Influence of the Medial Knee Structures on Valgus and Rotatory Stability in Total Knee Arthroplasty

Iizawa, Norishige; Mori, Atsushi; Majima, Tokifumi; Kawaji, Hidemi; Matsui, Shusuke; Takai, Shinro

doi:10.1016/j.arth.2015.09.027

Cited by 23 publications

(20 citation statements)

References 26 publications

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“…18 Excessive release of the dMCL has been demonstrated to lead to rotatory instability of the knee, and that of the dMCL and the POL leads to a rotatory and valgus instability. 15 Contradictory to the traditional soft-tissue releases; recently, the focus has shifted to the importance of medial soft-tissue conservation to preserve physiologically natural knee kinematics post-TKA The Journal of Knee Surgery because physiological knee kinematics is proven to be lateral pseudolaxity. 2 Our results similarly showed trapezoidal and asymmetric gaps, with the lateral compartment wider than the medial compartment and the flexion gap larger than the extension gap in varus osteoarthritic knees.…”

Section: Discussionmentioning

confidence: 99%

“…As excessive release of soft tissues may result in knee instability post-TKA to maintain physiological knee stability, the importance of medial soft-tissue preservation has been emphasized. 15 Therefore, in contrast to traditional TKA balancing, surgeons at our institution do not routinely release medial soft tissues in cases of mild or moderate varus deformity.…”

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confidence: 99%

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The Influence of Posterior Cruciate Ligament Resection on Tibiofemoral Joint Gap in Varus Osteoarthritic Knees

et al. 2020

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Posterior cruciate ligament (PCL) resection during posterior-stabilized total knee arthroplasty (PS-TKA) has been reported to preferentially increase the tibiofemoral joint gap in flexion compared with extension. However, previous assessments of the joint gaps have been performed after bone resection and medial soft tissue release. Thus, these procedural steps may have the potential to influence soft tissue balance. In native knees, soft tissue laxity is generally greater in the lateral compartment than in the medial compartment both with the knee in extension and in flexion. Some surgeons may retain this natural soft tissue balance with less aggressive medial release during TKA. We performed this study to evaluate the impact of the PCL resection on the extension and flexion gaps in the absence of bone resection or medial soft tissue release. Tibiofemoral joint gaps for 41 patients (10 males and 31 females) in full extension and at 90 degrees of flexion both before and after the resections of both the anterior cruciate ligament (ACL) and PCL were assessed using a ligament tensioner device. The statistical analyze was performed using the Mann–Whitney U test. The results showed that medial gap in extension and flexion were 6.7 ± 1.0 and 7.3 ± 0.9 mm, and lateral gap in extension and flexion were 7.6 ± 1.1 and 8.4 ± 1.6 mm, respectively. Thus, physiological tibiofemoral gaps just after knee arthrotomy were trapezoidal and asymmetric shape with the significantly wider gaps in lateral and flexion, compared with the medial and extension, respectively (p < 0.05). However, the increases of the gaps with the ACL and PCL resections were less than 1 mm under the existence of medial soft tissues. As the medial collateral ligament is the primary restraint for the valgus instability, it was also considered to prevent the increase of the flexion gap although the PCL—which is the secondary restraint for the valgus instability—was resected. This finding is critically important for orthopedic surgeons applying PS-TKA implants, particularly for preserving soft tissues to achieve natural knee kinematics postoperatively.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The Influence of Posterior Cruciate Ligament Resection on Tibiofemoral Joint Gap in Varus Osteoarthritic Knees

et al. 2020

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“…Some similar studies have applied a manual maximum valgus load 9.15 . In this study, a 10Nm load was applied as was in the following studies on ligaments of normal knees 16 and TKA knees 6 . Griffith et al 16 reported a 6.5° correction by applying 10N-m valgus load at 30° flexion in normal knees.…”

Section: Discussionmentioning

confidence: 99%

“…To correct varus deformity, osteophytes are usually removed after release of the deep medial collateral ligament (dMCL) 3.4 , followed by release of the superficial medial collateral ligament (sMCL), and posteromedial capsule including the posterior oblique ligament (POL) 5 . However, release of the dMCL and POL increases rotatory instability of the knee 6 and posterior translation of the medial condyle of femur with flexion in cruciateretaining TKA (CR-TKA) 7 . In patients with post-TKA, it has been reported that medial pivot motion is correlated with good clinical outcomes 8 .…”

Section: Introductionmentioning

confidence: 99%

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Effect of Medial Osteophyte Removal on Correction of Varus Deformity in Total Knee Arthroplasty

et al. 2020

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Background: In order to restore the neutral limb alignment in total knee arthroplasty (TKA), surgical procedure usually starts with removing osteophytes in varus osteoarthritic knees, however, that the exact influence on alignment correction is unknown. The purpose of this study was to define the influence of osteophyte removal alone on limb alignment correction in the coronal plane in TKA for varus knee. Methods: Fifteen medial osteoarthritic knees with varus malalignment scheduled for TKA were included in this study. After registration of a navigation system, each knee was tested at maximum extension, and at 30, 40 and 60 degrees of flexion before and after osteophyte removal. External loads of 10 N-m valgus torque at each angle and in both states were applied. Subsequently, the widths of the resected osteophytes were measured. Results: The average pre-operative hip-knee-ankle angle was-14.2 degrees. The average width of osteophytes was 7.6 mm in femur and 5.3 mm in tibia, respectively. Angle corrections after osteophyte removal were 3.4 degrees at maximum extension, 3.4 degrees at 30 degrees flexion and 3.6 degrees at 60 degrees flexion; and at all angles, the difference was significant. There was positive correlation between the widths of osteophytes and the degree of angle correction at 30 degrees. Conclusion: Correlation was found at 30 degrees of knee flexion between the widths of osteophytes and the degree of angle correction in the coronal plane in TKA. We found the degree of angle correction per 1mm width of osteophyte removal to be 0.4 degrees.

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Ligament Balancing in Total Knee Arthroplasty

Vendittoli

Matta²,

Fornasieri

et al. 2021

Evidence‐Based Orthopedics

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Influence of the Medial Knee Structures on Valgus and Rotatory Stability in Total Knee Arthroplasty

Cited by 23 publications

References 26 publications

The Influence of Posterior Cruciate Ligament Resection on Tibiofemoral Joint Gap in Varus Osteoarthritic Knees

The Influence of Posterior Cruciate Ligament Resection on Tibiofemoral Joint Gap in Varus Osteoarthritic Knees

Effect of Medial Osteophyte Removal on Correction of Varus Deformity in Total Knee Arthroplasty

Ligament Balancing in Total Knee Arthroplasty

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