{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T12:11:42Z","timestamp":1767183102825},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T00:00:00Z","timestamp":1639008000000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Amphia wetenschapsfonds","award":["NL65535.100.18"],"award-info":[{"award-number":["NL65535.100.18"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The Flexion First Balancer (FFB) technique for total knee arthroplasty (TKA) was developed to maintain the isometry of the medial collateral ligament (MCL) by restoring the medial anatomy of the knee. Inability to correct MCL isometry could hypothetically result in an increased mid-flexion laxity. The aim of the current study was to evaluate if the FFB technique results in improved functional outcome and less mid-flexion laxity compared to Measured Resection (MR).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A cross-sectional study was performed comparing 27 FFB patients with 28 MR patients. Groups were matched for age, gender, BMI and ASA classification. All patient received the cruciate retained type, Vanguard Complete Knee System (Biomet Orthopedics, Warsaw, IN, USA). Stress X-rays of the knee with 30 degrees of flexion were made to assess varus-valgus laxity. Furthermore, three tests were conducted to asses functional outcome: a 6\u2009min walk test, a stair climb test and quadriceps peak force measurements. Mean follow-up was respectively 2.6 (SD 0.4) and 3.9\u2009years (SD 0.2).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The MR group showed a postoperative elevation in joint line in contrast to the FFB group, the mean difference between the two groups was 3\u2009mm (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). No differences in total laxity between the two groups was found. The FFB group showed a higher quadriceps peak force (1.67 (SD 0.55) N\/BMI) in comparison with the MR group (1.38 (SD 0.48) N\/BMI) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). All other outcome parameters were comparable between the two groups (p: n.s.). Correlation analysis showed a moderate negative correlation between joint line elevation and quadriceps peak force (r\u2009=\u2009\u2212\u20090.29, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The FFB technique did not lead to less coronal laxity in the mid-flexion range compared to MR. Although peak quadriceps force was significantly higher for the FFB group no clinically relevant benefits could be identified for the patients with regards to functional outcome. Therefore, minor deviations in joint line seems to have no effect on functional outcome after TKA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>ISRCTN, ISRCTN85351296. Registered 23 april 2021 - Retrospectively registered, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.isrctn.com\/ISRCTN85351296\">https:\/\/www.isrctn.com\/ISRCTN85351296<\/jats:ext-link><\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12891-021-04869-3","type":"journal-article","created":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T11:11:23Z","timestamp":1639048283000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The effect of restored medial knee anatomy in total knee arthroplasty with the flexion first balancer technique on mid-flexion laxity and functional outcome"],"prefix":"10.1186","volume":"22","author":[{"given":"W. A. 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The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Prior to participation in the study all patients signed informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Financial interests.\nOur research foundation (FORCE) receives funding from ZimmerBiomet, Stryker and Mathys not directly related to the content of this study. The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.\nNon-financial interests.\nDr. R.C.I. van Geenen is a consulting orthopaedic surgeon for ZimmerBiomet.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1029"}}