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. 2018 Dec;33(4):274-278.
doi: 10.1097/BTO.0000000000000277. Epub 2017 Dec 25.

Rotational Shortening of Collateral Ligament in TKR With Severe Deformity

Ming-Chou Ku  1 , Yiing-Feng Hwang  1 , Cheng-Kung Cheng  2 , Jr-Kai Chen  1 , Atul Kumar  3   4
Affiliations

Rotational Shortening of Collateral Ligament in TKR With Severe Deformity

Ming-Chou Ku et al. Tech Orthop. 2018 Dec.

Abstract

Instability of the knee joint after total knee replacement (TKR) is one of the most important reasons for revision TKR. Inadequate release or tightening of the collateral ligaments in the knee joint may cause instability and early failure. This study presents a case series study of a new technique for ligament balancing wherein the collateral ligament is detached from its origin and rotated (twisted) around its longitudinal axis to tighten the ligament before the origin is reattached to its original position. The surgical technique for collateral ligament tightening during TKR was performed on 6 patients with a deformed knee caused by osteoarthritis and rheumatoid arthritis. The range of motion, knee society score, and laxity of the patients' knee joint, after 7 months to 13 years of follow-up, were evaluated. The technique was successful, achieving good range of motion and satisfactory stability of the joint. Further evaluation in a larger number of cases and a comparative analysis with different techniques would further support the usefulness of this rotational ligamentoplasty technique.

Keywords: TKR; arthroplasty; rotational ligamentoplasty.

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Figures

FIGURE 1
FIGURE 1
A, Diagram to show the collateral ligament rotation (twist). B, Rotation of the ligament in 1 turn (360 degrees), the ligament shortened only by 2.5 mm (in cadaver knee). C, The same ligament rotated at 2 turns (720 degrees) shortened by 7 mm (in cadaver knee). The increment is not proportional.
FIGURE 2
FIGURE 2
A, The preoperative x-ray of a 71-year-old woman with right knee osteoarthritis showing a 30-degree valgus change. B, After 13 years of follow-up of the same patient, x-ray films did not show loosening or wearing. The range of motion was 0 to 135 degrees and KSS was 159. C, Telos (Telos Medical, USA) tensioning of MCL demonstrated a well-functioning MCL. MCL indicates medial collateral ligament; KSS, knee society score.
FIGURE 3
FIGURE 3
Midflexion tightness developed with anterosuperior transfer of a stretched collateral ligament.
See this image and copyright information in PMC

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