💠 Predictive Radiographic Factors for Soft Tissue Release and Distal Femoral Cut Angle for Appropriate Biomechanics in Total Knee Arthroplasty
👥 Arash Sharafat Vaziri, Ehsan Hedayat, Maryam Salimi, Fardis Vosoughi, Ramin Shayan-Moghadam, Ghazaleh Moradkhani, Hamidreza Nematy, Morad Karimpour*
📔 The Archives of Bone and Joint Surgery (Q1)
🗓 October 2025
🗂 Original research
📄 Abstract:
Objectives: Total knee arthroplasty (TKA) success depends on precise soft tissue release and bone cuts to achieve balanced biomechanics. However, predicting the extent of medial soft tissue release (MSTR) and determining the appropriate distal femoral valgus cut angle (VCA) remain challenging. This study explored the relationship between radiographic parameters, MSTR, and VCA to identify predictive factors guiding intraoperative decision-making.
Methods: In a prospective cohort of 62 limbs (57 patients), preoperative lower-limb radiographs were analyzed. Univariate and multivariate regression models assessed correlations between radiographic indices, MSTR stage, and VCA.
Results: VCA showed strong positive correlations with medial hip offset (MHO) and femoral length (FL) (P < 0.001). Patients with shorter femurs and MHO > 4.35 cm required a distal femoral cut ≥ 6°, while those with longer femurs and MHO < 4.35 cm needed < 6° (SEN = 83%, SPE = 80%). Joint line congruency angle (JLCA), varus angle (VA), and lateral distal femoral angle (LDFA) correlated significantly with MSTR, with VA being the strongest predictor (SEN = 91.7%, SPE = 100%).
Conclusion: Increasing LDFA > 93.5°, JLCA > 7.5°, and VA > 19° increases the likelihood of extensive MSTR. MHO and FL are key predictive factors for determining the ideal distal femoral cut angle to optimize biomechanics and soft tissue balance in TKA.
🔗 https://doi.org/10.22038/ABJS.2025.80846.3689
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