Original ArticleThe Effectiveness of Sequential Medial Soft Tissue Release on Coronal Alignment in Total Knee Arthroplasty: Using a Computer Navigation Model
Section snippets
Materials and Methods
We used 10 fresh (4 females and 6 males), not formalin-fixed, anatomic full-body cadavers for our testing. The median age was 52 years (range, 18-72 years). All knees were without deformities (coronal alignment in between ±3° varus-valgus). No specimen had previous operations concerning the ipsilateral foot, knee, and hip. The cadavers were kept at a temperature of +7°C and were not older than 36 hours. Inclusion criteria were full range of movement of the ipsilateral hip and the operated knee.
Anteroposterior Limb Axis
The difference in ap limb axis measured through navigation control with varus and valgus stress for each release step was statistically significant for both full extension and 90° flexion (P < .001). The coronal angle increased constantly after each release step (Fig. 5, Fig. 6). After the 6-cm release and release of the MCL, the increase in coronal angle was found to be strongest in contrast to the previous release step (6 cm: range 1.2°-3.7°, P < .0001; MCL: range 1°-3°, P < .0001). Massive
Discussion
Longevity of total knee prosthesis is based on a perfectly aligned and stable prosthesis over a full range of motion with sufficient tension of the soft tissues 29, 30, 31. It is commonly accepted that ligament balancing is an essential step in achieving this goal 16, 17, 18, 33, 34. The current literature provides many reports about different soft tissue releases, their necessity, and the clinical results of different techniques 5, 11, 12, 14, 21, 22, 35, but lacks experimental setups dealing
Conclusion
Our in vitro study addresses the influence of sequential medial ligament release in TKA on the ap leg axis and the tibiofemoral gaps. The results show that each sequential medial soft tissue release step has its desired impact on the ap leg axis and the tibiofemoral gaps. According to our cadaveric study, release of the MCL has a major influence during ligament balancing. But all performed release steps have a significant influence on both ap leg axis and the tibiofemoral gaps. The surgeon has
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Cited by (56)
Influence of Intraoperative Medial Collateral Ligament Bony Avulsion Injury on the Outcome of Primary Total Knee Arthroplasty
2021, Journal of ArthroplastyCitation Excerpt :In the series by Leopold et al [3], cruciate-retaining knees were used in all the knees in whom the MCL repair was done. Some studies [2,5,29] show that the posterior cruciate ligament acts as a secondary coronal stabilizer thereby augmenting the stability. But the study by Shahi et al [11] used posterior-stabilized knees and 22% (ten knees) of the Bohl et al [2] series also used posterior-stabilized knees and none of these knees failed as a result of instability in the final follow-up (Table 6).
Stability of knee ligament complex of Thiel-embalmed cadaver compared to in vivo knee
2017, Journal of the Mechanical Behavior of Biomedical MaterialsSemimembranosus Release for Medial Soft Tissue Balancing Does Not Weaken Knee Flexion Strength in Patients Undergoing Varus Total Knee Arthroplasty
2016, Journal of ArthroplastyCitation Excerpt :The term “balanced knee” describes a knee with normal motion that is not hindered by soft tissue constraint [31]. A stepwise release technique is the ideal way to correct medial contracture in varus knees and avoid unnecessary overrelease [3,11,20,32,33]. Although variations in releasing structures and sequences exist, many authors include SR as a sequential medial release step for varus TKA [1,2,16-19,21,34].
Influence of the Medial Knee Structures on Valgus and Rotatory Stability in Total Knee Arthroplasty
2016, Journal of ArthroplastyEfficacy and Safety of a Novel Three-Step Medial Release Technique in Varus Total Knee Arthroplasty
2015, Journal of Arthroplasty
No benefits or funds were received in support of the study.