title: [Ligament-controlled positioning of the knee prosthesis components].
abstract: BACKGROUND
  There are at least two predominant goals in total knee replacement: first, the surgeon aims to achieve an optimal postoperative kinematic motion close to the patient's physiological range, and second, he aims for concurrent high ligament stability to establish pain-free movement for the entire range of motion. A number of prosthetic designs and surgical techniques have been developed in recent years to achieve both of these targets.
  
  
  OBJECTIVE
  This study presents another modified surgical procedure for total knee implantation. As in common practice the osteotomies are planned preoperatively, referencing well-defined bony landmarks, but their placement and orientation are also controlled intraoperatively in a stepwise sequence via ligamentous linkages.
  
  
  METHODS
  This method is open to all surgical approaches and can be applied for PCL-conserving or -sacrificing techniques. The anterior femoral osteotomy is carried out first, followed by the distal femoral osteotomy. Then, the extension gap is finalized by tensioning the ligaments and "top-down" referencing at the level of the tibial osteotomy, followed by finishing the flexion gap in the same way, except that the osteotomy of the posterior condyles is referenced in a "bottom-up" fashion.
  
  
  CONCLUSIONS
  Hence, this technique relies on both bony and ligament-controlled procedures. Thus, it respects the modified ligamentous framework and drives the prosthetic components into the new ligamentous envelope. Further improvement may be achieved by additional control of the kinematics during surgery by applying modern computer navigation technology.
authors: Department für Orthopädie, Universität Basel, Spitalstrasse 21, 4031, Basel, Schweiz, Karl-Heinz.Widmer@unibas.ch.
authors: K-H
authors: KH
authors: Widmer
authors: A
authors: A
authors: Zich
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D007720:Knee Prosthesis; D008022:Ligaments / Q000000981:diagnostic imaging* / Q000601:surgery*; D056888:Patient Positioning / Q000379:methods*; D017755:Prosthesis Fitting; D011859:Radiography; D016059:Range of Motion, Articular