Varus-valgus stress radiograph as a predictor for extensive medial release in total knee arthroplasty

Ahn, Ji Hyun; Lee, Sung Hyun; Yang, Tae Yeong

doi:10.1007/s00264-015-3018-x

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…However, when aHKA is higher or lower than the vcHKA, this suggests medial collateral ligament has changed length either through attenuation or ibrosis. These indings are supported by Lee et al [20] who recently demonstrated that valgus stress x-rays can predict the need for soft tissue release in varus deformity during TKA [1,34]. In these scenarios a functional that accounts for the change in laxity would be required to obtain a well-balanced knee.…”

Section: Discussionmentioning

confidence: 70%

Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs

Sappey‐Marinier

Meynard

Shatrov

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The alignment goal in total knee arthroplasty (TKA) remains debated. Two major strategies have emerged based on recreating the native knee: kinematic and functional alignment (KA and FA). Recently a new Coronal Plane Alignment of the Knee (CPAK) classiication for KA, based on bony landmarks, was described considering joint line obliquity and the arithmetic HipKneeAnkle angle (aHKA). Valgus corrected HKA medial angle (vcHKA) was measured on distractive valgus preoperative radiographs compensating for cartilage wear and ligament balance in varus osteoarthritis. The purpose of this study was to determine if aHKA accounts for diferences in medial laxity for the extension gap by comparing vcHKA to aHKA. The hypothesis was that no signiicant diference would be observed between the two measurements. Methods This is a retrospective analysis of 749 knees in consecutive patients presenting to a single-centre with primary medial osteoarthritis. Patients underwent standardized weight bearing long-leg and valgus stress radiographs. Tibial mechanical angle (TMA), femoral mechanical angle (FMA) and vcHKA were measured using digital software. aHKA and vcHKA were compared to determine diferences due to soft tissue balancing. ResultsThe mean FMA was 91.3 ± 2.2° (range 82°-97°), the mean TMA was 85.7 ± 2.5° (range 75°-98°), the mean aHKA was 177.0 ± 3.0° (range 164°-185°) and the mean vcHKA was 176.6 ± 3.1° (range 165°-192°). No signiicant diference was observed between aHKA and vcHKA (p = 0.06). A signiicant correlation was found between vcHKA and TMA (ρ = 0.3; p < 0.001) and between vcHKA and FMA (ρ = 0.41; p < 0.001). Conclusion This study showed that vcHKA was similar to aHKA conirming that aHKA accounts for ligamentous medial laxity. Therefore, kinematic alignment based on the CPAK classiication matches the pre-arthritic coronal alignment of the knee for the extension gap. Level of evidence IV.

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Section: Discussionmentioning

confidence: 70%

Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs

Sappey‐Marinier

Meynard

Shatrov

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…8 While, Ahn et al and Lee et al demonstrated that the significant predictive risk factor of the extensive soft tissue release is the preoperative sum of the mechanical varus and valgus stress angles and preoperative varus-valgus stress angles difference, respectively. 28,33 Also, preoperative distractive stress radiographs were suggested to be a more important risk factor in predicting the extent of soft tissue release in other studies. 26,34 Using additional preoperative stress or distraction radiographs may be effective in predicting the extent of soft tissue release, but it also incurs additional costs and the patient receives more radiation.…”

Section: Discussionmentioning

confidence: 95%

“…6,21,24,25 The preoperative risk factors of the extent of medial release in varus knee during TKA have been evaluated in a few studies, but most of them have focused on the stress or distractive angles and radiographs. 8,26,28,33,34 Moon et al showed that the extent of MCL release had the most significant correlation with the preoperative valgus stress angle. 8 While, Ahn et al and Lee et al demonstrated that the significant predictive risk factor of the extensive soft tissue release is the preoperative sum of the mechanical varus and valgus stress angles and preoperative varus-valgus stress angles difference, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25][26][27] The progressive and gradual MCLs release is a widely used procedure to correct the varus knee, but several authors described the release sequences with some differences. 1,8,10,16,21,28,29 Therefore, precise preoperative assessments that predict the extension of medial collateral release are essential. In our present study, we measured different angles on preoperative standing coronal hip-knee-ankle alignment radiographs to evaluate the estimating value of each angle on the extent of medial soft tissue release.…”

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confidence: 99%

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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?

et al. 2021

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The aim of this study was to assess the predictive value of the femoral intermechanical-anatomical angle (IMA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), femorotibial or varus angle (VA), and joint line convergence angle (CA) in predicting the stage of the medial collateral ligament (MCL) during total knee arthroplasty (TKA) of varus knee. We evaluated 229 patients with osteoarthritic varus knee who underwent primary TKA, prospectively. They were categorized in three groups based on the extent of medial soft tissue release that performed during TKA Group 1, osteophytes removal and release of the deep MCL and posteromedial capsule (stage 1); Group 2, the release of the semimembranosus (stage 2); and Group 3, release of the superficial MCL (stage 3) and/or the pes anserinus (stage 4). We evaluated the preoperative standing coronal hip-knee-ankle alignment view to assessing the possible correlations between the knee angles and extent of soft tissue release. A significant difference was observed between the three groups in terms of preoperative VA, CA, and MPTA by using the Kruskal–Wallis test. The extent of medial release increased with increasing VA and CA as well as decreasing MPTA in preoperative long-leg standing radiographs. Finally, a patient with a preoperative VA larger than 19, CA larger than 6, or MPTA smaller than 81 would need a stage 3 or 4 of MCL release. The overall results showed that the VA and MPTA could be useful in predicting the extent of medial soft tissue release during TKA of varus knee.

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“…Preoperative full-length lower limb radiographs under valgus stress [1,13,17,30] are useful for determining the type of surgery and predicting prognosis for medial knee osteoarthritis (OA) [2,15,19,25,33]. Especially for unicompartmental knee arthroplasty (UKA), they are important for preoperative planning [7,30] because overcorrection might cause lateral tibiofemoral (TF) compartment OA [12,26] and undercorrection might increase the risk of early subsidence of the tibial component after surgery [12,29].…”

Section: Introductionmentioning

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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Varus-valgus stress radiograph as a predictor for extensive medial release in total knee arthroplasty

Abstract: Level III, retrospective comparative study.

Cited by 5 publications

References 26 publications

Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs

Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs

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

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

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