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Updated: Feb 13, 2026

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Second-Generation Electronic Ligament Balancing for Knee Arthroplasty: A Cadaver Study.

Evan S Nielsen1, Albert Hsu1, Shantanu Patil1

  • 1Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, La Jolla, CA.

The Journal of Arthroplasty
|March 21, 2018
PubMed
Summary

An electronic device accurately measured knee balance during total knee arthroplasty (TKA), improving upon subjective surgical techniques. This technology enhances soft-tissue balancing for better TKA outcomes.

Keywords:
balanced gap techniquegap balancingknee instabilityligament balancesoft-tissue balancetotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Biomechanics

Background:

  • Knee instability is a significant complication following total knee arthroplasty (TKA).
  • Ligament laxity and component alignment are key factors influencing TKA outcomes.
  • Current knee balancing relies heavily on surgeon's subjective assessment.

Purpose of the Study:

  • To evaluate the accuracy of an electronic ligament-balancing device in quantifying knee balance corrections after soft-tissue releases.
  • To measure the change in knee laxity following medial release during TKA procedures.

Main Methods:

  • A second-generation electronic ligament-balancing device was compared against two mechanical instruments.
  • The study involved 12 cadaver knees undergoing total knee arthroplasty (TKA).
  • Measurements were taken sequentially: pre-TKA, post-trial component, post-medial release, and post-PCL resection.

Main Results:

  • The electronic device demonstrated superior accuracy over mechanical instruments in measuring distracted gap and force.
  • Medial release increased the medial gap in flexion and induced greater passive knee valgus laxity.
  • Posterior cruciate ligament (PCL) release enlarged the tibiofemoral gap, particularly the lateral aspect.

Conclusions:

  • The electronic balancing device proved significantly more accurate than mechanical methods.
  • This device can accurately record knee balance across the full range of flexion.
  • Improved accuracy in soft-tissue balancing holds potential for enhanced TKA patient outcomes.