Soft Tissue Releases in Total Knee Arthroplasty for Valgus Deformities

Xie, Ke; Lyons, Steven T.

doi:10.1016/j.arth.2017.01.024

Cited by 17 publications

(25 citation statements)

References 22 publications

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“…In our series, additional soft-tissue release after the standard exposure was required in 11 out of the 46 patients (24%). This is much less compared to the study done by Xie [6] which reports additional soft-tissue releases in 85% patients in his study of 181 patients. All patients in his study were operated by the medial parapatellar approach.…”

Section: Discussionmentioning

confidence: 61%

“…A further advantage of the lateral approach is the avoidance of a medial retinacular release. As a lateral retinacular release is sometimes necessary in cases of valgus deformity operated by medial parapatellar approach as observed in Xie et al [6], the performance of both medial and lateral patellar releases is not desirable due to concern of patellar devascularisation.…”

Section: Discussionmentioning

confidence: 99%

“…Medial parapatellar approach is the most commonly used approach for TKA and has been described traditionally for TKA in valgus knee arthritis. However, this involves multiple lateral soft tissue releases [6]. In an effort to improve patella maltracking and preserve medial blood supply, Keblish in 1991 [3] recommended a lateral capsular approach with an elevation of the tibial tubercle for valgus knee arthroplasty, which was later refined by Buechel [7].…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Soft-Tissue Releases, Clinical and Radiological Outcomes of Lateral Parapatellar Approach for Valgus Arthritic Knees: A 4-year Follow-up Study with A Review of Literature

Dalal

Chandratreya

Singhal

et al. 2020

IJOO

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Purpose To analyse the incidence of additional soft tissue releases with the lateral parapatellar approach, and the clinical and radiological outcomes of total knee arthroplasties performed using the lateral parapatellar approach for valgus arthritic knees. A review of the existing literature on valgus arthritic knees undergoing knee replacement was performed and our results compared. Materials and Methods This is a prospective cohort study of 50 patients operated by this approach. Operation and clinical records were assessed to determine the number and sequence of soft tissue releases. Functional outcome was measured using the Oxford Knee Score. Radiological assessment included measurement of alignment and implant positioning. Results 46 patients included. Mean follow-up of 4 years. Additional lateral releases were performed in 11 (24%) cases. Mean valgus alignment corrected from 13.1 degrees pre-operatively to 5.7 degrees post-operatively. Oxford Knee Score improved from a mean pre-operative score of 11.9 to a mean post-operative score of 38.3 at final follow-up. Radiographs revealed lateralisation of the tibial component in 4 patients. No immediate or late post-operative wound complications, late instabilities or revisions were observed. Conclusion Lateral parapatellar approach is highly effective in correcting the valgus deformity with a low incidence of additional soft tissue releases. Medium-term results indicate an excellent functional outcome with no complications.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence of Soft-Tissue Releases, Clinical and Radiological Outcomes of Lateral Parapatellar Approach for Valgus Arthritic Knees: A 4-year Follow-up Study with A Review of Literature

Dalal

Chandratreya

Singhal

et al. 2020

IJOO

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“…Restrictive prosthesis or semi-restrictive prosthesis, combined with complete release of lateral soft tissue, is commonly used. Xie and Lyons 5 followed up 214 patients with valgus knees for TKAs, and found that 38% of them needed three releases and 14% needed four or more releases. It is generally believed that the more loosening of lateral structures, the more restrictive prostheses are needed.…”

Section: Discussionmentioning

confidence: 99%

“…4 When restrictive prostheses are used in TKA, only the lateral structures need to be released and there is no need to consider the laxity of the medial ligament. [5][6][7] However, when nonrestrictive prostheses are used, after releasing the lateral structures, the MCL needs to be advanced. Several techniques are used to tighten the MCL, 3,[8][9][10][11][12] such as cutting the MCL at midsubstance and imbrication, moving the tibial attachment of the MCL to the distal tibia, and removing the femoral attachment of the MCL to the proximal femur.…”

Section: Introductionmentioning

confidence: 99%

Tightening medial collateral ligament during total knee arthroplasty for patients with fixed valgus deformity: A novel technique

Cheng

Wang

Zhang

et al. 2019

J Orthop Surg (Hong Kong)

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Background: This study aimed to explore a new surgical technique for gap balance by tightening the medial collateral ligament (MCL) in total knee arthroplasty (TKA) in patients with fixed valgus deformity. Materials and Methods: A prospective analysis was performed on 15 patients (16 knees) with a fixed valgus deformity that was corrected by tightening the MCL during TKA. A single surgeon performed all the 16 TKAs using nonconstrained posterior substituting implant, with two knees treated with long-stem tibial prosthesis. Clinical scores, knee stability, and radiographic evaluations were recorded preoperatively and postoperatively. Results: Complete weight-bearing could be carried out under the protection of the brace postoperatively. At the third month after surgery, X-rays showed the brace was not worn. The mean follow-up was 26.6 months (range 12-42 months). The average preoperative mechanical axis was 15.4 + 2.3 (range 11-25), and postoperatively it was 0.6 + 0.1 (range 0-2). No complication relative to the technique occurred. Conclusion: This new surgical technique has demonstrated excellent early clinical results and can be a good supplement for fixed valgus knee arthroplasty. Level of Evidence: III.

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Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps

Eller

Scior

Graichen

2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study was to investigate the dynamic gap widths of valgus knees in extension and flexion to evaluate the influence of deformity on gap differences and to find out whether different ligamentous subtypes in valgus knees exist. MethodsDynamic gap widths of 1000 consecutive total knee arthroplasty (TKA) patients were measured at different flexion angles by applying a computer‐assisted surgery (CAS) technique. 198 knees showed a valgus deformity and were assessed regarding its degree of fulfillment of the following criteria of valgus knee: 1. Medial extension gap greater than lateral; 2. Medial flexion gap greater than lateral; 3. Flexion gap greater than extension gap. A single‐factor ANOVA subgroup analysis was performed, based on the amount of deformity. The effect of other patient factors (age, gender, weight) on gap differences was investigated. ResultsThe medial extension gap (3.7 ± 2.2 mm) was significantly (p < 0.01) larger than the lateral extension gap (1.1 ± 2.9 mm). The amount of deformity correlated highly with gap difference in extension (r2 = 0.67) but not in flexion. In 92.4% (183), the flexion gap (6.2 ± 3.1 mm) was significantly (p < 0.01) larger than the extension gap (2.4 ± 2.3 mm). Only 29.3% (58) of patients met all three criteria, this was mainly due to the fact that in flexion the medial gap was larger than the lateral in only 35.4% (70). Patient factors showed no significant influences (NS) on the gap widths. ConclusionValgus knees show large variability in terms of gap widths. The extent of deformity correlates highly with gap difference in extension, but not in other flexion angles. Vast majority of valgus knees were valgus in extension only. Because of this variability, it should be aimed for an individualized balancing technique based on intraoperative gap sizes. Level of EvidenceLevel III.

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Soft Tissue Releases in Total Knee Arthroplasty for Valgus Deformities

Cited by 17 publications

References 22 publications

Incidence of Soft-Tissue Releases, Clinical and Radiological Outcomes of Lateral Parapatellar Approach for Valgus Arthritic Knees: A 4-year Follow-up Study with A Review of Literature

Incidence of Soft-Tissue Releases, Clinical and Radiological Outcomes of Lateral Parapatellar Approach for Valgus Arthritic Knees: A 4-year Follow-up Study with A Review of Literature

Tightening medial collateral ligament during total knee arthroplasty for patients with fixed valgus deformity: A novel technique

Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps

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