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Related Concept Videos

Knee Joint01:23

Knee Joint

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The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
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The movement of the legs is facilitated by numerous muscles located within the anterior, medial, and posterior compartments of the thigh.
Anterior Compartment
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Bones of the Lower Limb: Femur and Patella01:16

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The femur is the body's longest and strongest bone spanning the thigh region. Its head articulates with the acetabulum of the hip bone to form the hip joint. A minor indentation on the medial side of the femoral head, called the fovea capitis, serves as the site of attachment for the ligament of the head of the femur. This weak ligament spans the femur and acetabulum and supports the hip joint. The narrowed region below the head is the neck of the femur. The inclination angle between the...
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Related Experiment Video

Updated: Mar 21, 2026

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty
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Midflexion instability in primary total knee replacement: a review.

Manjunath Ramappa1

  • 1James Cook University Hospital Middlesbrough TS4 3BW UK.

SICOT-J
|May 11, 2016
PubMed
Summary

Midflexion instability in total knee replacement (TKR) can stem from elevated joint line, specific femoral components, or medial collateral ligament (MCL) laxity. Further research is needed to confirm these findings and improve TKR outcomes.

Keywords:
KneeMidflexion instability

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Knee Biomechanics

Background:

  • Midflexion instability is an emerging concern in primary total knee replacement (TKR).
  • Understanding the distinct types of instability is crucial for effective TKR treatment.
  • This review focuses on factors contributing to midflexion instability in primary TKR.

Purpose of the Study:

  • To review and synthesize current literature on midflexion instability in primary total knee replacement (TKR).
  • To identify key factors influencing midflexion instability.
  • To highlight the limitations of existing research and suggest future directions.

Main Methods:

  • A comprehensive literature review was conducted following PRISMA guidelines.
  • Searches were performed across major databases including Embase, Medline, Cochrane Library, and PubMed.
  • Cross-references were also utilized to identify relevant studies.

Main Results:

  • Three primary factors identified: elevated joint line, multiradii femoral component, and medial collateral ligament (MCL) laxity.
  • Mediolateral instability between 30-60° flexion is suggested as a diagnostic indicator.
  • Evidence largely derived from cadaveric studies; clinical data is limited by small sample sizes and short follow-up periods.

Conclusions:

  • Elevated joint line, multiradii femoral components, and MCL laxity are implicated in primary TKR midflexion laxity.
  • Current evidence strength is limited, necessitating more robust clinical studies.
  • This review establishes a baseline for future research and promotes routine assessment of midflexion instability in TKR.