Medial epicondyle osteotomy: a method of choice in severe varus knee arthroplasty

Lack of evidence to support present medial release methods in total knee arthroplasty

“…All studies shown in Table 2 were clinical and involved between 30 [42] and 359 knees [61]. Ten studies assessed balance according to post‐operative alignment [8, 20, 27, 33, 43, 45, 46, 49, 51, 61]. In five of these studies, the overall effect of releases was reported which did not allow for the effect of individual release stages to be determined.…”

“…An average KSS of 93 was achieved, with no reported instability. This technique has also been suggested to be suitable for use in more severe varus knees (15°–40° varus) [21, 49]. However, although Engh and Ammeen [20] reported that bone union only occurred in 54 % of the knees, no associations were seen with symptoms such as focal tenderness or restricted motion [20].…”

“…However, although Engh and Ammeen [20] reported that bone union only occurred in 54 % of the knees, no associations were seen with symptoms such as focal tenderness or restricted motion [20]. Orban et al [49] did not consider bone union to be necessary, given the lack of statistically different outcomes between patients with presence or lack of bone union. The natural MCL femoral attachment is isometric in the normal knee in order to maintain MCL tension across the range of knee motion.…”

“…Most medial release sequences involve MCL release from the tibial attachment [10, 12, 23, 51]. A few studies did, however, employ other techniques, including osteotomy of the femoral or tibial attachments of the MCL [2, 20, 21, 49] and ‘pie‐crusting [33, 61] or needle‐puncturing [9] the MCL.…”

“…This aspect of TKA surgery is developing rapidly and will affect decisions about soft tissue releases and knee realignment. An overriding principle could be that the extent of medial soft tissue release, except in the most severe cases of >15° varus [46, 49], should be as conservative as possible.…”