Mid-flexion laxity could be identified with continuous flexion-arc gap assessment in patients with a large preoperative convergence angle

Sang Jun Song, Hyun Woo Lee, Dae Kyung Bae, Cheol Hee Park

Research output: Contribution to journalArticlepeer-review


Purpose: To analyze the incidence of intraoperative mid-flexion laxity using continuous flexion-arc gap assessment, risk factors for mid-flexion laxity, and clinical results in navigation-assisted total knee arthroplasty (TKA). Methods: Ninety posterior-stabilized TKAs were performed under navigation guidance for patients with degenerative arthritis and varus deformity. Intraoperatively, the gap between the trial femoral component and insert was evaluated in the navigation system with continuous flexion-arc gap assessment. Each medial and lateral gap at flexion (90°) and extension (0°) were made to be less than 3 mm. Mid-flexion laxity was determined when the gap in the flexion range between 15° and 60° was 3 mm or more. The proportion of knees with mid-flexion laxity was investigated. The factors affecting mid-flexion laxity were identified in terms of demographics, preoperative convergence angle, and change in joint line height and posterior femoral offset. The Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were evaluated. Results: There were 31 cases (34.4%) of lateral mid-flexion laxity (average peak mid-flexion gap = 3.7 mm). The other 59 cases did not show mid-flexion laxity. The preoperative convergence angle was the only significant factor affecting lateral mid-flexion laxity (odds ratio = 1.466, p = 0.002). There were no significant differences in the clinical results between the groups with and without mid-flexion laxity. Conclusions: The continuous flexion-arc gap assessment was useful in evaluating mid-flexion laxity using navigation-assisted TKA. The preoperative convergence angle, reflecting soft-tissue laxity, can be a practical and simple radiographic finding for predicting lateral mid-flexion laxity. Level of evidence: IV.

Original languageEnglish
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Publication statusAccepted/In press - 2022


  • Continuous gap
  • Knee
  • Knee replacement
  • Laxity
  • Mid-flexion
  • Navigation
  • Total knee arthroplasty


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