gms | German Medical Science

54. Jahrestagung der Norddeutschen Orthopädenvereinigung e. V.

Norddeutsche Orthopädenvereinigung

16.06. bis 18.06.2005, Hamburg

Quantitative load depending gap-balancing for PCL retaining TKR

Meeting Abstract

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  • corresponding author P. Ritschl - Orthopädisches Krankenhaus der Stadt Wien Gersthof, I. Orthopädische Abteilung, Wien
  • F. Machacek - Wien
  • R. Fuiko - Wien

Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05novK4.04

The electronic version of this article is the complete one and can be found online at:

Published: June 13, 2005

© 2005 Ritschl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




The outcome of TKR is strongly influenced by the ligamentous stability. Navigation Systems support precise axis reconstruction reliably. Soft tissue balancing is still a field of experience. Quantitative soft tissue balancing for the individual patient is still not defined. Surgical navigation can be a valuable tool to quantify and improve soft tissue parameters during surgery.


The two surgical strategies-bone referencing (group A) and soft-tissue based (group B) were formulated in the workflow of a surgical navigation system (PiGalileo, Aarau Switzerland). The bone referencing technique (A: 47 patients) was based on classical Landmarks, performing resections before soft-tissue balancing. Soft tissue balancing (B: 47 patients) was carried out using a quantitative, force controlled, compartment-specific ligament-tensioner in 0 degree and 90 degree flexion before performing bone-resections. Component alignment and reconstruction of the joint line are visualised and adjusted in regard to the defined ligament stability.

With the prosthetic components implanted the joint function (ROM, stability, alignment) was quantified and recorded. KSS score with 2 years follow-up was evaluated.


Significant differences in stability through the ROM were achieved between A and B. Group B showed AKSS which in comparison with A was not significantly higher at all follow-up examinations.

Discussion & Conclusion

Quantitative ligament balancing leads to better stability as a major factor for successful TKR. Classical score rating does not show a significant difference between the two techniques. In the future, better criteria needs to be found in order to define the appropriate TKR stability for individual patients.