Original Article
The Effectiveness of Sequential Medial Soft Tissue Release on Coronal Alignment in Total Knee Arthroplasty: Using a Computer Navigation Model

https://doi.org/10.1016/j.arth.2005.05.031Get rights and content

Abstract

Soft tissue management is a major step in total knee arthroplasty. We aimed to analyze the relationship between sequential medial soft tissue release and the resulting change in the anteroposterior limb axis and the tibiofemoral gaps. Measurements were obtained using a CT-free navigation system (Ci navigation system, DePuy I-Orthopaedics, Munich, Germany). Concerning leg axis, each release step led to significant (P < .001) effects. The highest effect was seen for the 6-cm release in extension and the release of medial collateral ligament in 90° flexion. The medial gap difference was significant for each release step except the 4-cm release in extension. The highest increase resulted when sacrificing the entire posterior cruciate ligament in extension and in 90° flexion. Implementation of computer-assisted surgery allows this first navigation-controlled study, elucidating the effect of soft tissue release in total knee arthroplasty.

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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    No benefits or funds were received in support of the study.

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