Soft tissue balancing in total condylar knee arthroplasty

Soft tissue balancing and correct bone cuts are an entity in correcting malalignment in total knee arthroplasty, and cannot be considered isolated. Distinct bony deformations/deviations need enlarged soft tissue management. The extent of resection of the bone stock has to be planned exactly before the operation. Exact soft tissue balancing is necessary to stabilize the corrected knee. Soft tissue balancing has to be done primarily on the side of the contracture by lengthening of the shortened and contracted structures. After balancing the ligaments should have the same tension in extension and flexion together with the same height of the extension and flexion gap. Because of the classic resection of the tibial head, the femoral resection must follow the Insall-Line, that means 3degrees to 5degrees outer rotation in relation to the condyles. Only in this way a symmetric flexion gap can be achieved in combination with ligamentous stability in extension and flexion.