A new method to measure ligament balancing in total knee arthroplasty: laxity measurements in 100 knees

Eirik Aunan, Thomas Kibsgård, John Clarke-Jenssen, Stephan M Röhrl, Eirik Aunan, Thomas Kibsgård, John Clarke-Jenssen, Stephan M Röhrl

Abstract

Background: Ligament balancing is considered a prerequisite for good function and survival in total knee arthroplasty (TKA). However, there is no consensus on how to measure ligament balance intra-operatively and the degree of stability obtained after different balancing techniques is not clarified.

Purpose: This study presents a new method to measure ligament balancing in TKA and reports on the results of a try-out of this method and its inter-observer reliability.

Methods: After the implantation of the prosthesis, spatulas of different thickness were used to measure medial and lateral condylar lift-off in flexion and extension in 70 ligament-balanced knees and in 30 knees were ligament balancing was considered unnecessary. Inter-observer reliability for the new method was estimated and the degree of medial-lateral symmetry in extension and in flexion, and the equality of the extension gaps and flexion gaps were calculated.

Results: The method was feasible in all operated knees, and found to be very reliable (intraclass correlation coefficient = 0.88). We found no statistically significant difference in condylar lift-off between the ligament-balanced and the non ligament-balanced group, however, there was a tendency to more outliers in flexion in the ligament-balanced group.

Conclusions: Our method for measuring ligament balance is reliable and provides valuable information in assessing laxity intra-operatively. This method may be a useful tool in further research on the relationship between ligament balance, function and survival of TKA.

Figures

Fig. 1
Fig. 1
a The tool for measuring condylar lift-off consists of four spatulas made of polyethylene, from 2 to 5 mm thick. b With the knee in 90° of flexion medial condylar lift-off was defined as the distance in the frontal plane from the deepest point of the polyethylene tray to the most posterior point of the femoral condyle. The measurement was performed with the leg in a reversed crossed-leg position under passive varus-stress from the weight of the lower leg with the thickest spatula that could be introduced without force
Fig. 2
Fig. 2
The degree of medial–lateral symmetry in lift-off that was achieved after implantation of the prosthesis, in knees where ligament balancing was not necessary (n = 30) and in knees that were ligament balanced according to the Whiteside method (n = 70). Negative values represent more lift-off laterally than medially. Positive values mean more lift-off medially than laterally
Fig. 3
Fig. 3
The relationship between the flexion gap and the extension gap. Positive values mean the flexion gap is larger than the extension gap. Negative values mean the extension gap is larger. Zero means the two gaps are of equal size

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