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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2021

01-10-2021 | KNEE

Effect of medial collateral ligament release and osteophyte resection on medial laxity in total knee arthroplasty

Authors: Shizuka Sasaki, Eiji Sasaki, Yuka Kimura, Harehiko Tsukada, Hironori Otsuka, Yuji Yamamoto, Eiichi Tsuda, Yasuyuki Ishibashi

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2021

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Abstract

Purpose

The concept of medial stabilizing technique total knee arthroplasty (MST-TKA) is to minimize the medial release without the superficial layer of medial collateral ligament (MCL). However, it is unclear at what stage the proper medial laxity is obtained during surgery. The purpose of this study was to investigate the implication of deep layer of MCL (dMCL) and osteophyte resection on medial laxity during MST-TKA.

Methods

A total of 103 consecutive patients who underwent cruciate-retaining TKA using the navigation system were included. The intraoperative hip–knee–ankle (HKA) angle was recorded under three conditions (no stress, valgus, and varus stress) at four time points after the resection of the anterior cruciate ligament (ACL) and meniscus (1st evaluation), after the dMCL release (2nd evaluation), and after osteophyte resection on both the femoral and tibial side (3rd evaluation). To assess valgus laxity, the differences in intraoperative HKA angle between 1st and 2nd evaluation (stage 1) and between 2nd and 3rd evaluation (stage 2) were calculated.

Results

Under the valgus stress condition, the intraoperative HKA angle change in stage 2 was significantly larger than that in stage 1 in full extension (stage 1; − 0.5 ± 1.0°, stage 2; − 2.0 ± 1.3°, p < 0.001) and 30° flexion (stage 1; − 0.8 ± 1.4°, stage 2; − 1.5 ± 2.0°, p = 0.008). There were no significant differences at 60° and 90° of knee flexion. Under the no stress and varus stress conditions, there were no significant differences in knee flexion at all angles.

Conclusion

The medial laxity during MST-TKA increased significantly more after dMCL release and osteophyte resection than after just dMCL release at full extension and 30° flexion, and it was, therefore, considered that osteophyte resection is a key procedure for a successful MST-TKA.

Level of evidence

Level II, therapeutic prospective cohort study.
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Metadata
Title
Effect of medial collateral ligament release and osteophyte resection on medial laxity in total knee arthroplasty
Authors
Shizuka Sasaki
Eiji Sasaki
Yuka Kimura
Harehiko Tsukada
Hironori Otsuka
Yuji Yamamoto
Eiichi Tsuda
Yasuyuki Ishibashi
Publication date
01-10-2021
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-06257-1

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