{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:46:47Z","timestamp":1791953207781,"version":"4.3.4"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:00:00Z","timestamp":1722988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:00:00Z","timestamp":1722988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthroplasty"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>One major goal of total knee arthroplasty (TKA) is to achieve balanced medial and lateral gaps in flexion and extension. While bone resections are planned by the surgeon, soft tissue laxity is largely intrinsic and patient-specific in the absence of additional soft tissue releases. We sought to determine the variability in soft tissue laxity in patients undergoing TKA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We retrospectively reviewed 113 patients undergoing TKA. Data on preoperative knee deformity were collected. Data from a dynamic intraoperative stress examination were collected by a robotic tracking system to quantify maximal medial and lateral opening in flexion (85\u201395 degrees) and extension (-5\u201320 degrees). T-tests were used to assess the differences between continuous variables.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A valgus stress opened the medial compartment a mean of 4.3\u2009\u00b1\u20092.3\u00a0mm (0.0\u201312.4\u00a0mm) in extension and 4.6\u2009\u00b1\u20092.3\u00a0mm (0.0\u201312.9\u00a0mm) in flexion. A varus stress opened the lateral compartment a mean of 5.4\u2009\u00b1\u20092.4\u00a0mm (0.3\u201312.6\u00a0mm) in extension and 6.2\u2009\u00b1\u20092.5\u00a0mm (0.0\u201313.4\u00a0mm) in flexion.<\/jats:p>\n                <jats:p>The medial compartment of varus knees opened significantly more in response to valgus stress than valgus knees in both extension (5.2\u00a0mm vs. 2.6\u00a0mm; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and flexion (5.4\u00a0mm vs 3.3\u00a0mm; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). The lateral compartment of valgus knees opened significantly more in response to varus stress than varus knees in both extension (6.7\u00a0mm vs. 4.8\u00a0mm; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and flexion (7.4\u00a0mm vs. 5.8\u00a0mm; <jats:italic>P<\/jats:italic>\u2009=\u20090.0003).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Soft tissue laxity is highly variable in patients undergoing TKA, contributing anywhere from 0\u201313\u00a0mm to the post-resection gap. Only a small part of this variability is predictable by preoperative deformity. These findings have implications for either measured-resection or gap-balancing techniques.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of Evidence<\/jats:title>\n                <jats:p>Level III.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s42836-024-00268-w","type":"journal-article","created":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:02:12Z","timestamp":1722988932000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Soft tissue laxity is highly variable in patients undergoing total knee arthroplasty"],"prefix":"10.1186","volume":"6","author":[{"given":"Travis R.","family":"Weiner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshan P.","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander L.","family":"Neuwirth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Geller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9272-668X","authenticated-orcid":false,"given":"H. John","family":"Cooper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,8,7]]},"reference":[{"key":"268_CR1","doi-asserted-by":"publisher","first-page":"3359","DOI":"10.1002\/art.11420","volume":"48","author":"L Sharma","year":"2003","unstructured":"Sharma L, Cahue S, Song J, et al. Physical functioning over three years in knee osteoarthritis: role of psychosocial, local mechanical, and neuromuscular factors. Arthritis Rheum. 2003;48:3359\u201370.","journal-title":"Arthritis Rheum"},{"key":"268_CR2","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1097\/00003086-200011000-00007","volume":"380","author":"LA Whiteside","year":"2000","unstructured":"Whiteside LA, Saeki K, Mihalko WM. Functional medical ligament balancing in total knee arthroplasty. Clin Orthop Relat Res. 2000;380:45\u201357. https:\/\/doi.org\/10.1097\/00003086-200011000-00007.","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"268_CR3","first-page":"222","volume":"12","author":"KA Krackow","year":"1999","unstructured":"Krackow KA, Mihalko WM. The effect of medial release on flexion and extension gaps in cadaveric knees: implications for soft-tissue balancing in total knee arthroplasty. Am J Knee Surg. 1999;12(4):222\u20138.","journal-title":"Am J Knee Surg"},{"key":"268_CR4","doi-asserted-by":"publisher","first-page":"61","DOI":"10.5792\/ksrr.2014.26.2.61","volume":"26","author":"MJ Chang","year":"2014","unstructured":"Chang MJ, Lim H, Lee NR, et al. Diagnosis, causes and treatments of instability following total knee arthroplasty. Knee Surg Relat Res. 2014;26:61\u20137.","journal-title":"Knee Surg Relat Res"},{"issue":"Suppl","key":"268_CR5","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1302\/0301-620X.98B1.36293","volume":"98-B","author":"M Khan","year":"2016","unstructured":"Khan M, Osman K, Green G, et al. The epidemiology of failure in total knee arthroplasty: avoiding your next revision. Bone Joint J. 2016;98-B(Suppl):105\u201312.","journal-title":"Bone Joint J"},{"issue":"Suppl","key":"268_CR6","doi-asserted-by":"publisher","first-page":"S21","DOI":"10.1016\/j.otsr.2016.06.024","volume":"103","author":"P Massin","year":"2017","unstructured":"Massin P. How does total knee replacement technique influence polyethylene wear? Orthop Traumatol Surg Res. 2017;103(Suppl):S21\u20137.","journal-title":"Orthop Traumatol Surg Res"},{"issue":"Suppl","key":"268_CR7","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1302\/0301-620X.98B1.36371","volume":"98-B","author":"JR Petrie","year":"2016","unstructured":"Petrie JR, Haidukewych GJ. Instability in total knee arthroplasty: assessment and solutions. Bone Joint J. 2016;98-B(Suppl):116\u20139.","journal-title":"Bone Joint J"},{"issue":"5","key":"268_CR8","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1055\/s-0036-1592149","volume":"30","author":"GM Freisinger","year":"2017","unstructured":"Freisinger GM, Schmitt LC, Wanamaker AB, Siston RA, Chaudhari AMW. Tibiofemoral osteoarthritis and varus-valgus laxity. J Knee Surg. 2017;30(5):440\u201351. https:\/\/doi.org\/10.1055\/s-0036-1592149.","journal-title":"J Knee Surg"},{"issue":"1","key":"268_CR9","doi-asserted-by":"publisher","first-page":"e0050","DOI":"10.2106\/JBJS.RVW.19.00050","volume":"8","author":"A Siddiqi","year":"2020","unstructured":"Siddiqi A, Smith T, McPhilemy JJ, Ranawat AS, Sculco PK, Chen AF. Soft-tissue balancing technology for total knee arthroplasty. JBJS Rev. 2020;8(1):e0050. https:\/\/doi.org\/10.2106\/JBJS.RVW.19.00050.","journal-title":"JBJS Rev"},{"key":"268_CR10","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. Pre-operative frontal plane malalignment predicts the extension gap asymmetry in knee osteoarthritis. Int Orthop. 2012;36:79\u201382. https:\/\/doi.org\/10.1007\/s00264-011-1294-7.","journal-title":"Int Orthop"},{"issue":"5","key":"268_CR11","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1007\/s00167-018-5276-9","volume":"27","author":"T Ushio","year":"2019","unstructured":"Ushio T, Mizu-Uchi H, Okazaki K, Miyama K, Akasaki Y, Ma Y, Nakashima Y. Medial soft tissue contracture does not always exist in varus osteoarthritis knees in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2019;27(5):1642\u201350. https:\/\/doi.org\/10.1007\/s00167-018-5276-9.","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"4","key":"268_CR12","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1007\/s11999-012-2745-1","volume":"471","author":"S Okamoto","year":"2013","unstructured":"Okamoto S, Okazaki K, Mitsuyasu H, Matsuda S, Iwamoto Y. Lateral soft tissue laxity increases but medial laxity does not contract with varus deformity in total knee arthroplasty. Clin Orthop Relat Res. 2013;471(4):1334\u201342. https:\/\/doi.org\/10.1007\/s11999-012-2745-1.","journal-title":"Clin Orthop Relat Res"},{"key":"268_CR13","doi-asserted-by":"publisher","first-page":"sti41\/1633","DOI":"10.52198\/22.STI.41.OS1633","volume":"41","author":"RS Charette","year":"2022","unstructured":"Charette RS, Sarpong NO, Weiner TR, Shah RP, Cooper HJ. Registration of bony landmarks and soft tissue laxity during robotic total knee arthroplasty is highly reproducible. Surg Technol Int. 2022;41:sti41\/1633. https:\/\/doi.org\/10.52198\/22.STI.41.OS1633.","journal-title":"Surg Technol Int"},{"issue":"8","key":"268_CR14","doi-asserted-by":"publisher","first-page":"2600","DOI":"10.1007\/s00167-021-06688-4","volume":"30","author":"H Graichen","year":"2022","unstructured":"Graichen H, Lekkreusuwan K, Eller K, Grau T, Hirschmann MT, Scior W. A single type of varus knee does not exist: morphotyping and gap analysis in varus OA. Knee Surg Sports Traumatol Arthrosc. 2022;30(8):2600\u20138. https:\/\/doi.org\/10.1007\/s00167-021-06688-4.","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"4","key":"268_CR15","doi-asserted-by":"publisher","first-page":"1398","DOI":"10.1007\/s00167-022-07088-y","volume":"31","author":"K Eller","year":"2023","unstructured":"Eller K, Scior W, Graichen H. Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps. Knee Surg Sports Traumatol Arthrosc. 2023;31(4):1398\u2013404. https:\/\/doi.org\/10.1007\/s00167-022-07088-y.","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"268_CR16","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1007\/s00167-009-0903-0","volume":"18","author":"J Bellemans","year":"2010","unstructured":"Bellemans J, Vandenneucker H, Vanlauwe J, Victor J. The influence of coronal plane deformity on mediolateral ligament status: an observational study in varus knees. Knee Surg Sports Traumatol Arthrosc. 2010;18:152\u20136. https:\/\/doi.org\/10.1007\/s00167-009-0903-0.","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"1","key":"268_CR17","doi-asserted-by":"publisher","first-page":"230949902110020","DOI":"10.1177\/23094990211002002","volume":"29","author":"S Toyooka","year":"2021","unstructured":"Toyooka S, Masuda H, Nishihara N, Kobayashi T, Miyamoto W, Ando S, Kawano H, Nakagawa T. Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis. J Orthop Surg (Hong Kong). 2021;29(1):23094990211002000. https:\/\/doi.org\/10.1177\/23094990211002002.","journal-title":"J Orthop Surg (Hong Kong)"},{"issue":"6","key":"268_CR18","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1007\/s11999-008-0588-6","volume":"467","author":"H Sekiya","year":"2009","unstructured":"Sekiya H, Takatoku K, Takada H, Sasanuma H, Sugimoto N. Postoperative lateral ligamentous laxity diminishes with time after TKA in the varus knee. Clin Orthop Relat Res. 2009;467(6):1582\u20136. https:\/\/doi.org\/10.1007\/s11999-008-0588-6.","journal-title":"Clin Orthop Relat Res"},{"issue":"3","key":"268_CR19","doi-asserted-by":"publisher","first-page":"e16","DOI":"10.2106\/JBJS.ST.L.00002","volume":"2","author":"CS Ranawat","year":"2012","unstructured":"Ranawat CS, Meftah M, Ranawat AS. The \u201cInside-Out\u201d technique for correcting a fixed varus deformity with flexion contracture in total knee arthroplasty. JBJS Essent Surg Tech. 2012;2(3):e16. https:\/\/doi.org\/10.2106\/JBJS.ST.L.00002.","journal-title":"JBJS Essent Surg Tech"},{"issue":"6","key":"268_CR20","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.knee.2013.06.007","volume":"20","author":"J Joseph","year":"2013","unstructured":"Joseph J, Simpson PM, Whitehouse SL, English HW, Donnelly WJ. The use of navigation to achieve soft tissue balance in total knee arthroplasty - a randomised clinical study. Knee. 2013;20(6):401\u20136. https:\/\/doi.org\/10.1016\/j.knee.2013.06.007. Epub 2013 Jul 26 PMID: 23891167.","journal-title":"Knee"},{"issue":"7S","key":"268_CR21","doi-asserted-by":"publisher","first-page":"S126","DOI":"10.1016\/j.arth.2018.02.044","volume":"33","author":"KR Cidambi","year":"2018","unstructured":"Cidambi KR, Robertson N, Borges C, Nassif NA, Barnett SL. Intraoperative comparison of measured resection and gap balancing using a force sensor: a prospective, randomized controlled trial. J Arthroplasty. 2018;33(7S):S126\u201330. https:\/\/doi.org\/10.1016\/j.arth.2018.02.044.","journal-title":"J Arthroplasty"},{"issue":"7","key":"268_CR22","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.artd.2020.12.022","volume":"30","author":"MB Held","year":"2021","unstructured":"Held MB, Grosso MJ, Gazgalis A, Sarpong NO, Boddapati V, Neuwirth A, Geller JA. Improved compartment balancing using a robot-assisted total knee arthroplasty. Arthroplast Today. 2021;30(7):130\u20134. https:\/\/doi.org\/10.1016\/j.artd.2020.12.022.","journal-title":"Arthroplast Today"}],"container-title":["Arthroplasty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42836-024-00268-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42836-024-00268-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42836-024-00268-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:02:29Z","timestamp":1722988949000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroplasty.biomedcentral.com\/articles\/10.1186\/s42836-024-00268-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,7]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["268"],"URL":"https:\/\/doi.org\/10.1186\/s42836-024-00268-w","relation":{},"ISSN":["2524-7948"],"issn-type":[{"value":"2524-7948","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,7]]},"assertion":[{"value":"30 January 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by our institutional review board (IRB-AAAT6504) and conducted in accordance with the ethical standards in the 1964 Declaration of Helsinki.","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":"T.R.W. and A.L.N. have no competing interests. R.P.S. is a board or committee member of American Association of Hip and Knee Surgeons and US FDA, a paid consultant for Link Orthopaedics, Monogram, and Zimmer, an unpaid consultant for OnPoint, and has stock or stock options for Parvizi Surgical Innovations. J.A.G. is on the editorial or governing board for Clinical Orthopaedics and Related Research, Journal of Arthroplasty, and Journal of Bone and Joint Surgery\u2013British is a paid consultant for Nimble Health and Smith & Nephew, receives research support from Orhtopaedic Science Research Foundation, Orthosensor, and Smith & Nephew, has stock or stock options for Zimmer, and receives IP royalties and is a paid presenter or speaker for Smith & Nephew. H.J.C. is a board or committee member of American Academy of Orthopaedic Surgeons and Eastern Orthopaedic Association, on the editorial or governing board for Journal of Bone and Joint Surgery\u2013American, a paid consultant for 3M, Canary, Polaris, Zimmer-Biomet, and DePuy, a paid presenter or speaker for 3M, receives stock or stock options from Polaris, and receives research support from Smith & Nephew.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"45"}}