The Effectiveness of Sequential Medial Soft Tissue Release on Coronal Alignment in Total Knee Arthroplasty

Lüring, C.; Hüfner, T.; Perlick, L.; Bäthis, H.; Krettek, Christian; Grifka, Joachim

doi:10.1016/j.arth.2005.05.031

Cited by 66 publications

(62 citation statements)

References 26 publications

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“…Sequential medial release was performed in 7 steps as described by Luring et al [1]. The sequential steps were Step 1: 2 cm release of antero medial tibial sleeve, Step 2: Postero-medial release, Step 3: 4cm medial sleeve release, Step 4: 6cm medial sleeve release, Step 5: Deep medial collateral ligament release,…”

Section: Methodsmentioning

confidence: 99%

“…Its effects on kinematics and knee alignment as measured by femoro-tibial mechanical-angle (FTMA) have been described in extension and 90° flexion in coronal plane [1]. However most studies have missed what happens when the knee flexes from 0 to 90 degrees [1,4,5]. Traditionally it would be impossible to note little changes produced by these releases during the TKR surgery using conventional instruments.…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally sequential medial soft tissue release is performed for balancing in varus deformity to correct the alignment in TKR surgery. Its effects on kinematics and knee alignment as measured by femoro-tibial mechanical-angle (FTMA) have been described in extension and 90° flexion in coronal plane [1]. However most studies have missed what happens when the knee flexes from 0 to 90 degrees [1,4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Numerous soft tissue balancing release sequences have been published in literature [1][2][3][4][5][6]. Matseuda et al [5] had proposed a sequential release of medial structures as opposed to Insall et al [6] who proposed release of all medial structures as one [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Femoro-Tibial-Mechanical-Angle (FTMA) was studied in extension, 0°, 15°, 30°, 45°, 60°, 90° and maximum flexion. Sequential medial release was performed in 7 steps, described by Luring et al [1]. At each step FTMA was measured with and without varus and valgus stressing.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Traditional Sequential Medial Soft Tissue Release on Knee Kinematics and Alignment

Deep¹

2016

MOJOR

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Traditionally sequential medial soft tissue release is performed for balancing varus knees in total knee arthroplasty. Its effects on kinematics have been described in extension and 90° flexion in coronal plane but not through complete range of flexion. This study describes its effects on knee kinematics, throughout the range of motion of the knee, studied using a computer navigation system. Twelve cadaveric knees were studied. Femoro-Tibial-Mechanical-Angle (FTMA) was studied in extension, 0°, 15°, 30°, 45°, 60°, 90° and maximum flexion. Sequential medial release was performed in 7 steps, described by Luring et al. [1]. At each step FTMA was measured with and without varus and valgus stressing. A 10 Newton Meter (NM) moment was applied for varus and valgus stress.Most of the initial release steps had little effect on FTMA without force application, especially in the initial 60° of flexion. Application of varus force demonstrated very small changes. Even the application of valgus force demonstrated little change in initial arc of flexion until step 5 in the release was reached.Our study concludes that the present sequence of medial release may not be correct and should be investigated further to modify the sequence for sequential medial release for balancing in varus knees.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effect of Traditional Sequential Medial Soft Tissue Release on Knee Kinematics and Alignment

Deep¹

2016

MOJOR

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The influence of sequential debridement in total knee arthroplasty on the flexion axis of the knee using computer‐aided navigation

Morishige

McQueen

Chong

et al. 2010

Journal Orthopaedic Research

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The effects of osteophyte debridement, bony cuts, and soft tissue releases on the functional flexion axis of the knee can be assessed by evaluating 3D kinematics following each step of a total knee arthroplasty. Using a navigated knee system with dedicated software, the functional flexion axis (helical axis) can be determined after each step. Five paired fresh-frozen cadaveric knees were used with a CT scan performed on each specimen identifying implanted fiducial markers. Kinematics data were recorded during each step of sequential osseous cuts and soft tissue releases for both an unloaded and loaded limb by each of three surgeons. The functional helical (flexion/extension) axis was identified for all specimens. The internal/external rotation angle (y) of the helical axis differed from the transepicondylar axis by À8.38 to þ6.78 for the unloaded condition. y ranged from À7.28 to þ7.48 with distraction. Soft tissue releases had no effect on y; until a bony cut of the articular surface, which increased y from À0.38 to þ9.78. Implantation of cruciate retaining prosthetic components subsequently reduced the y range À7.38 to þ4.08. Thus, soft tissue releases had minimal effect on y of the helical axis except for resection of the proximal tibia. Implantation of the CR prosthesis reduced è close to that of the intact knee. In a minority of knees, the helical axis did not coincide exactly with the transepicondylar axis. Interspecimen and left/right variability of y were significant, although interinvestigator variability and an applied distraction force were insignificant. ß

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45 Treatment of Instability After Total Knee Replacement

Becker

2015

The Unhappy Total Knee Replacement

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The Effectiveness of Sequential Medial Soft Tissue Release on Coronal Alignment in Total Knee Arthroplasty

Cited by 66 publications

References 26 publications

Effect of Traditional Sequential Medial Soft Tissue Release on Knee Kinematics and Alignment

Effect of Traditional Sequential Medial Soft Tissue Release on Knee Kinematics and Alignment

The influence of sequential debridement in total knee arthroplasty on the flexion axis of the knee using computer‐aided navigation

45 Treatment of Instability After Total Knee Replacement

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