Comparison of Complete Distal Release of the Medial Collateral Ligament and Medial Epicondylar Osteotomy during Ligament Balancing in Varus Knee Total Knee Arthroplasty

Sim, Jae Ang; Lee, Yong Seuk; Kwak, Ji Hoon; Yang, Sang Hoon; Kim, Kwang Hui; Lee, Beom Koo

doi:10.4055/cios.2013.5.4.287

Cited by 20 publications

(15 citation statements)

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“…5. 15 It is important to note that the major stabilizer of the epicondylar fragment after osteotomy would be the Adductor Magnus that is tight in extension. For this reason, all of the fixation methods should be done in full extension.…”

Section: Discussionmentioning

confidence: 99%

Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement

et al. 2019

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Background Total knee arthroplasty is a challenging task in patients with severe varus deformity. In most of these patients, an extensive medial release is needed that may lead to instability. Medial epicondylar osteotomy may be a better substitute for complete medial collateral release. Materials and Methods Fourteen patients with bilateral knee osteoarthritis and severe varus deformity were enrolled in this study. In one side, the patients underwent medial epicondylar osteotomy for mediolateral imbalance if the only option was superficial medial collateral ligament (MCL) release. In contralateral side, the extensive medial release was performed and MCL was released either by pie-crusting technique or by subperiosteally release. The results of the two sides were compared. Patients were followed up for 12 months after the operation. Physical examination, clinical questionnaires, and radiography findings were recorded. Union of the osteotomies fragment and complications was evaluated. Results The mean varus angle before surgery was 21.6 ± 4.7 degrees, which was corrected to 8.6 ± 2.9 degrees after operation with an extensive medial release. The mean varus angle of contralateral side was 22.6 ± 1.7 degrees, which was corrected to 7.5 ± 2.3 degrees following medial femoral epicondyle osteotomy. There was no significant difference in varus correction (p = 0.1). Medial joint line opening in valgus stress test was 2.7 ± 0.4 mm in the osteotomized side and 3.5 ± 0.9 mm in contralateral side. Mean range of motion for the osteotomized side was 97.8 ± 4.3 degrees and 100.7 ± 2.7 degrees for contralateral side (p = 0.6). Nonunion occurred in a case in the osteotomized side and no medial instability was observed in medial release or osteotomies sides. No statistical difference was recorded based on clinical questionnaires (Oxford and WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index] scores). Conclusion Medial epicondylar osteotomy is a safe technique with the well-controlled medial extensive release in the patients with severe varus deformity during total knee arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement

et al. 2019

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“…It has been recently reported, however, that this technique led to unpredictable gap increments and frequent early over-release 5 19) . Finally, medial femoral epicondylar osteotomy has been proposed as an alternative to the medial tissue release technique 2 8 9) . In spite of its efficacy and safety, the medial epicondylar osteotomy led to significant coronal and transverse plane laxity compared with the conventional subperiosteal elevation of the MCL from the tibial side in the study by Mihalko et al 21) .…”

Section: Discussionmentioning

confidence: 99%

“…Although most varus knees can be dealt with these procedures, inadvertent over-release of the medial structures, especially the superficial MCL, can occur during procedure in knees with severe varus deformity 2 4 5 6 7) . Alternatively, medial epicondylar osteotomy has been presented with satisfactory clinical outcomes in severe varus knees 2 8 9) . This technique can be advantageous over the superficial MCL release because it is based on the bone-to-bone healing and does not manipulate the broad tibial insertion of the superficial MCL which requires an extensive soft tissue healing process 2 9) .…”

Section: Introductionmentioning

confidence: 99%

A Novel Medial Soft Tissue Release Method for Varus Deformity during Total Knee Arthroplasty: Femoral Origin Release of the Medial Collateral Ligament

Lee

Yang

Lee

et al. 2016

Knee Surg Relat Res

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IntroductionNumerous methods of medial soft tissue release for severe varus deformity during total knee arthroplasty (TKA) have been reported. These include tibial stripping of the superficial medial collateral ligament (MCL), pie-crusting technique, and medial epicondylar osteotomy. However, there are inherent disadvantages in these techniques. Authors hereby present a novel quantitative method: femoral origin release of the medial collateral ligament (FORM).Surgical TechniqueFor medial tightness remaining even after the release of the deep MCL and semimembranosus, the FORM is initiated with identification of the femoral insertion area of the MCL with the knee in flexion. Starting from the most posterior part of the femoral insertion, one third of the MCL femoral insertion is released from its attachment. If necessary, further sequential medial release is performed.Materials and MethodsSeventeen knees that underwent the FORM were evaluated for radiological and clinical outcomes.ResultsRegardless of the extent of the FORM, no knees showed residual valgus instability at 24 weeks after surgery.ConclusionsAs the FORM is performed in a stepwise manner, fine adjustment during medial release might be beneficial to prevent inadvertent over-release of the medial structures of the knee.

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“…He observed good results with this pattern of release and the size of spacer used was also smaller. Sim et al has advocated the use of adjunct medial epicondylar osteotomy along with soft tissue release to achieve varus correction [14].…”

Section: Discussionmentioning

confidence: 99%

Management of Complex Knee Deformities in Asian Population: Our Experience of 11 Cases

Noor¹,

Zamir²,

Najjad³

2015

JISRF

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Osteoarthritis (OA) of the knees and non specific lower back pain are one of the most common disorders of population of Asia Pacific region. Knee OA has significant effect on the quality of life of patients, as they are not able to perform their daily activities with ease and gradually develop dependence on other family members. This leads to eventual disconnection from the social life and development of depression in patients. Incidence of knee OA is well documented in Asian countries with figures reaching up to 28% in the urban population of Pakistan. Incidence is found to be greater in patients of female gender and those with greater body mass index (BMI). Population of Pakistan has tendency to develop OA earlier than the European population mostly having isolated involvement of the knee joints only.Total Knee Arthroplasty (TKA) is a life changing procedure for such patients. Great improvements in quality of life and outcome measure scores have been observed in patients undergone TKA. Our patients are challenging further as compared to western population because they present late for consultation when the disease and deformity is advanced. Their expectations are high, as they wish to resume their ground base activities such as kneeling for prayers. Furthermore with financial constraints present with most of the patients, one has to be careful in choosing the type of implant and keep in consideration other alternative available options. This case series encompasses our experience of TKA on patients with variety of challenging deformities, their short term outcome and a review of the literature.

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Comparison of Complete Distal Release of the Medial Collateral Ligament and Medial Epicondylar Osteotomy during Ligament Balancing in Varus Knee Total Knee Arthroplasty

Cited by 20 publications

References 14 publications

Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement

Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement

A Novel Medial Soft Tissue Release Method for Varus Deformity during Total Knee Arthroplasty: Femoral Origin Release of the Medial Collateral Ligament

Management of Complex Knee Deformities in Asian Population: Our Experience of 11 Cases

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