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Using a Knee Arthrometer to Evaluate Tissue-specific Contributions to Knee Flexion Contracture in the Rat

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Laxity phenotyping in total knee arthroplasty: A current concept article.

Heiko Graichen¹, George M Avram^2,3, Rüdiger von Eisenhart-Rothe⁴

¹Department of Personalised Orthopaedics (PersO), Privatklinik Siloah, Bern, Switzerland.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA

|June 24, 2026

Summary

This study introduces a new classification for knee laxity phenotypes to guide total knee arthroplasty (TKA) balancing. A tailored treatment algorithm helps surgeons address specific bony and ligamentous imbalances for improved patient outcomes.

Keywords:

alignment balancing goals extension gap flexion gap laxity phenotypes personalised arthroplasty

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In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty

Published on: May 5, 2023

Area of Science:

Orthopedic surgery
Biomechanics
Arthroplasty

Background:

Phenotypic variation in the knee is influenced by bone anatomy and ligamentous laxity.
Understanding this interplay is crucial for assessing patient-specific laxity.
Current total knee arthroplasty (TKA) balancing may not account for diverse laxity phenotypes.

Purpose of the Study:

To develop a clinically applicable classification system for knee laxity phenotypes.
To create a corresponding treatment algorithm for balancing during TKA.
To personalize TKA procedures based on individual patient anatomy and laxity.

Main Methods:

Evaluated patient-specific laxity phenotypes in relation to bony phenotypes.
Developed a 3x3 classification system based on coronal gap characteristics in extension and flexion.
Created a treatment algorithm to guide corrective strategies for gap imbalance.

Main Results:

Identified nine distinct knee laxity phenotypes.
Lateral laxity was the most common flexion phenotype (>60%).
Only two phenotypes met standard gap balance criteria; seven required correction.

Conclusions:

A treatment algorithm addresses imbalance via bone cuts, soft-tissue releases, insert selection, or implant constraint.
Standardized balancing goals may compromise bone or soft-tissue reconstruction.
Tailoring TKA balancing to patient-specific laxity phenotypes is essential.