Soft Tissue Release for Varus Knees during Posterior Stabilized Total Knee Arthroplasty: A New Algorithm
Journal Title: Journal of Orthopaedic Science and Research - Year 2022, Vol 3, Issue 1
Abstract
Introduction: Total Knee Replacement (TKA) surgeries are frequently performed surgeries used to treat knee osteoarthritis. Several methods of medial soft tissue balancing in the varus knee during total knee replacement surgeries have been reported. Traditionally, they included releasing the superficial Medial Collateral Ligament (sMCL) in severe varus cases by several methods. However, this release can create instability in the knee. The aim of this study was to create an algorithm for soft tissue release in varus osteoarthritic knees and to evaluate its efficacy in achieving intraoperative gap balancing without releasing the superficial MCL. Materials and Methods: One hundred and five varus osteoarthritic knees who received primary posterior stabilized total knee arthroplasties between October 2015 and January 2016 were included in this study. Varus deformities ranged between 10 to 40 degrees. Sequential balancing was done into 5 steps: step 1 – releasing of deep MCL, step 2 – excision of osteophytes, step 3 – excision of scarred tissue in the posteromedial corner, step 4 – excision of the posteromedial capsule and step 5 – release of semimembranosus. The V-STAT® Variable Soft Tissue Alignment Tensor was used to ensure a balanced medial and lateral gap following each step. Once the gaps were balanced, no further soft tissue release were carried out. Results: All knees were balanced without releasing the superficial MCL ligament. The maximum release step necessary was: step 1 (0 cases), step 2 (31 cases), step 3 (35 cases), step 4 (25 cases) and step 5 (14 cases). Conclusion: Superficial medial collateral ligament should not be released during intraoperative varus knees soft tissue balancing in posterior stabilized total knee arthroplasties. Preserving the superficial MCL is beneficial in maintaining implant stability without any increase in the constraint level of the implant even in cases with severe deformity.
Authors and Affiliations
Mohamed Elkabbani1, 2*, Kamel Youssef1, Mohamed Ragab2, Omar Ibrahim2, Amr Osman2, Apostu Dragos3, Samih Tarabichi2
Assessment of the Piso-Triquetral Kinematics-A Pilot Study Using Dynamic CT
Introduction: The purpose of this study was to use 4D-CT to quantify the motion of the pisiform with relation to the triquetrum, in order to understand the piso-triquetral joint kinematics through active wrist movement...
New Therapy Option: Maisonneuve Fracture without Trans-syndesmotic Fixation
Ankle fracture is one of the common injuries in orthopedic department, the Maisonneuve fracture is a specific type of ankle injury. This fracture is usually caused by rotational force. According to the Lauge-Hansen class...
Morbid Constellation of Osseous and Vascular Abnormalities in a Female Patient with Congenital Central Hypoventilation/Overgrowth Syndrome
Background: Congenital Central Hypoventilation Syndrome (CCHS), is a condition characterized by ventilatory impairment that results in arterial hypoxemia. Studies revealed that the vast majority of patients with CCHS are...
Resistance of Enterobacteriaceae to Antibiotics in Wastewaters From the Mindoube Municipal Landfill (Libreville, Gabon)
This study aimed to identify antibiotic-resistant Enterobacteriaceae in wastewater discharged into the landfill. 12 samples were collected from the stream point of tanker truck in The MINDOUBÉ municipal landfill to th...
A Paradox Called Interwar
Interwar was a short and turbulent period that lasted barely 20 years. It spanned from the signing of the armistice at the end of the First World War (1918) to the beginning of the Second World War (1939) [1]. The fam...