Open Access
Review

Table 1

Surgical parameters for each kind of alignment.

Mechanical alignment Kinematic alignment Inverse kinematic alignment Restricted alignment Functional alignment
Femoral component Flexion Follows distal femoral bowing Follows distal femoral bowing Follows distal femoral bowing Follows distal femoral bowing Follows distal femoral bowing
Target: 0 to 5° of flexion Target: 2 ± 3° Target: 2 ± 3° Target: 2 ± 3° Target: 0 to 5° of flexion
Distal cut Systematic and perpendicular to the femoral mechanical axis Parallel to the distal femoral joint line (considering wear) Parallel to the distal femoral joint line (considering wear) Correct to < 5°, then Parallel to the distal femoral joint line (considering wear) Parallel to the distal femoral joint line (considering wear)
Target: 0° Target: < 5° Target: 0 to 5°
Posterior cut External or neutral rotation relative to posterior condylar line. Parallel to the posterior condylar line Parallel to the posterior condylar line Parallel to the posterior condylar line Surgical trans epicondylar axis; ± 3°
Measured resection or gap-balancing techniques.
Posterior or anterior referencing techniques
Mediolateral Slightly lateralized Centered on the notch Centered on the notch Centered on the notch Centered on the distal femur
Tibial component Coronal cut Systematic and perpendicular to the tibial mechanical axis Parallel to proximal tibial joint line (considering wear) Parallel to proximal tibial joint line (considering wear) within safe zone of 84° to 92° Correct to < 5°, then Parallel to proximal tibial joint line (considering wear) Perpendicular to the tibial mechanical axis
Target: 0° Target: −6° to 9° Target: −6° to 2° Target: < 5° Target: 0 ± 3°
Slope Systematic. Between 2° and 7° relative to sagittal tibial mechanical axis Parallel to the medial plateau slope Parallel to the medial plateau slope Parallel to the medial plateau slope Parallel to the medial plateau slope; Target: 0° to 3°
Rotation Towards the medial third of the tibial tuberosity Parallel to lateral plateau long-axis Parallel to lateral plateau long-axis Parallel to lateral plateau long-axis 0 to 5° of external rotation to Akagi’s line
Knee balancing Soft tissues Tibial cut Femoral cut (distal and/or posterior) Tibial cut + Soft tissues Femoral and tibial positioning + Soft tissues
Soft tissue Release Femorotibial joint Frequent None None Sometimes Sometimes
Lateral retinaculum Sometimes Rarely Rarely Rarely Rarely
Technologies All All Robotic-assisted All Robotic-assisted

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