Ligament Balancing in Total Knee Arthroplasty

1. Introduction.- 2. Patella.- 3. Posterior Cruciate Ligament.- 3.1. Tight Posterior Cruciate Ligament.- 3.2. Release of the Posterior Cruciate Ligament.- 4. Varus Knee.- 4.1. Tight Medially in Flexion, Loose in Extension.- 4.2. Tight Medially in Extension, Balanced in Flexion.- 4.3. Tight Medially in Flexion and Extension.- 4.4. Tight Popliteus Tendon.- 4.5. Compensatory Lateral Release - Extension Only.- 4.6. Compensatory Lateral Release - Flexion and Extension.- 4.7. Pitfalls of the Varus Knee.- 5. Valgus Knee.- 5.1. Tight Laterally Flexion and Extension.- 5.2. Tight Laterally in Extension, Normal Stability in Flexion.- 5.3. Tight Laterally in Flexion, Normal Stability in Extension.- 5.4. Deficient Posterior Cruciate Ligament.- 5.5. Pitfalls of the Valgus Knee.- 5.5.1. Release of Extension-only Stabilizers - Tight in Flexion and Extension.- 5.5.2. Release of Extension-only Structures - Tight in Flexion and Extension.- 5.5.3. Retaining Lateral Collateral Ligament - Cutting Flexion Space Guided by Tensioners.- 5.5.4. Using the Deficient Lateral Condyle as Reference for Bone Resection.- 6. Flexion Contracture and Femoral Sizing.- 6.1. Varus Knee with Flexion Contracture.- 6.2. Pitfalls with Flexion Contracture.- 7. Recurvatum.- 8. Summary.