title: Posterior cruciate ligament balancing in total knee replacement: the quantitative relationship between tightness of the flexion gap and tibial translation.
abstract: We have examined the relationship between the size of the flexion gap and the anterior translation of the tibia in flexion during implantation of a posterior cruciate ligament (PCL)-retaining BalanSys total knee replacement (TKR). In 91 knees, the flexion gap and anterior tibial translation were measured intra-operatively using a custom-made, flexible tensor-spacer device. The results showed that for each increase of 1 mm in the flexion gap in the tensed knee a mean anterior tibial translation of 1.25 mm (SD 0.79, 95% confidence interval 1.13 to 1.37) was produced. When implanting a PCL-retaining TKR the surgeon should be aware that the tibiofemoral contact point is related to the choice of thickness of the polyethylene insert. An additional thickness of polyethylene insert of 2 mm results in an approximate increase in tibial anterior translation of 2.5 mm while the flexed knee is distracted with a force of between 100 N and 200 N.
authors.affiliation: Orthopaedic Clinic Salemspital, Schänzlistrasse 39, CH-3000, Berne, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Christen
authors.forename: P
authors.initials: P
authors.lastname: Heesterbeek
authors.forename: P V
authors.initials: PV
authors.lastname: Heesterbeek
authors.forename: A
authors.initials: A
authors.lastname: Wymenga
authors.forename: U
authors.initials: U
authors.lastname: Wehrli
mesh_terms: D000368:Aged; D053587:Arthrometry, Articular / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D016119:Posterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies