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Laxity after complete release of the medial collateral ligament in primary total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Medial collateral ligament (MCL) release is one of the essential steps toward the achievement of ligament balancing during the total knee arthroplasty (TKA) in patients with varus deformity. When the varus deformity is severe, complete release of the MCL until balanced is often required. However, it is believed that complete MCL release may lead to catastrophic laxity. The purpose of this prospective study is to compare the medial joint gap opening in postoperative valgus stress radiograph in patients with complete MCL release against patients with partial release.

Methods

Out of 209 primary TKAs performed for degenerative osteoarthritis, complete MCL release was required in 33 cases (group I) by sub-periosteal detachment at proximal tibia using periosteal elevator. For the remaining 176 knees (group II), partial release of MCL was done. At postoperative 6 months and 1 year, both groups were evaluated for comparing the joint gap on valgus stress radiographs using modified Telos device in 0°, 45°, and 90° of flexion. Additional parameters which were analyzed included preoperative varus and valgus stress radiographs in full extension and pre- and postoperative mechanical alignment in each group. The knee range of motion (ROM) and clinical scores were evaluated at 1-year follow-up.

Results

The mean values of the joint opening on the postoperative valgus stress test with the knee joint extended, and in the 45° and 90° flexed states at 6 months and at 1 year postoperatively in group I were not statistically significantly different from those of group II. The clinical scores also did not show a statistically significant difference between two groups. There was a statistically significant difference in ROM between two groups, pre- and postoperatively and the difference was 5°, respectively.

Conclusion

This study suggests that complete MCL release for ligament balancing is a safe procedure and does not lead to postoperative laxity.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea

    Woo-Shin Cho & Jaeyoun Yoon

  2. Department of Orthopaedic Surgery, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea

    Seong-Eun Byun

  3. Department of Orthopaedic Surgery, Teunteun Hospital, Guri-si, Gyeonggi-do, Republic of Korea

    Sang-Jun Lee

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  1. Woo-Shin Cho
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  2. Seong-Eun Byun
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Correspondence to Seong-Eun Byun.

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Cho, WS., Byun, SE., Lee, SJ. et al. Laxity after complete release of the medial collateral ligament in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23, 1816–1823 (2015). https://doi.org/10.1007/s00167-014-3288-7

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  • DOI: https://doi.org/10.1007/s00167-014-3288-7

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