09 June 2026
The Soft-Tissue Priority: A Conversation on Precision and Reproducibility
Soft Tissue Balancing in Total Knee Arthroplasty is often viewed as a final adjustment, but for many experts, it is the very foundation of the procedure. As part of Enovis’ campaign “Soft Tissue Balancing - the sense of stability,” we spoke with a surgeon who views the knee not just as a structure of bone, but as a complex dynamic envelope.
When asked to define Soft Tissue Balancing, the perspective is clear: it is the systematic operative approach required to achieve the proper soft-tissue envelope for a well-functioning prosthesis. “I believe that total knee arthroplasty is mostly a soft-tissue operation,” Dr. L. Necas, Slovakia, explains. This philosophy shifts the focus of the surgery from simple bony alignment to the management of the ligaments and capsular structures that will ultimately drive the patient's mobility.
Achieving this balance requires a disciplined technical approach. In this practice, the dependent operative technique is utilized, supported by the use of a mechanical balancer. By using a physical reference to assess tension, the surgeon ensures that the soft-tissue envelope is perfectly tuned to the mechanical components.
The impact of this method is felt directly in the surgical outcome. “In my hands, it makes a significant difference in the Range of Motion (ROM) and the overall stability of the prosthesis,” the surgeon notes. "Total knee arthroplasty is mostly a soft-tissue operation."
While many surgical techniques offer benefits, the most critical advantage of a structured Soft Tissue Balancing approach is its reproducibility. In a field where consistency is the key to patient satisfaction, having a reliable, repeatable method for tensioning the knee is invaluable.
By prioritizing the soft-tissue envelope through a mechanical, dependent technique, surgeons can achieve predictable stability across their entire patient base.
Regarding the future of the field, Dr. L. Necas, Slovakia remains sceptical of the current trend toward robotics but sees a bright future for other digital assistants.
“I do not believe in robotics for this application, but Augmented Reality (AR) and Virtual Reality (VR) could significantly improve the control of pre-operative planning during the surgery.” The expectation is that these technologies will not replace the surgeon’s hands, but rather enhance their "vision", providing better real-time data to ensure the surgical plan is executed with absolute precision.
This interview reinforces a core pillar of our campaign: that stability is not just a goal, but a sense, one best achieved when the soft tissue is treated as the primary focus of the procedure.
