[Soft tissue management in total knee replacement. Analysis of ligament balancing]

Total knee replacement must provide good function with stability, range of motion and long durability. The easiest part of the surgery concerns bone cuts. It is widely accepted today that the quality of the results mostly relies on the soft tissue management. Intraoperative soft tissue management is still challenging since pre-existing soft tissue quality and bony anatomy have to be respected. The surgeon may have to address the soft tissue to fit with the new alignment and prosthetic mechanics. This challenge must be mastered with correct understanding and use of instruments to quantify these soft tissues. Tensors, distractors, spacer blocks and use of navigation were evaluated, and the authors compared these methods. The parameters for better use of soft tissues are described. Objective measurements are still difficult due to the pre-operative conditions that influence measurement accuracy.