Abstract
Introduction
The convincible wisdom is that the release of MCL in severe varus knee should be progressive. This release is usually carried on after resecting the osteophyte and gradually carried on until the MCL is well balanced. However, sometimes, extensive release and releasing the superficial MCL can lead to instability in flexion. On a personal communication with many Asian surgeons they have been doing a careful release of the posteromedial corner in the varus knee and in majority of cases such release is adequate. And even in severe cases of varus knee superficial MCL doesn't need to be released.
20 total knee replacements were performed by the same surgeon using ZimmerPS implant. In the varus deformity ranges from 15–35 degrees. The first bony section was made carefully. All osteophytes were removed and resected. The posterior bone osteophytes were also resected and the intercondylar notches were made along with the posterior release. After doing the bony cut in 18 of those cases the medial compartment was still tight and both flexion and extension
A careful release was carried in the postal medial corner-First using an osteotome around the posteromedial corner to release the soft tissue. After that the thick fibrous tissue that formed like pseudo meniscus was also resected until we were able to reach the posterior capsule. In some cases those scar tissues even extended to the capsule requiring the resecting of the postal medial capsule. We meticulously resected all those scar tissues and in many of those cases were able to visualize the MCL ligament which was well preserved. A tensioning device was used before and after the release. In all of those cases we were able to document an opening ranging from two to seven millimeter after the proper release. In all cases the superficial MCL were still intact and can be operated carefully
Result
This study clearly shows that we did not have to release the superficial MCL and the careful posteromedial release was adequate to obtain a good balance gap immediately and the knee was quite stable. The superficial MCL was maintained and preserved and tensioning device clearly document opening after releasing the postural medial corner
Discussion
In varus knee there is an extensive scar tissue which can sometimes tension the mcl ligament and releasing the deep mcl along with posture medial corner without releasing the superficial will preserve the stability of the knee allowing us to ambulate the patient immediately and preventing instability.
Conclusion
Although MCL release has been described in diff ways in multiple literatures, little attention has been paid to the posture medial corner. This paper clearly shows that the complex anatomy of the posture medial corner along with scarring can lead to a tight mcl Releasing such structures would balance MCL&LCL without compromising the superficial MCL which normally lead to obvious flexion instability and a mid-section instability. We strongly recommend surgeon to do the posteromedial release before doing any release to the superficial mcl. Doing so will prevent the incidence of instability after extensive release in varus deformity.
