In this booklet, experts from across the world, including members of the ISAKOS Knee Arthroplasty Committee, offer clear, up-to-date guidance on all aspects of soft tissue or ligament balancing in primary total knee arthroplasty with the aim of enabling the reader to achieve optimal patient outcomes. After an introduction explaining the normal soft tissue condition in the native knee, surgical procedures are described, including techniques for the management of severe deformity. The most striking feature of the booklet, however, is the many pages devoted to the accurate evaluation and clinical relevance of ligament balancing. Different techniques and devices for intraoperative soft tissue assessment are discussed, highlighting, for example, the use of gap-measuring devices or trial liners with load-bearing sensors to achieve more objective evaluation. Above all, special attention is devoted to the crucial issue of the impact of intraoperative soft tissue balance on postoperative results. In the closing chapter, very experienced surgeons introduce intraoperative troubleshooting in order to assist successful completion of arthroplasty.

Native knee: Anatomy and biomechanics

Soft tissue balance in native knee
Knee kinematics in native knee. Operative procedure 1 - primary TKA: Primary principals in soft tissue balancing
CR: Measured resection technique
PS: Gap technique
BCR: How to achieve near normal kinematics. Operative procedure 2 - primary TKA: Varus knee - severe cases included
Valgus knee - severe cases included
Complicated cases - recurvatum, severe contracture
Increasing ROM. Assessment in primay TKA: Intraoperative assessment - tensor
Intraoperative assessment - navigation
Intraoperative assessment - OrthoSenser. Clinical relevance: primary TKA: Postoperative changes in soft tissue balance
Intraoperative soft tissue balance and postoperative knee kinematics
Intraoperative soft tissue balance and clinical results(ROM, function)
Knee kinematics and patient satisfaction. Patella: Avoiding patellar maltracking
Management of patellar baja and alta. Trouble shooting: Intraoperative MCL injury
Patellar tendon rupture.