The relevance of ligament balancing in total knee arthroplasty: how important is it? A systematic review of the literature

Abstract

Ligament balancing affects many of the postoperative criteria for a successful knee replacement. A balanced knee contributes to improved alignment and stability. Ligament balancing helps reduce wear and loosening of the joint. A patient with a balanced knee is more likely to have increased range of motion and proprioception, and decreased pain. All these factors help minimize the need for revision surgery. Complications associated with ligament balancing can include instability caused by over-balancing and the possibility of neurovascular damage during or as a result of ligament balancing. This article attempts to summarize the literature, to define a balanced knee, and outline the benefits and possible complications of ligament balancing. Different techniques, sequences, and tools used in ligament balancing, and their relevance in correcting various deformities are reviewed.

Keywords: arthroplasty.; knee; ligament balancing.

Figure 1

Common peroneal nerve.

Figure 2

(A) Mechanical alignment, (B) anatomical alignment, (C) tibiofemoral angle, and (D, E) bony cuts.

Figure 3

Balanced resection using tensor balancer device.

Figure 4

Severely valgus knee.

Figure 5

Posterior capsule.

Figure 6

Varus knee.

Figure 7

(A) Whiteside's line, (B) epicondylar axis, (C) posterior condylar axis, and (D) tibial bony cut, perpendicular to tibial long axis.

Figure 8

Computer-assisted surgery.