010) Computer assistance increase precision of component placement in total knee arthroplasty with articular deformity. Clin Orthop Relat Res 468:1237\u20131241. https:\/\/doi.org\/10.1007\/s11999-009-1175-1","journal-title":"Clin Orthop Relat Res"},{"issue":"10 Suppl","key":"5263_CR6","first-page":"S137","volume":"29","author":"D Saragaglia","year":"2006","unstructured":"Saragaglia D, Chaussard C, Rubens-Duval B (2006) Navigation as a predictor of soft tissue during 90 cases of computer-assisted total knee arthroplasty. Orthopedics 29(10 Suppl):S137\u2013S142","journal-title":"Orthopedics"},{"issue":"4","key":"5263_CR7","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1007\/s00167-018-4989-0","volume":"27","author":"V Mehli\u03b2","year":"2019","unstructured":"Mehli\u03b2 V, Strauch Leira M, Serrano-Olaizola A, Scior W, Graichen H (2019) Proven accuracy for a new dynamic gap measurement in navigated TKA. Knee Surg Sports Traumatol Arthrosc 27(4):1189\u20131195. https:\/\/doi.org\/10.1007\/s00167-018-4989-0","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"9","key":"5263_CR8","doi-asserted-by":"publisher","first-page":"1736","DOI":"10.1007\/s00167-011-1752-1","volume":"20","author":"EM Suero","year":"2012","unstructured":"Suero EM, Plaskos C, Dixon PL, Pearle AD (2012) Adjustable cutting bloks improve alignment and surgical time in computer-assisted total knee replacement. Knee Surg Sports Traumatol Arthrosc 20(9):1736\u20131741. https:\/\/doi.org\/10.1007\/s00167-011-1752-1","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"5","key":"5263_CR9","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1302\/2058-5241.2.170001","volume":"2","author":"J Victor","year":"2017","unstructured":"Victor J (2017) Optimizing position and stability in total knee arthroplasty. EFORT Open Rev 2(5):215\u2013220. https:\/\/doi.org\/10.1302\/2058-5241.2.170001","journal-title":"EFORT Open Rev"},{"issue":"3","key":"5263_CR10","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1016\/j.arth.2019.10.002","volume":"35","author":"SR Tapasvi","year":"2020","unstructured":"Tapasvi SR, Shekhar A, Patil SS, Dipane MV, Chowdhry M, McPherson J (2020) Comparison of gap balancing vs measured resection technique in patients undergoing simultaneous bilateral total knee arthroplasty: one technique per knee. J Artrhoplasty 35(3):732\u2013740. https:\/\/doi.org\/10.1016\/j.arth.2019.10.002","journal-title":"J Artrhoplasty"},{"key":"5263_CR11","first-page":"173","volume-title":"Revision total knee arthroplasty","author":"MA Mont","year":"1999","unstructured":"Mont MA, Delanois R (1999) Hungerford DS (1999) Balancing and alignment: surgical techniques on how to achieve soft-tissue balancing. In: Lotke PA, Garino JP (eds) Revision total knee arthroplasty. Lippincott- Raven, Philadelphia, pp 173\u2013186"},{"issue":"8","key":"5263_CR12","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1007\/s00402-012-1536-1","volume":"132","author":"E Aunan","year":"2012","unstructured":"Aunan E, Kibsgard T, Clarke-Jenssen J, R\u00f6hrl S (2012) A new method to measure ligament balancing in total knee arthroplasty: laxity measurements in 100 knees. Arch Orthop Trauma Surg 132(8):1173\u20131181. https:\/\/doi.org\/10.1007\/s00402-012-1536-1","journal-title":"Arch Orthop Trauma Surg"},{"issue":"9","key":"5263_CR13","doi-asserted-by":"publisher","first-page":"1496","DOI":"10.1007\/s00167-011-1483-3","volume":"19","author":"H-N Pang","year":"2011","unstructured":"Pang H-N, Yeo S-J, Chong H-C, Chin P-L, Lo N-N (2011) Computer-assisted gap balancing technique improve outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthosc 19(9):1496\u20131503. https:\/\/doi.org\/10.1007\/s00167-011-1483-3","journal-title":"Knee Surg Sports Traumatol Arthosc"},{"issue":"1","key":"5263_CR14","doi-asserted-by":"publisher","first-page":"e0050","DOI":"10.2106\/JBJS.RVW.19.00050","volume":"8","author":"A Siddiqui","year":"2020","unstructured":"Siddiqui A, Tyler S, McPhilemy JJ, Ranawat AS, Sculco PK, Chen AF (2020) Soft- tissue balancing technology for total knee arthroplasty. JBJS Rev 8(1):e0050. https:\/\/doi.org\/10.2106\/JBJS.RVW.19.00050","journal-title":"JBJS Rev"},{"key":"5263_CR15","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1097\/01.blo.0000218725.29344.c0","volume":"446","author":"WM Mihalko","year":"2006","unstructured":"Mihalko WM, Krackow KA (2006) Flexion and extension gap balancing in revision total knee arthroplasty. Clin Orthop Relat Res 446:121\u2013126. https:\/\/doi.org\/10.1097\/01.blo.0000218725.29344.c0","journal-title":"Clin Orthop Relat Res"},{"issue":"2","key":"5263_CR16","doi-asserted-by":"publisher","first-page":"110","DOI":"10.4055\/cios.2009.1.2.110","volume":"1","author":"JA Sim","year":"2009","unstructured":"Sim JA, Kwak JH, Yang SH, Moon SH, Lee BK, Kim JY (2009) Utility of preoperative distractive stress radiograph for beginners to extent of medial release in total knee arthroplasty. Clin Orthop Surg 1(2):110\u2013113. https:\/\/doi.org\/10.4055\/cios.2009.1.2.110","journal-title":"Clin Orthop Surg"},{"issue":"9","key":"5263_CR17","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1302\/0301-620X.91B9.22043","volume":"91","author":"S Hakki","year":"2009","unstructured":"Hakki S, Coleman S, Saleh K, Bilotta VJ, Hakki A (2009) Navigational predictors in determining the necessity for collateral ligament release in total knee replacement. J Bone Jt Surg (Br) 91(9):1178\u20131182. https:\/\/doi.org\/10.1302\/0301-620X.91B9.22043","journal-title":"J Bone Jt Surg (Br)"},{"key":"5263_CR18","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1007\/s11999-012-2520-3","volume":"471","author":"AB Mullaji","year":"2013","unstructured":"Mullaji AB, Shetty GM, Lingaraju AP, Bhayde S (2013) Witch factors increase risk of malalignment of the hip-knee-ankle axis in TKA? Clin Orthop Relat Res 471:134\u2013141. https:\/\/doi.org\/10.1007\/s11999-012-2520-3","journal-title":"Clin Orthop Relat Res"},{"issue":"39","key":"5263_CR19","doi-asserted-by":"publisher","first-page":"e5006","DOI":"10.1097\/MD.0000000000005006","volume":"95","author":"YW Moon","year":"2016","unstructured":"Moon YW, Kim HJ, Ahn HS, Park CD, Lee DH (2016) Comparison of soft tissue balancing, femoral component rotation, and joint line change between the gap balancing and measured resection techniques in primary total knee arthroplasty. A meta-analysis. Medicine (Baltimore) 95(39):e5006. https:\/\/doi.org\/10.1097\/MD.0000000000005006","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"5263_CR20","doi-asserted-by":"publisher","first-page":"36","DOI":"10.4055\/cios.2013.5.1.36","volume":"5","author":"YW Moon","year":"2013","unstructured":"Moon YW, Kim JG, Han JH, Do KH, Seo JG, Lim HC (2013) Factors correlated with the reducibility of varus deformity in knee osteoarthritis: an analysis using navigation guided TKA. Clin Orthop Surg 5(1):36\u201343. https:\/\/doi.org\/10.4055\/cios.2013.5.1.36","journal-title":"Clin Orthop Surg"},{"issue":"1","key":"5263_CR21","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1177\/230949901001800106","volume":"18","author":"H Sasanuma","year":"2010","unstructured":"Sasanuma H, Sekiya H, Takatoku K, Takada H, Sugimoto N (2010) Evaluation of soft-tissue balance during total knee arthroplasty. J Orthop Surg (Hong Kong) 18(1):26\u201330. https:\/\/doi.org\/10.1177\/230949901001800106","journal-title":"J Orthop Surg (Hong Kong)"}],"container-title":["International Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-021-05263-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00264-021-05263-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-021-05263-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T03:08:27Z","timestamp":1647572907000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00264-021-05263-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,24]]},"references-count":21,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["5263"],"URL":"https:\/\/doi.org\/10.1007\/s00264-021-05263-3","relation":{},"ISSN":["0341-2695","1432-5195"],"issn-type":[{"type":"print","value":"0341-2695"},{"type":"electronic","value":"1432-5195"}],"subject":[],"published":{"date-parts":[[2021,11,24]]},"assertion":[{"value":"20 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Regional Ethics Committee of Asturias, Spain. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}