{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:40:01Z","timestamp":1788432001403,"version":"build-2803163510"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A critical and difficult aspect of total knee arthroplasty (TKA) is ligamentous balancing for which cadavers and models have played a large role in the education and training of new arthroplasty surgeons, although they both have several shortcomings including cost, scarcity, and dissimilarity to in vivo ligament properties. An advanced knee simulator (AKS) model based on computed tomography (CT) scans was developed in the setting of these challenges with cadavers and previous models. In this study, we compared the ligament balancing between AKS and human cadaveric knees to assess the validity of using the AKS for ligament balancing training during TKA. A CT scan of a TKA patient with varus deformity was used to design the AKS model with modular components, using three-dimensional printing. Three fellowship-trained arthroplasty surgeons used technology-assisted TKA procedure to plan and balance three cadaver knees and the AKS model. Medial and lateral laxity data were captured using manual varus and valgus stress assessments for cadavers and the model in an extension pose (10\u2009degrees of flexion from terminal extension) and between 90 and 95\u2009degrees for flexion. After preresection assessments, surgeons planned a balanced cruciate-retaining TKA. Following bony cuts and trialing, extension and flexion ligament laxity values were recorded in a similar manner. Descriptive statistics and Student's t-tests were performed to compare the cadavers and model with a p-value set at 0.05. Preresection medial\/lateral laxity data for both extension and flexion were plotted and showed that the highest standard deviation (SD) for the cadavers was 0.67\u2009mm, whereas the highest SD for the AKS was 1.25\u2009mm. A similar plot for trialing demonstrated that the highest SD for the cadavers was 0.6\u2009mm, whereas the highest SD for the AKS was 0.61\u2009mm. The AKS trialing data were highly reproducible when compared with cadaveric data, demonstrating the value of the AKS model as a tool to teach ligament balancing for TKA and for future research endeavors.<\/jats:p>","DOI":"10.1055\/a-2343-2346","type":"journal-article","created":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T23:00:40Z","timestamp":1718233240000},"page":"873-878","source":"Crossref","is-referenced-by-count":2,"title":["An Advanced Knee Simulator Model Can Reproducibly Be Used for Ligament Balancing Training during Total Knee Arthroplasty"],"prefix":"10.1055","volume":"37","author":[{"given":"Scott","family":"Logan","sequence":"additional","affiliation":[{"name":"Department of Marketing and Engineering, Stryker, Mahwah, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean B.","family":"Sequeira","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth A.","family":"Jerabek","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur L.","family":"Malkani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ormond M.","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Athens Orthopaedic Clinic, Athens, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"Crutcher","sequence":"additional","affiliation":[{"name":"Orthopedic Physician Associates, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Mont","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Faizan","sequence":"additional","affiliation":[{"name":"Department of Marketing and Engineering, Stryker, Mahwah, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,7,5]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1007\/s00402-021-04208-0","article-title":"The MAKO robotic-arm knee arthroplasty system","volume":"141","author":"M Roche","year":"2021","journal-title":"Arch Orthop Trauma Surg"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1177\/15563316211028568","article-title":"Relative clinical outcomes comparing manual and robotic-assisted total knee arthroplasty at minimum 1-year follow-up","volume":"17","author":"J 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Arthroplasty"},{"issue":"09","key":"ref9","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1007\/s00132-022-04287-w","article-title":"Learning curves of robotic technology in an orthopedic teaching hospital","volume":"51","author":"T Probst","year":"2022","journal-title":"Orthop\u00e4die"},{"issue":"08","key":"ref10","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1054\/arth.2000.6503","article-title":"Accuracy of soft tissue balancing in total knee arthroplasty","volume":"15","author":"F M Griffin","year":"2000","journal-title":"J Arthroplasty"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s00167-009-0983-x","article-title":"Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection","volume":"18","author":"D H Lee","year":"2010","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1097\/CORR.0000000000002184","article-title":"Arthroplasty surgeons differ in their intraoperative soft tissue assessments: a study in human cadavers to quantify surgical decision-making in TKA","volume":"480","author":"S S Elmasry","year":"2022","journal-title":"Clin Orthop Relat Res"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"720740","DOI":"10.3389\/fvets.2021.720740","article-title":"The past, present, and future: a discussion of cadaver use in medical and veterinary education","volume":"8","author":"C Varner","year":"2021","journal-title":"Front Vet Sci"},{"issue":"08","key":"ref14","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1055\/a-2232-7511","article-title":"Robotic-assisted total knee arthroplasty technology provides a repeatable and reproducible method of assessing soft tissue balance","volume":"37","author":"L Scholl","year":"2024","journal-title":"J 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