Not all knees are the same

Bone Joint J. 2024 Jun 1;106-B(6):525-531. doi: 10.1302/0301-620X.106B6.BJJ-2023-1292.R1.


The aim of mechanical alignment in total knee arthroplasty is to align all knees into a fixed neutral position, even though not all knees are the same. As a result, mechanical alignment often alters a patient's constitutional alignment and joint line obliquity, resulting in soft-tissue imbalance. This annotation provides an overview of how the Coronal Plane Alignment of the Knee (CPAK) classification can be used to predict imbalance with mechanical alignment, and then offers practical guidance for bone balancing, minimizing the need for soft-tissue releases.

Publication types

  • Review

MeSH terms

  • Arthroplasty, Replacement, Knee* / methods
  • Biomechanical Phenomena
  • Bone Malalignment / diagnostic imaging
  • Humans
  • Knee Joint* / diagnostic imaging
  • Knee Joint* / surgery