Ligament balancing in the valgus knee

Total knee arthroplasty in the knee with valgus deformity is a challenge for surgeons. Making distal and posterior femoral and tibial bone cuts perpendicular to the mechanical axis are essential for obtaining alignment throughout the flexion–extension arc of motion. A well-balanced knee assures correct function, which is realized by a functional approach for releasing the ligaments that are found to be tight in flexion and/or extension while testing the knee after bone cuts have been made. Special attention to normalized tracking of the patella and quadriceps mechanism is crucial at the end of the surgical procedure.