Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

Sajjadi, Mohammadreza Minator; Okhovatpour, Mohammad Ali; Safaei, Yaser; Faramarzi, Behrooz; Zandi, Reza

doi:10.1055/s-0040-1721787

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…The multiple regression analyses in the present study showed that smaller MPTA is accompanied by smaller %MA with valgus stress and amount of %MA change. Sajjadi et al reported that there was a relationship between the extent of medial soft tissue release and small MPTA for medial‐lateral ligament balancing during TKA [24]. In addition, Shetty et al showed that small MPTA in healthy knees is associated with constitutional varus alignment [28].…”

Section: Discussionmentioning

confidence: 99%

Small medial proximal tibial angle is a radiographic finding strongly associated with less coronal alignment correction under valgus stress in medial knee osteoarthritis

Ichiyanagi,

Kuriyama,

Sakai

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe degree to which varus knees can be corrected manually is important when considering total versus unicompartmental knee arthroplasty (UKA). The primary aim was to clarify the relationship between the degree of coronal alignment correction and radiographic parameters involved in UKA prognosis using preoperative full‐length lower extremity valgus stress radiography. The secondary aim was to identify the factors affecting alignment correction.MethodsThis retrospective observational study included 115 knees with medial osteoarthritis that underwent knee osteotomy or arthroplasty. Percent mechanical axis without valgus stress (%MA: neutral, 50%; varus, <50% and valgus, >50%), mechanical lateral distal femoral angle, lateral bowing femoral angle, medial proximal tibial angle (MPTA), joint line convergence angle, medial and lateral joint space width (LJSW) and medial femoral and tibial joint osteophyte size were measured using preoperative full‐length weight‐bearing radiographs. Correlation and multiple linear regression analyses were used to assess associations between parameters and %MA with valgus stress or amount of %MA change (%MA with valgus stress minus %MA without valgus stress).Results%MA with valgus stress was correlated with all radiographic parameters. %MA change was correlated with parameters except for MPTA and LJSW. Multiple regression analyses showed that %MA without valgus stress and MPTA were associated with both %MA with valgus stress and %MA change. When %MA with valgus stress was set at 30%, 40% and 50%, MPTA cutoff values were 81.6°, 83.5° and 84.9°, and cutoffs for %MA without valgus stress were 10.7%, 17.1% and 25.1%, respectively.ConclusionSmall MPTA is strongly associated with less alignment correction under valgus stress in varus knees. The finding is useful in surgical planning, especially to avoid undercorrection with UKA when valgus stress radiographs are unavailable.Level of EvidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Small medial proximal tibial angle is a radiographic finding strongly associated with less coronal alignment correction under valgus stress in medial knee osteoarthritis

Ichiyanagi,

Kuriyama,

Sakai

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…Failure to achieve soft tissue balance may lead to complications such as restricted range of motion (ROM), pain, and instability, possibly necessitating revision surgery [11][12][13]. Researchers have proposed various methods to achieve soft tissue balance, but the most accurate method has not yet been established [14][15][16][17][18]. The selection of an appropriate polyethylene (PE) insert thickness is one such approach based on the assessment of soft tissue tension and joint stability during TKA [19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Can a Total Knee System Providing 1 mm Increment of Polyethylene Insert Thickness Offer a Clinical Benefit?

Lee,

Jang,

Kim

et al. 2024

Medicina

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Background and Objectives: The purpose of this study was to compare clinical outcomes and polyethylene (PE) insert thickness between total knee arthroplasty (TKA) systems providing 1 mm and 2 mm increments. Materials and Methods: In this randomized controlled trial, 50 patients (100 knees) undergoing same-day or staggered bilateral TKA were randomized to receive a TKA system providing 1 mm increments in one knee (1 mm group) and a TKA system providing 2 mm increments in the other knee (2 mm group). At 2 years postoperatively, Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Forgotten Joint Score (FJS), range of motion (ROM), and insert thicknesses were compared between the groups. Results: A total of 47 patients (94 knees) participated in follow-up analysis. In each group, patient-reported outcomes improved significantly after TKA (all, p < 0.05). There were no significant differences in patient-reported outcomes. The mean ROM was not significantly different between groups at preoperative and 2-year points. The rate of postoperative flexion contracture ≥ 5° was 2.1% and 4.3%, and the rate of postoperative recurvatum ≥ 5° was 4.3% and 2.1% in the 1 mm group and 2 mm, respectively (all, p = 1.000). Mean insert thickness was significantly thinner in the 1 mm group than the 2 mm group (p = 0.001). The usage rate of a thick insert (≥14 mm) was 12.7% and 38.3% in the 1 mm group and 2 mm group (p = 0.005). Conclusions: The use of a TKA system providing 1 mm PE insert thickness increments offered no clinical benefit in terms of patient reported outcomes over systems with 2 mm increments at 2 years of follow-up. However, the TKA system with 1 mm increments showed significantly thinner PE insert usage. As a theoretical advantage of 1 mm increments has yet to be proven, the mid- to long-term effects of thinner PE insert usage must be determined.

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Predictive factors for deep medial collateral ligament release in adjusted mechanical alignment total knee arthroplasty

Thongpulsawasdi,

Achawakulthep,

Intiyanaravut

et al. 2024

J Orthop Surg Res

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Background Total knee arthroplasty (TKA) demands precision in achieving optimal alignment and soft tissue balance, especially in cases of medial compartment osteoarthritis where the need for medial soft tissue release is critical yet challenging to ascertain. Objective This study aims to systematically investigate the relationship between preoperative data, initial knee conditions and the necessity for deep collateral ligament (MCL) release in adjusted mechanical alignment total knee arthroplasty. Methods We conducted a retrospective study involving 61 TKA patients who underwent adjusted mechanical alignment robotic-assisted procedures. Soft tissue release was carried out when clinically indicated. We collected and statistically analyzed patient demographics, initial knee conditions, and surgical details. Results Among the patients, 52% required deep MCL release. Notably, patients without soft tissue release exhibited lower initial hip-knee-ankle (HKA) angles, reduced varus-valgus stress test angles, and a greater range of flexion. We identified a predictive threshold HKA angle of 6.250 degrees, demonstrating high sensitivity and specificity for determining the need for deep MCL release. Conclusion This study underscores the significance of the initial HKA angle and varus-valgus stress tests in predicting deep MCL release during TKA. The established HKA angle threshold simplifies surgical decision-making, reducing the likelihood of unnecessary soft tissue release.

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Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

Cited by 4 publications

References 34 publications

Small medial proximal tibial angle is a radiographic finding strongly associated with less coronal alignment correction under valgus stress in medial knee osteoarthritis

Small medial proximal tibial angle is a radiographic finding strongly associated with less coronal alignment correction under valgus stress in medial knee osteoarthritis

Can a Total Knee System Providing 1 mm Increment of Polyethylene Insert Thickness Offer a Clinical Benefit?

Predictive factors for deep medial collateral ligament release in adjusted mechanical alignment total knee arthroplasty

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