Laxity after complete release of the medial collateral ligament in primary total knee arthroplasty

详细信息    查看全文

• 作者：Woo-Shin Cho ; Seong-Eun Byun ; Sang-Jun Lee…
• 关键词：Complete medial collateral ligament release ; Ligament balancing ; Total knee arthroplasty
• 刊名：Knee Surgery, Sports Traumatology, Arthroscopy
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：23
• 期：6
• 页码：1816-1823
• 全文大小：820 KB
• 参考文献：1.Ahn JH, Back YW (2013) Comparative study of two techniques for ligament balancing in total knee arthroplasty for severe varus knee: medial soft tissue release vs. bony resection of proximal medial tibia. Knee Surg Relat Res 25:13-8View Article PubMed PubMed Central
  2.Ballmer PM, Jakob RP (1988) The non operative treatment of isolated complete tears of the medial collateral ligament of the knee. A prospective study. Arch Orthop Trauma Surg 107:273-76View Article PubMed
  3.Bottros J, Gad B, Krebs V, Barsoum WK (2006) Gap balancing in total knee arthroplasty. J Arthroplasty 21:11-5View Article PubMed
  4.Colizza WA, Insall JN, Scuderi GR (1995) The posterior stabilized total knee prosthesis. Assessment of polyethylene damage and osteolysis after a ten-year-minimum follow-up. J Bone Joint Surg Am 77:1713-720PubMed
  5.Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D (1997) Total knee replacement in young, active patients. Long-term follow-up and functional outcome. J Bone Joint Surg Am 79:575-82PubMed
  6.Dixon MC, Parsch D, Brown RR, Scott RD (2004) The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone. J Arthroplasty 19:19-2View Article PubMed
  7.Edwards E, Miller J, Chan KH (1988) The effect of postoperative collateral ligament laxity in total knee arthroplasty. Clin Orthop Relat Res 236:44-1PubMed
  8.Engh GA (2003) The difficult knee: severe varus and valgus. Clin Orthop Relat Res 416:58-3
  9.Engh GA (1999) Medial epicondylar osteotomy: a technique used with primary and revision total knee arthroplasty to improve surgical exposure and correct varus deformity. Instr Course Lect 48:153-56PubMed
  10.Engh GA, Ammeen D (1999) Results of total knee arthroplasty with medial epicondylar osteotomy to correct varus deformity. Clin Orthop Relat Res 367:141-48PubMed
  11.Fehring TK, Valadie AL (1994) Knee instability after total knee arthroplasty. Clin Orthop Relat Res 299:157-62PubMed
  12.Heesterbeek PJC, Keijsers NLW, Wymenga AB (2010) Ligament releases do not lead to increased postoperative varus-valgus laxity in flexion and extension: a prospective clinical study in 49 TKR patients. Knee Surg Sports Traumatol Arthrosc 18:187-93View Article PubMed
  13.Indelicato PA, Hermansdorfer J, Huegel M (1990) Nonoperative management of complete tears of the medial collateral ligament of the knee in intercollegiate football players. Clin Orthop Relat Res 256:174-77PubMed
  14.Insall JN, Binazzi R, Soudry M, Mestriner LA (1985) Total knee arthroplasty. Clin Orthop Relat Res 192:13-2PubMed
  15.Insall JN, Hood RW, Flawn LB, Sullivan DJ (1983) The total condylar knee prosthesis in gonarthrosis. A five to nine-year follow-up of the first one hundred consecutive replacements. J Bone Joint Surg Am 65:619-28PubMed
  16.Koo MH, Choi CH (2009) Conservative treatment for the intraoperative detachment of medial collateral ligament from the tibial attachment site during primary total knee arthroplasty. J Arthroplasty 24:1249-253View Article PubMed
  17.Krackow KA, Mihalko WM (1999) The effect of medial release on flexion and extension gaps in cadaveric knees: implications for soft-tissue balancing in total knee arthroplasty. Am J Knee Surg 12:222-28PubMed
  18.Kuster MS, Bitschnau B, Votruba T (2004) Influence of collateral ligament laxity on patient satisfaction after total knee arthroplasty: a comparative bilateral study. Arch Orthop Trauma Surg 124:415-17View Article PubMed
  19.Laskin RS (1996) Total knee replacement with posterior cruciate ligament retention in patients with a fixed varus deformity. Clin Orthop Relat Res 331:29-4View Article PubMed
  20.Meftah M, Blum YC, Raja D, Ranawat AS, Ranawat CS (2012) Correcting fixed varus deformity with flexion contracture during total knee arthroplasty: the “inside-out-technique: AAOS exhibit selection. J Bone Joint Surg Am 94:e66PubMed
  21.Meneghini RM, Daluga AT, Sturgis LA, Lieberman JR (2013) Is the pie-crusting technique safe for MCL release in varus deformity correction in total knee arthroplasty? J Arthroplasty 28:1306-309View Article PubMed
  22.Mihalko WM, Whiteside LA, Krackow KA (2003) Comparison of ligament-balancing techniques during total knee arthroplasty. J Bone Joint Surg Am 85:132-35PubMed
  23.Miyasaka KC, Ranawat CS, Mullaji A (1997) 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 345:29-7PubMed
  24.Mullaji AB, Padmanabhan V, Jindal G (2005) Total knee arthroplasty for profound varus deformity: technique and radiological results in 173 knees with varus of more than 20 degrees. J Arthroplasty 20:550-61View Article PubMed
  25.Okamoto S, Okazaki K, Mitsuyasu H, Matsuda S, Iwamoto Y (2013) Lateral soft tissue laxity increases but medial laxity does not contract with varus deformity in total knee arthroplasty. Clin Orthop Relat Res 471:1334-
• 作者单位：Woo-Shin Cho (1)
  Seong-Eun Byun (2)
  Sang-Jun Lee (3)
  Jaeyoun Yoon (1)
  
  1. Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
  2. Department of Orthopaedic Surgery, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
  3. Department of Orthopaedic Surgery, Teunteun Hospital, Guri-si, Gyeonggi-do, Republic of Korea
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Orthopedics
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1433-7347

文摘

Purpose Medial collateral ligament (MCL) release is one of the essential steps toward the achievement of ligament balancing during the total knee arthroplasty (TKA) in patients with varus deformity. When the varus deformity is severe, complete release of the MCL until balanced is often required. However, it is believed that complete MCL release may lead to catastrophic laxity. The purpose of this prospective study is to compare the medial joint gap opening in postoperative valgus stress radiograph in patients with complete MCL release against patients with partial release. Methods Out of 209 primary TKAs performed for degenerative osteoarthritis, complete MCL release was required in 33 cases (group I) by sub-periosteal detachment at proximal tibia using periosteal elevator. For the remaining 176 knees (group II), partial release of MCL was done. At postoperative 6?months and 1?year, both groups were evaluated for comparing the joint gap on valgus stress radiographs using modified Telos device in 0°, 45°, and 90° of flexion. Additional parameters which were analyzed included preoperative varus and valgus stress radiographs in full extension and pre- and postoperative mechanical alignment in each group. The knee range of motion (ROM) and clinical scores were evaluated at 1-year follow-up. Results The mean values of the joint opening on the postoperative valgus stress test with the knee joint extended, and in the 45° and 90° flexed states at 6?months and at 1?year postoperatively in group I were not statistically significantly different from those of group II. The clinical scores also did not show a statistically significant difference between two groups. There was a statistically significant difference in ROM between two groups, pre- and postoperatively and the difference was 5°, respectively. Conclusion This study suggests that complete MCL release for ligament balancing is a safe procedure and does not lead to postoperative laxity.