Comparison of the joint laxity of total knee arthroplasty evaluated by the distraction force and the varus–valgus force

Component gap (CG) measurement help surgeons evaluate intraoperative soft-tissue balance. One technique is measuring the CG using tensioner devices with distraction force. Another is to evaluate the laxity under a varus–valgus force using navigation or robotics. The aim was to compare the JL evaluated by CG and varus–valgus force between the different types of total knee arthroplasties.

Forty-three bi-cruciate stabilized (BCS) knees and 33 bi-cruciate retaining (BCR) knees were included. After bone resection and soft tissue balancing, the CG was measured and after the final implantation and capsule closure, JL under a maximum varus–valgus stress was recorded with navigation. JL evaluated by the CG (JLCG) was defined as CG minus selected thickness of the tibial component and JL under varus–valgus force (JLVV) was defined as difference between varus–valgus angles without stress and maximum varus–valgus angles under varus–valgus force. The evaluations were performed at flexions of 10°, 30°, 60° and 90°.

Although JLCGs of lateral compartment of BCS were larger than those of BCR, no difference was found between JLVVs of BCS and BCR. Although JLCGs of lateral compartment did not change at each knee flexion angle in both BCS and BCR, JLVVs of lateral compartment increased by 3° from 10° to 90° knee flexion.

JLVVs of BCS and BCR were equivalent, whereas BCS showed larger JLCGs of lateral compartment. JLVVs of lateral compartment increased by 3° in the range from 10° to 90° knee flexion whereas JLCGs remained stable.