Redefining Knee Balance in a Medially Stabilized Prosthesis: An In-Vitro Study

Philippe Van Overschelde1, *, Vera Pinskerova2, Peter P. Koch3, Christophe Fornasieri4, Sandro Fucentese5
1 AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000 Gent , Belgium
2 Charles University, First Orthopaedic Clinic, Faculty of Medicine, Prague, Czech Republic
3 Kantonsspital Winterthur, Klinik für Orthopädie und Traumatologie, Brauerstrasse 15, 8400 Winterthur, Switzerland
4 Clinique Générale Annecy, 4 Chemin de la Tour la Reine, 74000 Annecy, France
5 University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland

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© 2017 Van Overschelde et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000 Gent, Belgium; Tel: +3292208868; E-mail:



To date, there is still no consensus on what soft tissues must be preserved and what structures can be safely released during total knee arthroplasty (TKA) with a medially stabilized implant.


The aim of this study was to analyze the effect of a progressive selective release of the medial and lateral soft tissues in a knee implanted with a medially stabilized prosthesis.


Six cadaveric fresh-frozen full leg specimens were tested. In each case, kinematic pattern and mediolateral laxity were measured in three stages: firstly, prior to implantation; secondly, after the implantation of the trial components, but before any soft tissue release; and thirdly, progressively as soft tissue was released with the trial implant in place. The incremental impact of each selective release on knee balance was then analyzed.


In all cases sagittal stability was not affected by the progressive release of the lateral soft tissue envelope. It was possible to perform progressive lateral release provided the anterior one-third of the iliotibial band (ITB) remained intact. Progressive medial release could be performed on the medial side provided the anterior fibers of the superficial medial collateral ligament (sMCL) remained intact.


The medially conforming implant remains stable provided the anterior fibers of sMCL and the anterior fibers of the ITB remain intact. The implant’s sagittal stability is mainly dependent on its medial ball-in-socket design.

Keywords: Total knee arthroplasty, Prosthetic design, Cadaveric study, Ligament balancing, Medially stabilized knee, Ligament release.