Total knee replacement (TKR) stands as the definitive, end-stage solution for severe osteoarthritis. Yet, despite massive advances in highly cross-linked polyethylene, robotic-arm assistance, and dynamic navigation arrays, up to 14% of patients remain clinically dissatisfied with their reconstructed joint. The primary driver of early and late mechanical failure isn’t always the hardware; it’s the soft tissue. Chronic stiffness and giving-way instability, which consistently lead to catastrophic aseptic revision surgeries, are directly tethered to ligamentous imbalance and unmanaged gap mismatch.
Currently, establishing symmetrical tension between the medial and lateral collateral ligaments relies almost entirely on the subjective, tactile “feel” of the operating surgeon. While computerized tensioning blocks provide snapshots of gap pressures on the operating table, the orthopedic community severely lacks longitudinal, in vivo data to prove that brief intraoperative balance actually translates to stable, pain-free kinematics when the patient walks, climbs stairs, or pivots in the real world.
