No detrimental effect of ligament balancing on functional outcome after total knee arthroplasty: a prospective cohort study on 129 mechanically aligned knees with 3 years’ follow-up

Background and purpose — In the classical mechanical alignment technique, ligament balancing is considered a prerequisite for good function and endurance in total knee arthroplasty (TKA). However, it has been argued that ligament balancing may have a negative effect on knee function, and some authors advocate anatomic or kinematic alignment in order to reduce the extent of ligament releases. The effect of the trauma induced by ligament balancing on functional outcome is unknown; therefore, the aim of this study was to investigate this effect.

Patients and methods — 129 knees (73 women) were investigated. Mean age was 69 years (42–82), and mean BMI was 29 (20–43). Preoperatively 103 knees had a varus deformity, 21 knees had valgus deformity, and 5 knees were neutral. The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measures were the Oxford Knee Score (OKS) and patient satisfaction (VAS). All ligament releases were registered intraoperatively and outcome at 3 years’ follow-up in knees with and without ligament balancing was compared

Results — 86 knees were ligament balanced and 43 knees were not. Ligament-balanced varus knees had more preoperative deformity than varus knees without ligament balancing (p = 0.01). There were no statistically significant differences in outcomes between ligament-balanced and non-ligament-balanced knees at 3 years’ follow-up. No correlation was found between increasing numbers of soft tissue structures released and outcome.

Interpretation — We did not find any negative effect of the trauma induced by ligament balancing on knee function after 3 years.