Soft-Tissue Balancing

  • Ermanno A. Martucci


The knee is the joint most affected by arthritis, which causes degenerative changes not only in the osteocartilaginous tissue but also in the surrounding capsuloligamentous structures. In fact, these undergo compromise of the collagen fibers with a reduction in glycosaminoglycans and water content (2). If we use the femorotibial angle delimited by the anatomical axis as a reference parameter, the knee is defined varus when this angle is ≥ 0° with the apex directed laterally, valgus when the angle is ≥ 10° with a medial apex, neutral if the angle is included between 1° and 9° with the apex turned in a medial direction (13). Deformity of the knee is generally the result of abnormal skeletal structure and capsuloligamentous imbalance. Corresponding to the knee, the periarticular tissues constitute a sort of envelope, whose circumference is partially interrupted by the presence of the patella. The occurrence of osteocartilaginous pathology results in contracture, that is, anatomofunctional adaptation, of some of the capsuloligamentous formations that make up this envelope. Depending on the localization of the osteocartilaginous defect, which is generally asymmetrical, contracture may involve the medial, lateral and/or posterior compartment of the knee, thus producing a deformity in varus, valgus, and flexion, respectively. In gonarthrosis, the osteocartilaginous defect is usually medial (Fig. 1).To redistribute the mechanical stress on a wider surface, osteophytic formations develop to a greater or lesser extent. This triggers shortening of the medial collateral ligament and, because of the high compressive forces on the medial compartment, lengthening of the lateral collateral ligament may also take place. In this manner, contracture in varus originates, representing the most common deformity.


Total Knee Arthroplasty Posterior Cruciate Ligament Medial Collateral Ligament Valgus Deformity Primary Total Knee Arthroplasty 
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© Springer-Verlag Wien 2001

Authors and Affiliations

  • Ermanno A. Martucci
    • 1
  1. 1.Rizzoli Orthopaedic InstituteBologna

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