The meta‐ analysis showed that GB techniques result ed in statistically significant improvements in the restoration of mechanical and rotational alignment and mean Knee Society Scores and Knee Society Function scores two years post‐operatively , but result ed in greater elevation of the position of the joint line .
There is no significant difference in the other radiographic data .
Conclusion This study suggests that GB may provide better radiographic and clinical outcomes than MR when used to determine mechanical rotation in TKAs
Aims There are two techniques widely used to determine the rotational alignment of the components in total knee arthroplasty ( TKA ) ;  gap balancing ( GB ) and measured resection ( MR ) .
Which technique is the best remains controversial .
We aim ed to investigate this in a systematic review and meta‐ analysis .
Gap balancing sacrifices joint-line maintenance to improve gap symmetry: a randomized controlled trial comparing gap balancing and measured resection.
A total knee arthroplasty can be completed using two techniques ; measured resection or gap balancing . A prospect i ve blinded r and omized controlled trial was completed with 103 patients r and omized to measured resection ( n = 52 ) or gap balancing ( n = 51 ) . Primary outcome measure was femoral component rotation . Secondary outcome measures were joint-line change , gap symmetry and function and quality -of-life outcomes .  Gap balancing result ed in a significantly raised joint-line compared to measured resection .  Gap symmetry was significantly better using gap balancing .  Functional outcomes and quality -of-life were not significantly different at 24 months . Using computer navigation , gap balancing significantly raises the joint-line in order to improve gap symmetry . This does not result in a clinical difference in function or quality of life at 24 months
The meta‐ analysis showed that GB techniques result ed in statistically significant improvements in the restoration of mechanical and rotational alignment and mean Knee Society Scores and Knee Society Function scores two years post‐operatively , but result ed in greater elevation of the position of the joint line .
There is no significant difference in the other radiographic data .
Conclusion This study suggests that GB may provide better radiographic and clinical outcomes than MR when used to determine mechanical rotation in TKAs
Aims There are two techniques widely used to determine the rotational alignment of the components in total knee arthroplasty ( TKA ) ;  gap balancing ( GB ) and measured resection ( MR ) .
Which technique is the best remains controversial .
We aim ed to investigate this in a systematic review and meta‐ analysis .