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. 2023 Apr;31(4):1347-1353.
doi: 10.1007/s00167-022-07015-1. Epub 2022 Jun 1.

Posteromedial vertical capsulotomy selectively expands the intraoperative extension gap in cruciate-retaining total knee arthroplasty

Kensuke Yoshino  1   2 , Ryutaku Kaneyama  3   4 , Hitoshi Watanabe  5 , Masaaki Sakamoto  5 , Seiji Ohtori  6
Affiliations

Posteromedial vertical capsulotomy selectively expands the intraoperative extension gap in cruciate-retaining total knee arthroplasty

Kensuke Yoshino et al. Knee Surg Sports Traumatol Arthrosc. 2023 Apr.

Abstract

Purpose: Effective soft-tissue balancing procedures for expanding the extension gap (EG) are needed in cases of gap mismatch in total knee arthroplasty (TKA). A posteromedial vertical capsulotomy (PMVC) is performed to restore mobility in a knee with a flexion contracture. The purpose of this study was to evaluate the effectiveness and safety of PMVC for intraoperative gap adjustment in cruciate-retaining TKA.

Methods: A total of 120 consecutive knees undergoing cruciate-retaining TKA for varus osteoarthritis were examined. The EG and flexion gap (FG) with a trial femoral component were measured using spacer blocks before and after PMVC. PMVC was performed when the first FG was larger than the first EG by > 2 mm.

Results: Sixty-five knees underwent PMVC, and the mean EG significantly increased by 2.4 mm (p < 0.001). This increase was significantly larger than that of the FG by 2.0 mm (p < 0.001). The preoperative extension range of motion (ROM) was negatively correlated with the EG change after PMVC (r = - 0.39, p = 0.001). A receiver operating characteristic (ROC) curve indicated a preoperative extension ROM cut-off of -10° for predicting PMVC (sensitivity 72.3%, specificity 56.4%). No associated complications were observed during a minimum 2-year follow-up period, and there was no difference in the postoperative Knee Society Score between the PMVC and non-PMVC groups.

Conclusion: PMVC may be a useful soft-tissue treatment for gap adjustment with a selective EG expansion in TKA, especially in cases of a limited preoperative extension of - 10° or less.

Level of evidence: Therapeutic study, level III.

Keywords: Extension gap; Gap adjustment; Posteromedial vertical capsulotomy; Selective expansion; Soft-tissue treatment; Total knee arthroplasty.

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