Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty

Tang, Qian; Yu, Huachen; Shang, Peng; Tang, Shangkun; Xu, Huazi; Liu, Haixiao

doi:10.1186/s13018-017-0681-1

Cited by 10 publications

(11 citation statements)

References 26 publications

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“…However, this may have negative impact on long-term durability for the TKA. 2,4 With these limitations to the medial release, the medial epicondylar osteotomy seems to be a good alternative for knee balance in TKA. Our results confirmed that epicondylar osteotomy in one knee resulted in outcomes similar to those of the contralateral side with a good medial release.…”

Section: Discussionmentioning

confidence: 99%

“…Due to preoperative deformity, some ligaments around the knee are contracted that will be carefully released in a stepwise manner to balance the soft tissues around the knee and allow optimum knee kinematics. Several structures may be addressed during correction of severe varus deformity: (1) removal of osteophytes, (2) increase in the pes anserine complex release, (3) release of the tibial insertion of the deep head of the medial collateral ligament (MCL), (4) posteromedial capsule complex, (5) resection of the posterior cruciate ligament (PCL), and (6) release of the superficial MCL medially and posteriorly. [1][2][3] In varus knees, most surgeons prefer to release or elevate the soft tissues of the tibial insertion site by either sharp or blunt techniques.…”

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confidence: 99%

“…However, the intrinsic risk of this maneuver is the potential for excessive release and early or late iatrogenic instability. 4,5 In moderate-to-severe varus knees, pie crusting of the MCL midsubstance can be a solution. 6 Although most varus knees can be treated with these procedures, inadvertent over-release of the medial structures, especially the superficial MCL, can occur during the procedure in knees suffering from severe varus deformity.…”

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confidence: 99%

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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%

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confidence: 99%

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confidence: 99%

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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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“…As described by Tang et al [8], we fully flexed the knee to subluxate the joint forward and outward using a Hoffman hook. The tibial plateau and posteromedial corner structures were completely exposed, and subperiosteal release was performed as that in experimental group.…”

Section: Step 2 In Control Group (Conventional Full Flexion)mentioning

confidence: 99%

Posteromedial Corner Release with the Knee in Figure-of-Four Position vs Conventional Position for Varus Knee Arthroplasty

Zheng

et al. 2020

Preprint

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Backgroud: The objective of this study is to introduce posteromedial corner release with the knee in the figure-of-four position versus the conventional position for varus knee arthroplasty. Methods : From March 2015 to September 2019, 123 patients (139 knees) with varus knee were randomly and blindly allocated to experimental group (60 patients; 68 knees) and control group (57 patients; 65 knees). Patients in experimental group underwent posteromedial corner release with the knee in the figure-of-four position; and patients in control group with the knee in the conventional position. Time for soft tissue balancing was defined as the time from the start of spacer test to the end of balance test. Length of release was defined as the distance from the osteotomy surface of the tibial plateau to the farthest structures released. The rating system of Hospital for Special Surgery (HSS) knee score was used to evaluate the clinical results. Differences were considered statistically significant at p < 0.05. Results: The mean time for soft tissue balancing was 8.4±3.3 minutes and 8.4±3.3 minutes in experimental and control group, respectively ( p <0.05). The mean length of releasing posteromedial corner structures was 35.5±13.4 mm and 27.3±9.7 mm in experimental and control group, respectively ( p <0.05). HSS scores 5 years after surgery were 95.1±16.9 and 94.8±17.2 respectively ( p >0.05). Conclusion: During varus knee arthroplasty, the posteromedial corner can be released more extensively and thoroughly when the knee is placed in the figure-of-four position.

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“…However, a cadaver study 15 considered the success of the MCL pie-crusting technique is likely technique dependent since failure occurs within the ligament itself. A new-published article 16 also found that the pie-crusting technique has a higher rate of failure in the ML gap balance compared with reduction osteotomy.…”

Section: Introductionmentioning

confidence: 98%

Posteromedial Corner Release with the Knee in Figure‐of‐Four Position vs Conventional Position for Varus Knee Arthroplasty

Zheng

et al. 2021

Orthopaedic Surgery

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Objective: To introduce posteromedial corner release with the knee in the figure-of-four position versus the conventional position for varus knee arthroplasty.Methods: This is a retrospective study. From March 2015 to September 2019, a series of 123 patients (139 knees) with varus knee were randomly and blindly allocated to experimental group (60 patients; 68 knees) and control group (57 patients; 65 knees). Patients in experimental group underwent posteromedial corner release with the knee in the figure-of-four position; and patients in control group with the knee in the conventional position. If soft tissue balance was not completely achieved or the medial gap was still tight, an additional loosening technique were used to achieve symmetric medial and lateral space in both groups. Time for soft tissue balancing was defined as the time from the start of the spacer test to the end of the balance test. Length of release was defined as the distance from the osteotomy surface of the tibial plateau to the farthest structures released. The rating system of Hospital for Special Surgery (HSS) knee score was used to evaluate the clinical results. Quantitative variables were described as mean and standard deviation, and compared by one-way analysis of variance. Results:The mean age of experimental group and control group was 70.2 AE 8.7 years and 68.7 AE 6.2 years, respectively (P > 0.05). Preoperatively, the mean HSS score of the groups was 38.2 AE 11.3 and 39.1 AE 10.7, respectively (P > 0.05). The mean varus knee angle was 19.7 AE 9.3 and 19.3 AE 10.7 , respectively (P > 0.05). The mean time for soft tissue balancing was 8.4 AE 3.3 min and 11.3 AE 6.9 min in experimental and control group, respectively (P < 0.05). The mean length of releasing posteromedial corner structures was 35.5 AE 13.4 mm and 27.3 AE 9.7 mm in experimental and control group, respectively (P < 0.05). Additional special loosening techniques were performed in eight knees in experimental group and seven knees in control group. The HSS scores 5 years after surgery were 95.1 AE 16.9 and 94.8 AE 17.2 respectively (P > 0.05). No complications were found during the follow-up time, and the clinical symptoms were observed to be significantly improved in the patients. Conclusion:The posteromedial corner can be released more extensively and thoroughly when the knee is placed in the figure-of-four position during varus knee arthroplasty.

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Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty

Cited by 10 publications

References 26 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

Posteromedial Corner Release with the Knee in Figure-of-Four Position vs Conventional Position for Varus Knee Arthroplasty

Posteromedial Corner Release with the Knee in Figure‐of‐Four Position vs Conventional Position for Varus Knee Arthroplasty

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