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Recess the PCL
4%
153/3697
Increase the tibial slope
2%
64/3697
Decrease the size of the femoral component
3%
128/3697
Resect more distal femur
86%
3197/3697
Resect more proximal tibia
137/3697
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Flexion/extension gap balancing is crucial to the success in total knee arthroplasty. The inability to achieve full extension suggests extension tightness. This can be improved by either resecting more distal femur or releasing the posterior capsule from the femoral insertion. While resecting more proximal tibia will improve the extension gap, it will loosen the flexion gap and require either upsizing of the femoral component with placement of posterior augments or translation of the femoral component posteriorly. Recessing the PCL and increasing the tibial slope would be appropriate for flexion not extension tightness. In their review, Ries et al discuss flexion/extension balancing, focusing on revision total knee arthroplasty.
4.3
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