Abstract
Introduction
The acquisition of proper soft tissue balance is one of the crucial factors for preventing long-term failure and obtaining successful treatment outcomes of total knee arthroplasty (TKA). Medial collateral ligament (MCL) release is essential for encountering severe varus deformity. However, conventional subperiosteal MCL release for severe varus deformity can cause the complete detachment of MCL. This study compared retrospectively the results of complete distal release of the MCL with those of medial epicondylar osteotomy during ligament balancing in varus knee TKA
Methods
This study retrospectively reviewed 9 cases of complete distal release of the MCL (group 1) and 11 cases of medial epicondylar osteotomy (group 2) which were used to correct severe medial contracture. The clinical assessment was based on the American Knee Society knee score (KS), function score (FS), and the ROM preoperatively and at the final follow-up. For the radiological assessment, the femorotibial angle was measured based on the whole lower extremity radiograph preoperatively and at the final follow-up. Three months after surgery and at the final follow-up, medial instability was assessed using the valgus stress radiographs, in which the contralateral side was compared using Telos (Telos, Weterstadt, Germany).
Results
The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively. There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. (Figure 1) In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely. (Figure 1)
Conclusions
This study showed that medial instability could not be removed completely in the complete MCL distal release group. Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.
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