Medial Varus Proximal Tibial Resection is Superior to Pie-Crusting of the Medial Collateral Ligament During Primary Total Knee Arthroplasty

Correction of Coronal Deformity and Intercompartmental Imbalance through Bone Resection

“…The ability to balance knees through bone modifications is growing in utilization as it leads to more predictable results both technically and functionally. [23][24][25][26][27][28][29] Balancing a knee in the coronal plane is commonly an asymmetric approach, as addition of varus-valgus addresses the overtensioned compartment, rather than resecting symmetric bone leading to increased gap in the contralateral compartment and potentially an elevated joint line. 29 Robotic utilization is evolving and gives surgeons the confidence in modifying coronal alignment prior to and after trailing.…”

“…The tight structures can be elongated-stripped or pie-crusted to alleviate the overtension, or the bone can be adjusted to increase the gap distance. 23 In varus knees, common overtensioned scenario is through a full ROM as the MCL is a fixed isometric ligament. In approximately 10% of cases, the flexion gap is balanced, but the mid flexion to extension gap is overtensioned and Correction of Coronal Deformity and Intercompartmental Imbalance through Bone Resection Roche, Law commonly a flexion contracture is seen.…”

“…The effects of intercompartmental balance through bone modifications have been documented with navigation and objective sensor data outputs. Vakharia et al 23 reported on medial proximal varus resection led to significant reductions in compartmental pressures at 10, 45, and 90 degrees compared with soft tissue releases (►Fig. 10).…”