Step-wise medial collateral ligament needle puncturing in extension leads to a safe and predictable reduction in medial compartment pressure during TKA

Herschmiller, Thomas A.; Grosso, Matthew J.; Cunn, Gregory; Murtaugh, Taylor; Gardner, Thomas R.; Geller, Jeffrey A.

doi:10.1007/s00167-017-4777-2

Cited by 17 publications

(12 citation statements)

References 27 publications

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“…Achieving rectangular soft tissue balancing is imperative for successful MA TKA [14]. Therefore, the medial soft tissue release is commonly required to obtain adequate balancing in varus knee deformities [8]. During TKA, proper osteophyte resection and deep MCL release are sufficient for implantation.…”

Section: Discussionmentioning

confidence: 99%

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Effect of mediolateral gap difference on postoperative outcomes in navigation-assisted total knee arthroplasty using an ultracongruent insert and the medial stabilising technique

Lee

Alharthi

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeThis study was aimed to compare the clinical, functional, and radiographic outcomes between symmetric and asymmetric extension and mediolateral gap balance after navigation‐assisted (NA) total knee arthroplasty (TKA) using ultracongruent (UC) insets and the medial stabilising technique (MST). MethodsIn all, 363 knees of 275 patients who underwent mechanical alignment‐target NA TKA with MST between January 2015 and December 2017 were analysed. Patients were divided into balanced (extension mediolateral gap difference ≤ 2 mm) and tight medial (difference ≥ 3 mm) groups. Pre‐ and postoperative clinical, functional (range of motion, Western Ontario and McMaster University Osteoarthritis [WOMAC] index, Knee Society Knee Score [KSKS], and Knee Society Function Score [KSFS]) and radiographic (hip–knee–ankle [HKA] angle, femoral condylar offset, extension angle [a minus indicates hyperextension], and joint line distance) outcomes were compared between the groups. Student’s t‐ or Chi‐squared test was used to compare the outcomes. ResultsAmong the 363 knees analysed, 279 (77%) were assigned to the balanced group and 84 (23%) to the tight medial group. The preoperative HKA angle was significantly greater in the tight medial group than in the balanced group (9.7° ± 4.1° vs 14.3° ± 4.7°, P < 0.001). The postoperative WOMAC index, KSKS, and KSFS were similar between the groups. The change in the joint line distance was not significantly different (1.5 ± 3.7 vs 2.0 ± 3.3; n.s). ConclusionThe clinical, functional, and radiographic outcomes, including joint line distance, were comparable between the tight medial and balanced group after mechanical alignment‐targeted UC TKA with MST. Level of evidenceLevel III, retrospective comparative study.

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Section: Discussionmentioning

confidence: 99%

“…MA in TKA aims to align the leg neutrally to allow loading of the knee prosthesis as evenly as possible. Rectangular soft tissue balancing is known for successful MA TKA [14]; occasionally, medial or lateral soft tissue release may be needed [8]. Release of the medial structures is required for varus deformities.…”

Section: Introductionmentioning

confidence: 99%

Effect of mediolateral gap difference on postoperative outcomes in navigation-assisted total knee arthroplasty using an ultracongruent insert and the medial stabilising technique

Lee

Alharthi

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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“…More quantifiable methods include measuring gapping (in mm) through a tensioning device. In this study, we measured compartment loads using Verasense, which can be used for both clinical guidance and quantitative measurement [15,22]. By giving us actual measurements in pounds for both the medial and lateral compartment throughout knee range of motion, this allowed to systematically assess compartment balancing from extension to flexion.…”

Section: Discussionmentioning

confidence: 99%

Improved Compartment Balancing Using Robot-Assisted Total Knee Arthroplasty

et al. 2021

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Background: Robot-assisted surgery was developed to improve accuracy and outcomes in total knee arthroplasty (TKA). One important determinant of TKA success is a well-balanced knee throughout the range of motion. The purpose of this study is to determine if robot-assisted TKA (RA-TKA) results in improved intracompartmental ligament balance compared with conventional jig-based instrumentation (CM-TKA). Methods: This retrospective cohort study included 2 cohortsda CM-TKA (n ¼ 49) vs RA-TKA (n ¼ 37) cohort. Demographic and intraoperative data, including intraoperative compartment loads, were measured after final implant implantation in extension (10 ), mid-flexion (45 ), and full flexion (90 ), using an intraoperative compartment pressure sensor. An a priori power analysis revealed our study exhibited >80% power in detecting a 5-pound (lb) difference in compartment loads in the 2 cohorts. Results: There was no difference between medial and lateral compartment loads in extension, midflexion, and full flexion for the conventional (15.1 lbs, 15.9 lbs, and 13.4 lbs, respectively) vs RA-TKA (14.2 lbs, 15.1 lbs, and 10.3 lbs, respectively). The percentage of patients with high load compartment pressure in flexion (>40 lbs) by the conclusion of the surgery was significantly greater for the conventional (18%) vs the robotic TKA cohort (3%, P ¼ .025). The percentage of patients with unbalanced knees (>20 lbs differential between medial and lateral compartments) in flexion was significantly greater in the conventional (24%) vs robotic TKA cohort (5%, P ¼ .018). Conclusions: In this series, RA-TKA resulted in improved intraoperative compartment balancing in flexion with no observed difference in mid-flexion and extension compared with CM-TKA.

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“…Sensor-assisted TKA may also enable clinicians to perform soft tissue releases in a controlled and safe manner. Step-wise puncturing of the medial collateral ligament (MCL) has been shown to significantly reduce the medial compartment pressures and correlated significantly with joint gap measurement [ 47 ]. Whether step-wise puncturing alters laxity postoperatively in the longer term remains unclear as this technique is used for arthroscopic meniscal surgery without being complicated by persistent MCL laxity [ 48 ].…”

Section: Intra-operative Technique and Supporting Evidencementioning

confidence: 99%

Total Knee Arthroplasty and Intra-Articular Pressure Sensors: Can They Assist Surgeons with Intra-Operative Decisions?

Yapp

Robinson

Clement

et al. 2021

Curr Rev Musculoskelet Med

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Purpose of Review Soft tissue imbalance, presenting as instability or stiffness, is an important cause of revision total knee arthroplasty (TKA). Traditional methods of determining soft tissue balance of the knee lack precision and are not reliable between operators. Use of intra-operative pressure sensors offers the potential to identify and avoid soft tissue imbalance following TKA. This review aims to summarise the literature supporting the clinical indication for the use of intra-articular pressure sensors during TKA. Recent Findings Analytical validation studies suggest that intra-operative pressure sensors demonstrate ‘moderate’ to ‘good’ intra-observer reliability and ‘good’ to ‘excellent’ interobserver reliability throughout the flexion arc. However, there are important errors associated with measurements when devices are used out-with the stated guidelines and clinicians should be aware of the limitations of these devices in isolation. Current evidence regarding patient benefit is conflicting. Despite positive early results, several prospective studies have subsequently failed to demonstrate significant differences in overall survival, satisfaction, and patient-reported outcome measures within 1 year of surgery. Summary Surgeon-defined soft tissue stability appears to be significantly different from the absolute pressures measured by the intra-operative sensor. Whilst it could be argued that this confirms the need for intra-articular sensor guidance in TKA; the optimal ‘target’ balance remains unclear and the relationship with outcome in patients is not determined. Future research should (1) identify a suitable reference standard for comparison; (2) improve the accuracy of the sensor outputs; and (3) demonstrate that sensor-assisted TKA leads to patient benefit in patient-reported outcome measures and/or enhanced implant survival.

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Step-wise medial collateral ligament needle puncturing in extension leads to a safe and predictable reduction in medial compartment pressure during TKA

Cited by 17 publications

References 27 publications

Effect of mediolateral gap difference on postoperative outcomes in navigation-assisted total knee arthroplasty using an ultracongruent insert and the medial stabilising technique

Effect of mediolateral gap difference on postoperative outcomes in navigation-assisted total knee arthroplasty using an ultracongruent insert and the medial stabilising technique

Improved Compartment Balancing Using Robot-Assisted Total Knee Arthroplasty

Total Knee Arthroplasty and Intra-Articular Pressure Sensors: Can They Assist Surgeons with Intra-Operative Decisions?

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