Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Mar;25(1):13-8.
doi: 10.5792/ksrr.2013.25.1.13. Epub 2013 Feb 27.

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

Ji Hyun Ahn  1 , Young Woong Back
Affiliations

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

Ji Hyun Ahn et al. Knee Surg Relat Res. 2013 Mar.

Abstract

Purpose: Bony resection of the proximal medial tibia, an alternative technique for soft tissue balancing in total knee arthroplasty (TKA), was compared to the conventional medial soft tissue release technique.

Materials and methods: From June 2005 to June 2007, we performed 40 TKA in 27 patients with ≥10° tibio-femoral varus deformity. The conventional, medial soft tissue release technique was applied in 20 cases and bony resection of proximal medial tibia in the other 20 cases (vertical osteotomy group). Total operation time, knee range of motion (ROM), hospital for special surgery (HSS) scores, and tibio-femoral medial-lateral gap ratio in 0°, 90°, and 130° flexion at postoperative 6 months were compared between the groups.

Results: The total operation time was shorter in the vertical osteotomy group. Tibio-femoral medial-lateral gap ratio in 130° flexion was closer to 1 in the vertical osteotomy group (p=0.000). There was no significant difference in the ROM, HSS score, or tibio-femoral medial-lateral gap ratio in 0° and 90° flexion at postoperative 6 months.

Conclusions: In severe varus knees, bony resection of proximal medial tibia can be considered as an alternative technique, in order to decrease total operation time and to obtain medial-lateral, soft-tissue balance in deep flexion.

Keywords: Bony resection; Knee; Proximal medial tibia; Total knee arthroplasty; Varus deformity.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Anteroposterior radiograph of both knees showing arthritic change of the medial, tibio-femoral joint with severe varus deformity.
Fig. 2
Fig. 2
Intraoperative photograph showing bony resection of proximal medial tibia using an osteotome for ligament balancing.
Fig. 3
Fig. 3
Anteroposterior radiographs by an X-ray image intensifier showing tibio-femoral medial-lateral gap ratio changes according to different flexion angles at postoperative 6 months. (A) 0° flexion. (B) 90° flexion. (C) 130° flexion.
Fig. 4
Fig. 4
(A) Anteroposterior radiograph of the right knee showing repair by staple for torn medial collateral ligament. (B) Intraoperative photograph showing torn medial collateral ligament during medial release.
See this image and copyright information in PMC

References

    1. Mullaji AB, Padmanabhan V, Jindal G. Total knee arthroplasty for profound varus deformity: technique and radiological results in 173 knees with varus of more than 20 degrees. J Arthroplasty. 2005;20:550–561. - PubMed
    1. Choi CH, Kim JH, Chung HK, Kim JH. Clinical and radiological evaluation of detached MCL cases in medial release during TKA: MCL detached vs stable CR vs stable PS. J Korean Knee Soc. 2002;14:1–8.
    1. Bottros J, Gad B, Krebs V, Barsoum WK. Gap balancing in total knee arthroplasty. J Arthroplasty. 2006;21(4 Suppl 1):11–15. - PubMed
    1. Yagishita K, Muneta T, Ikeda H. Step-by-step measurements of soft tissue balancing during total knee arthroplasty for patients with varus knees. J Arthroplasty. 2003;18:313–320. - PubMed
    1. Kim JH, Choi CH, Kang SK, Lee BK, Shon KH, Chung HK. Assessment of failure modes in total knee replacement arthroplasty. J Korean Knee Soc. 2003;15:177–184.

LinkOut - more resources