Ligament balancing and femoral component rotation in total knee arthroplasty

Dr Victor (Brugge) described the standard releases on the medial side of the knee. He found that in cases with a large contracture the ligament releases often result in a larger flexion space when the PCL is resected. One possible solution is to use a larger insert and recut the femur removing an extra 2–4 mm in order to allow sufficient extension of the knee, 1 mm being equal to 4° of extension. A forgotten structure is the popliteal tendon, which is contracted because of the fixed internal rotation of the tibia in severe varus knees. This structure should be released when tight.