Techniques and Outcomes of Medial Soft Tissue Release for Moderate to Severe Varus Deformity in Total Knee Arthroplasty: A Literature Review
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Published:
Oct 1, 2019
Keywords:
osteoarthritic knee varus deformity total knee arthroplasty medial soft tissue release
Main Article Content
Abstract
Total knee arthroplasty for osteoarthritic knee with severe varus deformity always requires medial soft tissue release to reach a perfect outcome of the surgery. Up until now, there is still no consensus for the best technique of medial soft tissue release. This literature review collected and compared some aspects of each proposed techniques. The data were recruited from the PubMed and Google Scholar. The authors chose six medial soft tissue release techniques to be reviewed. These included subperiosteal release of superficial medial collateral ligament, pie-crusting technique, multiple needle puncture technique, medial epicondylar osteotomy, femoral origin release of the medial collateral ligament, and semimembranosus release. The results showed that each technique had a distinct superiority to each other. Each technique may be preferred in some situations. After a thorough discussion, the authors preferred the conventional subperiosteal release of superficial medial collateral ligament technique.
Article Details
Section
Review Articles
References
1. Insall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clin Orthop Relat Res. 1985; 192: 13-22.
2. Hood RW, Vanni M, Insall JN. The correction of knee alignment in 225 consecutive total condylar knee replacements. Clin Orthop Relat Res. 1981; 160: 94-105.
3. Yasgur DJ, Scuderi GR, Insall JN. Medial release for fixed-varus deformity. In: Scuderi GR, Tria AJ Jr, eds. Surgical techniques in total knee arthroplasty. New York: Springer-Verlag, 2002: 189-96.
4. Dixon MC, Parsch D, Brown RR, Scott RD. The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone. J Arthroplasty. 2004; 19: 19-22.
5. Mihalko WM, Saleh KJ, Krackow KA, Whiteside LA. Soft-tissue balancing during total knee arthroplasty in the varus knee. J Am Acad Orthop Surg. 2009; 17: 766-74.
6. Mullaji A, Sharma A, Marawar S, Kanna R. Quantification of effect of sequential posteromedial release on flexion and extension gaps: a computer-assisted study in cadaveric knees. J Arthroplasty. 2009; 24: 795-805.
7. Bellemans J, Vandenneucker H, Van Lauwe J, Victor J. A new surgical technique for medial collateral ligament balancing: multiple needle puncturing. J Arthroplasty. 2010; 25: 1151-6.
8. Verdonk PC, Pernin J, Pinaroli A, Selmi TA, Neyret P. Soft tissue balancing in varus total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2009; 17: 660-6.
9. Hunt NC, Ghosh KM, Athwal KK, Longstaff LM, Amis AA, Deehan DJ. Lack of evidence to support present medial release methods in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014; 22: 3100-12.
10. Koo MH1, Choi CH. Conservative treatment for the intraoperative detachment of medial collateral ligament from the tibial attachment site during primary total knee arthroplasty. J Arthoplasty. 2009: 24; 1249-53.
11. Prateeptongkum P, Tanavalee A, Mekrungcharas N, Ngarmukos S. Complete release of superficial medial collateral ligament in TKA: Surgical technique and mid-term results. Thai J Orthop Surg. 2014; 38: 45-50.
12. Cho WS, Byun SE, Lee SJ, Yoon J. Laxity after complete release of the medial collateral ligament in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015; 23: 1816-23.
13. Choi YJ, Lee KW, Seo DK, Lee SK, Kim SB, Lee HI. Conservative management after intraoperative over-release of the medial collateral ligament from its tibial insertion site in patients undergoing total knee arthroplasty. J Knee Surg. 2018; 31: 786-91.
14. Aglietti P, Lup D, Cuomo P, Baldini A, De Luca L. Total knee arthroplasty using a pie crusting technique for valgus deformity. Clin Orthop Relat Res. 2007; 464: 73-7.
15. Roussignol X, Gauthe R, Rahali S, Mandereau C, Courage O, Duparc F. Opening the medial tibiofemoral compartment by pie-crusting the superficial medial collateral ligament at its tibial insertion: a cadaver study. Orthop Traumatol Surg Res. 2015; 101: 529-33.
16. Meneghini RM, Daluga AT, Sturgis LA, Lieberman JR. Is the pie-crusting technique safe for MCL release in varus deformity correction in total knee arthroplasty? J Arthroplasty. 2013; 28: 1306-9.
17. Ha C, Park Y, Lee C, Awe S, Park Y. Selective medial release technique using the pie-crusting method for medial tightness during primary total knee arthroplasty. J Arthroplasty. 2016; 31: 1005-10.
18. Mehdikhani KG, Moreno BM, Reid JJ, Nieves AP, Lee Y, Valle AG. An algortithmic, Pie-crusting medial soft tissue release reduces the need for constrained inserts patients with severe varus deformity undergoing total knee arthroplasty. J Arthroplasty. 2016; 31: 1465-9.
19. He X, Cai H, Zhang K. Pie-crusting technique is effective and safe to release superficial medial collateral ligament for total knee arthroplasty. J Orthop Translat. 2018; 13: 33-40.
20. Takaaki Ohmori, Tamon Kabata, Yoshitomo Kajino, Tomoharu Takagi, Hiroyuki Tsuchiya. Effectiveness and safety of needle medial collateral ligament pie-crusting in total knee arthroplasty: A cadaveric study. J Knee Surg. 2018; 31: 705-9.
21. Koh IJ, Kwak D, Kim TK, Park IJ, In Y. How effective is multiple needle puncturing for medial soft tissue balancing during total knee arthroplasty? A cadaveric study. J Arthroplasty. 2014; 29: 2478-83.
22. Sim JA, Lee YS, Kwak JH, Yang SH, Kim KH, Lee BK. Comparison of complete distal release of the medial collateral ligament and medial epicondylar osteotomy during ligament balancing in varus knee total knee arthroplasty. Clin Orthop Surg. 2013; 5: 287-91.
23. Lee S, Yang J, Lee Y, Yoon J. A novel medial soft tissue release method for varus deformity during total knee arthroplasty: Femoral origin release of the medial collateral ligament. Knee Surg Relat Res. 2016: 28; 153-60.
24. Koh HS, In Y. Semimembranosus release as the second step of soft tissue balancing in varus total knee arthroplasty. J Arthroplasty. 2013; 28: 273-8.
25. Kim MW, Koh IJ, Kim JH, Jung JJ, In Y. Efficacy and safety of a novel three-step medial release technique in varus total knee arthroplasty. J Arthroplasty. 2015; 30: 1542-7.
26. Jang SW, Koh IJ, Kim MS, Kim JY, In Y. Semimembranosus release for medial soft tissue balancing does not weaken knee flexion strength in patients undergoing varus total knee arthroplasty. J Arthroplasty. 2016; 31: 2481-6.
2. Hood RW, Vanni M, Insall JN. The correction of knee alignment in 225 consecutive total condylar knee replacements. Clin Orthop Relat Res. 1981; 160: 94-105.
3. Yasgur DJ, Scuderi GR, Insall JN. Medial release for fixed-varus deformity. In: Scuderi GR, Tria AJ Jr, eds. Surgical techniques in total knee arthroplasty. New York: Springer-Verlag, 2002: 189-96.
4. Dixon MC, Parsch D, Brown RR, Scott RD. The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone. J Arthroplasty. 2004; 19: 19-22.
5. Mihalko WM, Saleh KJ, Krackow KA, Whiteside LA. Soft-tissue balancing during total knee arthroplasty in the varus knee. J Am Acad Orthop Surg. 2009; 17: 766-74.
6. Mullaji A, Sharma A, Marawar S, Kanna R. Quantification of effect of sequential posteromedial release on flexion and extension gaps: a computer-assisted study in cadaveric knees. J Arthroplasty. 2009; 24: 795-805.
7. Bellemans J, Vandenneucker H, Van Lauwe J, Victor J. A new surgical technique for medial collateral ligament balancing: multiple needle puncturing. J Arthroplasty. 2010; 25: 1151-6.
8. Verdonk PC, Pernin J, Pinaroli A, Selmi TA, Neyret P. Soft tissue balancing in varus total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2009; 17: 660-6.
9. Hunt NC, Ghosh KM, Athwal KK, Longstaff LM, Amis AA, Deehan DJ. Lack of evidence to support present medial release methods in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014; 22: 3100-12.
10. Koo MH1, Choi CH. Conservative treatment for the intraoperative detachment of medial collateral ligament from the tibial attachment site during primary total knee arthroplasty. J Arthoplasty. 2009: 24; 1249-53.
11. Prateeptongkum P, Tanavalee A, Mekrungcharas N, Ngarmukos S. Complete release of superficial medial collateral ligament in TKA: Surgical technique and mid-term results. Thai J Orthop Surg. 2014; 38: 45-50.
12. Cho WS, Byun SE, Lee SJ, Yoon J. Laxity after complete release of the medial collateral ligament in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015; 23: 1816-23.
13. Choi YJ, Lee KW, Seo DK, Lee SK, Kim SB, Lee HI. Conservative management after intraoperative over-release of the medial collateral ligament from its tibial insertion site in patients undergoing total knee arthroplasty. J Knee Surg. 2018; 31: 786-91.
14. Aglietti P, Lup D, Cuomo P, Baldini A, De Luca L. Total knee arthroplasty using a pie crusting technique for valgus deformity. Clin Orthop Relat Res. 2007; 464: 73-7.
15. Roussignol X, Gauthe R, Rahali S, Mandereau C, Courage O, Duparc F. Opening the medial tibiofemoral compartment by pie-crusting the superficial medial collateral ligament at its tibial insertion: a cadaver study. Orthop Traumatol Surg Res. 2015; 101: 529-33.
16. Meneghini RM, Daluga AT, Sturgis LA, Lieberman JR. Is the pie-crusting technique safe for MCL release in varus deformity correction in total knee arthroplasty? J Arthroplasty. 2013; 28: 1306-9.
17. Ha C, Park Y, Lee C, Awe S, Park Y. Selective medial release technique using the pie-crusting method for medial tightness during primary total knee arthroplasty. J Arthroplasty. 2016; 31: 1005-10.
18. Mehdikhani KG, Moreno BM, Reid JJ, Nieves AP, Lee Y, Valle AG. An algortithmic, Pie-crusting medial soft tissue release reduces the need for constrained inserts patients with severe varus deformity undergoing total knee arthroplasty. J Arthroplasty. 2016; 31: 1465-9.
19. He X, Cai H, Zhang K. Pie-crusting technique is effective and safe to release superficial medial collateral ligament for total knee arthroplasty. J Orthop Translat. 2018; 13: 33-40.
20. Takaaki Ohmori, Tamon Kabata, Yoshitomo Kajino, Tomoharu Takagi, Hiroyuki Tsuchiya. Effectiveness and safety of needle medial collateral ligament pie-crusting in total knee arthroplasty: A cadaveric study. J Knee Surg. 2018; 31: 705-9.
21. Koh IJ, Kwak D, Kim TK, Park IJ, In Y. How effective is multiple needle puncturing for medial soft tissue balancing during total knee arthroplasty? A cadaveric study. J Arthroplasty. 2014; 29: 2478-83.
22. Sim JA, Lee YS, Kwak JH, Yang SH, Kim KH, Lee BK. Comparison of complete distal release of the medial collateral ligament and medial epicondylar osteotomy during ligament balancing in varus knee total knee arthroplasty. Clin Orthop Surg. 2013; 5: 287-91.
23. Lee S, Yang J, Lee Y, Yoon J. A novel medial soft tissue release method for varus deformity during total knee arthroplasty: Femoral origin release of the medial collateral ligament. Knee Surg Relat Res. 2016: 28; 153-60.
24. Koh HS, In Y. Semimembranosus release as the second step of soft tissue balancing in varus total knee arthroplasty. J Arthroplasty. 2013; 28: 273-8.
25. Kim MW, Koh IJ, Kim JH, Jung JJ, In Y. Efficacy and safety of a novel three-step medial release technique in varus total knee arthroplasty. J Arthroplasty. 2015; 30: 1542-7.
26. Jang SW, Koh IJ, Kim MS, Kim JY, In Y. Semimembranosus release for medial soft tissue balancing does not weaken knee flexion strength in patients undergoing varus total knee arthroplasty. J Arthroplasty. 2016; 31: 2481-6.