Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty

Journal of Orthopaedic Surgery and Research

Shang-kun Tang¹  Hai-xiao Liu²  Hua-zi Xu²  Yu Zhang²  Hua-chen Yu²  Qian Tang²  Ping Shang³ 

[1] Department of Clinical Medicine, Second Clinical Medical College, Wenzhou Medical University;Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University;Department of Rehabilitation, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University;

关键词: Total knee arthroplasty;    Medial collateral ligament;    Tibial reduction osteotomy;    Varus knee;    Soft tissue release;    Orthopedic surgery;   

DOI  :  10.1186/s13018-017-0681-1

来源: DOAJ

【 摘 要 】

Abstract Background To obtain the correct coronal alignment and balancing in flexion and extension, we established a selective medial release technique and investigated the effectiveness and safety of the technique during primary total knee arthroplasty (TKA). Methods Four hundred sixty-six primary TKAs with varus deformity were prospectively evaluated between June 2013 and June 2015. A knee joint position similar to Patrick’s sign was used to release the medial structure. The medial release technique consisted of release of the capsule and the deep medial collateral ligament (dMCL) (step1), selective release of superficial medial collateral ligament (sMCL) or posterior oblique ligament (POL) (step 2), and selective tibial reduction osteotomy (step 3). Improvement of medial joint gap at each step and other clinical outcomes were evaluated. Results Among the 466 knees, symmetrical gaps could be achieved by the limited release of the capsule and the dMCcL in 276 (59%) knees. One hundred fifty-two (33%) required additional sMCL release with 2–5 cm from the joint line distally or POL release. Thirty-eight (8%) necessitated an additional tibial reduction osteotomy. Anterior-medial release and 4-mm medial osteotomy contributed to more improvement of medial gap in flexion than in extension (each p < 0.01). Posteromedial release and posteromedial osteotomy contributed to more improvement in extension than in flexion (each p < 0.01). No specific complication related to our technique was identified. Conclusion The technique of the tibial reduction osteotomy combined with medial soft structure release using Patrick’s sign is effective, safe, and minimally invasive to obtain balanced mediolateral and extension-flexion gaps in primary TKA.

【 授权许可】

Unknown