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Soft tissue balancing in varus total knee arthroplasty: an algorithmic approach
Peter C M Verdonk1, Jerome Pernin, Alban Pinaroli
1Department of Orthopaedic Surgery, Centre Albert Trillat, Hospices Civils Lyon, Lyon, France. pverdonk@yahoo.com
Summary
An algorithmic approach to varus knee release, including a novel pie crust technique for the superficial medial collateral ligament (MCL), demonstrated effective soft tissue balancing in total knee arthroplasty. This method achieved satisfactory coronal alignment, proving beneficial for surgical outcomes.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
Background:
- Varus knee deformity presents challenges in total knee arthroplasty (TKA).
- Soft tissue balancing, particularly medial collateral ligament (MCL) release, is crucial for optimal TKA outcomes.
- Existing MCL release techniques may have limitations in addressing varying degrees of varus deformity.
Purpose of the Study:
- To present and evaluate an algorithmic release approach for the varus knee in TKA.
- To introduce and assess a novel pie crust release technique for the superficial MCL.
- To report the clinical and radiological outcomes of this algorithmic approach in a large patient cohort.
Main Methods:
- A retrospective study of 359 TKA patients utilizing an algorithmic release strategy.
- Classification into three groups based on MCL release technique: deep MCL release (Group 0), pie crust superficial MCL release (Group 1), and distal superficial MCL release (Group 2).
- Evaluation of medio-lateral stability, coronal alignment (hip-knee-ankle angle), and surgical outcomes.
Main Results:
- Medio-lateral stability was normal in 97% (Group 0), 95% (Group 1), and 83% (Group 2).
- Mean preoperative hip-knee angle improved from 174.0°, 172.1°, 169.5° to postoperative 179.1°, 179.2°, 177.6° for Groups 0, 1, and 2, respectively.
- Satisfactory coronal alignment (180° ± 3°) was achieved in 82.9% of patients.
Conclusions:
- The algorithmic release approach, including the pie crust technique, is beneficial for soft tissue balancing in TKA.
- Deep MCL release and osteophyte removal are recommended for all patients.
- The pie crust technique is safe and effective for mild to moderate releases (≤ 6-8 mm), while distal superficial MCL release is indicated for severe varus knees.