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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 8, 1046-1050.
doi: 10.1302/0301-620X.89B8.18976  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Posterior cruciate ligament balancing in total knee replacement

THE QUANTITATIVE RELATIONSHIP BETWEEN TIGHTNESS OF THE FLEXION GAP AND TIBIAL TRANSLATION

B. Christen, MD, MHA, Orthopaedic Surgeon1; P. V. Heesterbeek, MSc, Scientific Researcher2; A. Wymenga, MD, PhD, Orthopaedic Surgeon3; and U. Wehrli, MD, Orthopaedic Surgeon (Retired)4

1 Orthopaedic Clinic Salemspital, Schänzlistrasse 39, CH-3000 Berne 25, Switzerland.
2 Department of Research, Development and Education
3 Department of Orthopaedics Sint Maartenskliniek, Postbox 9011, 6500 GM Nijmegen, The Netherlands.
4 Department of Orthopaedics Spital Bern Ziegler, Route de la Crausa 35, 1789 Lugnorre, Switzerland.

Correspondence should be sent to Ms. P. V. Heesterbeek; e-mail: p.heesterbeek{at}maartenskliniek.nl

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.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General