Introduction: During total knee arthroplasty (TKA), release of the medial structures is often required in the varus knee to obtain adequate ligamentous balancing. The aim of this study is to investigate the

clinical outcome,

Materials and Methods: Between January 2000 and December 2004, 359 patients underwent a cemented posterostabilized TKA with a third condylar design (HLS prosthesis, Tornier, Grenoble, France) for primary unilateral varus osteoarthritis. One hundred twenty eight male and 231 female patients patients wer operated on at a mean age of 71 years. All patients were evaluated preoperatively and at 3 months, 6 months and 12 months postoperative.

In 255 of the 359 (71%) primary TKA’s, symmetrical gaps could be achieved by releasing the capsula and the deep MCL (group 0). In 87 cases (24%), an additional piecrust of the superficial MCL was necessary (group 1). In 55 cases out of these 87 an additional release of the insertion of the semimembranosus was performed. In 17 out of the 359 (5%), the medial tightness necessitated a distal release of the superficial MCL (group 2).

Results: All knees improved significantly postoperatively both in pain and function. Overall mean flexion at 12 months was 122 degrees.

The mean preoperative mechanical femorotibial angle (MFTA) was 174.0, 172.1 and 169.5 and was corrected postoperatively to 179.1, 179.2 and 177.6 for group 0, 1 and 2 respectively.

At 12 months, mediolateral stability was clinically evaluated as normal in 97% for group 0, 95% for group 1 and 83% for group 2. Three percent (3%), 5% and 17% has a mediolateral laxity ranging from 6–9 degrees for group 0,1 and 2, respectively.

Conclusion: Based on these results, the authors propose the following rationale: the capsule and deep MCL should always be released. In varus knees < 8°, a pie crust of the superficial MCL can be associated. In a varus knee between 8 and 10°, a release of the MCL on the tibial side is indicated. A release of the semimembranosus tendon can be associated for fixed flexion contracture. Pie crust of the MCL is a safe and reliable release technique and is able to selectively address the posterior and/or anterior fibers of the superficial MCL.

Purpose of the study: The purpose of this retrospective study was to analyze clinical datao n pigmented villon-odular synovitis (PVSN) of the knee as well as outcome after treatment in order to define the diagnostic stages, the surgical treatment, and follow-up modalities for this rare benign proliferative disease of the synovial which predominantly affects the knee joint.

Material and methods: Between 1996 and 2004, 28 patients were managed in our department, 13 men and 15 women, diffuse PVNS in 20 and localized PVNS in 8. IN the localized forms, symptoms were similar to those observed in knees with intra-articular foreign bodies or a meniscal lesion (75%) was present for 14 months on average at the first consultation. Mean age at onset of therapeutic management was 40 years (range 20–62). Localized arthroscopic or open resection was performed. For the diffuse forms, symptoms had been present for 15 months on average at the first consultation. Patients sought medical care because of spontaneous hemarthrosis or diffuse knee pain with no specific signs. Mean age at onset of therapeutic management was 38 years (range 15–59). Bony lesions were observed in 20%. Synoviorthesis or surgical synovectomy were performed. Mean follow-up was 97 months (range 12–309). Outcome was analyzed separately for the localized and diffuse forms.

Results: For the localized PVNS, there were no complications after surgical treatment but the relapse rate reached 12.5%. For diffuse PVNS, the cumulative rate of relapse was 50%, recurrence being noted on average 37 months after treatment. A stiff joint developed in 14% after open synovectomy. Surgical treatment was necessary in four cases (total arthroplasty in three) seen late after development of bony lesions; the clinical outcome was good with good gain in flexion.

Discussion: MRI is essential for the topographic diagnosis and to guide surgery. For diffuse PVNS seen at an advanced stage or after several recurrences, adjuvant synoviorthesis can be useful 4 to 8 months after surgery.

Conclusion: Appropriate treatment of PVNS of the knee depends on the presentation but usually involves a surgical procedure. The risk of recurrence for diffuse PVNS warrants annual MRI for four years.