["Ligament balancing" and varus deformity in total knee arthroplasty]

Coordinated bone resection and ligament balancing techniques represent prerequisites for long-term success in bicondylar total knee arthroplasty to correct mechanical leg axis and create a stable and balanced prosthesis over the entire range of motion. This review summarizes current ligament balancing techniques in knee arthroplasty to correct varus deformities. As ligament balancing techniques can only be discussed in the context of the principal surgical implantation technique and preoperative deformity, this review article defines evidence-based goals of correct implantation in knee arthroplasty, followed by a description of preoperative deformities and functional deficits of varus knees and their implications for soft tissue management. Then, principal implantation techniques in knee arthroplasty are illustrated and surgical techniques for successful ligament balancing are explained. Finally, evidence of current ligament balancing techniques is critically discussed.