Balancing the Flexion Gap: Relationship Between Tibial Slope and Posterior Cruciate Ligament Release and Correlation with Range of Motion by Adolph V

Balancing the Flexion Gap: Relationship Between Tibial Slope and Posterior Cruciate Ligament Release and

Correlation with Range of Motion

by Adolph V. Lombardi, Keith R. Berend, Jorge Aziz-Jacobo, and Mark B. Davis

J Bone Joint Surg AmVolume 90(Supplement 4):121-132

November 1, 2008

©2008 by The Journal of Bone and Joint Surgery, Inc.

Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90:121-132








The deep medial collateral ligament and the meniscal capsular ligament are released to assist with exposure.



An intramedullary alignment guide is used to perform a measured resection equivalent to the amount replaced by the implant.



An extramedullary guide is shown in position on the proximal part of the tibia, aligned perpendicular to the tibial shaft axis in the coronal plane.



A posterior referencing femoral sizing guide is placed on the resected distal part of the femur to determine the anteroposterior implant size.



Rotation of the femoral component is determined with use of a combination of landmarks, including the femoral anteroposterior (AP) axis, the transepicondylar axis, the posterior condylar

axis, and a line 90° to the tibial shaft axis.



Using a sliding cut block, the surgeon performs anterior, posterior condylar, and chamfer resections of the femur.







Illustration demonstrating a resected knee in which the flexion gap is slightly tighter than the extension gap.



If the surgeon determines that the tighter flexion gap is secondary to excessive tension in the collateral ligaments and the posterior cruciate ligament, tibial resection is adjusted to increase

the posterior slope of the tibia, which will slightly increase...



The three common methods of balancing the posterior cruciate ligament.



Screen image showing measurement of posterior tibial slope on a postoperative lateral radiograph with use of a calibrated picture archiving and communication system.



The range of motion preoperatively, at six weeks postoperatively, and at the most recent evaluation in the 136 knees that underwent intraoperative release of the posterior cruciate

ligament (PCL) compared with the 280 knees that did not undergo a release.



The range of motion preoperatively, at six weeks postoperatively, and at the most recent evaluation in the 208 knees with <3° of posterior tibial slope postoperatively compared with the

208 knees with >3° of tibial slope.



In the subgroup of 280 knees that did not undergo intraoperative release of the posterior cruciate ligament, the ranges of motion (ROM) preoperatively, at six weeks postoperatively, and at the

most recent evaluation are compared between the 130 knees with <...



In the subgroup of 136 knees that underwent intraoperative release of the posterior cruciate ligament, the ranges of motion (ROM) preoperatively, at six weeks postoperatively, and at the

most recent evaluation are compared between the seventy-eight knees wi...



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Balancing the Flexion Gap: Relationship Between Tibial Slope and Posterior Cruciate Ligament Release and Correlation with Range of Motion by Adolph V