Which specific surgical philosophy and technique in total knee arthroplasty (TKA) relies entirely on releasing soft tissues first to create perfectly equal, rectangular flexion and extension gaps prior to determining the definitive femoral bone cuts?

Explanation:
The correct option is d. The gap balancing technique prioritizes soft-tissue tension over bony landmarks. The surgeon first resects the proximal tibia and then aggressively releases contracted soft tissues (MCL, LCL, posterior capsule) to create a perfectly symmetrical, rectangular gap in full extension. The knee is then brought into 90 degrees of flexion, and a tensioner is applied to create a rectangular flexion gap that precisely equals the extension gap. The size, external rotation, and AP placement of the femoral component are then strictly dictated by these balanced gaps, rather than relying on anatomical landmarks like the transepicondylar axis. Reference: Dennis DA et al. Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res.