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CC BY-NC-ND 4.0 · J Knee Surg 2025; 38(07): 328-335
DOI: 10.1055/a-2395-6831
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No Radiographic Evidence of Medial Collateral Ligament Elongation in Valgus Osteoarthritic Knees Enables Treatment with Kinematically Aligned Total Knee Arthroplasty

Alexander J. Nedopil 
1   Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
,
Anand Singh Dhaliwal
2   College of Medicine, California Northstate University, Elk Grove, California
,
Antonio Klasan 
3   Department of Orthopaedics and Traumatology, AUVA UKH Steiermark, Graz, Austria
,
Stephen M. Howell 
4   Department of Biomedical Engineering, University of California at Davis, Davis, California
,
Maury L. Hull 
4   Department of Biomedical Engineering, University of California at Davis, Davis, California
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Funding None.
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Abstract

When performing caliper-verified kinematically aligned total knee arthroplasty (KA TKA) in the osteoarthritic (OA) knee with valgus deformity, an elongated medial collateral ligament (MCL) could result in a valgus setting of the tibial component. The present study analyzed KA TKA in patients with valgus deformities (i.e., tibiofemoral angle > 10 degrees of valgus) and determined (1) the occurrence of radiographic MCL elongation, (2) the incidence of lateral collateral ligament (LCL) and posterior cruciate ligament (PCL) release and the use of constrained components, and (3) whether the 1-year Forgotten Joint Score (FJS), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), and Likert satisfaction score were comparable to KA TKAs for OA deformities ≤10 degrees of valgus. One hundred and two consecutive patients who underwent KA TKA by a single surgeon were analyzed radiographically and clinically at a minimum follow-up of 1 year. Radiographic MCL elongation was identified by a greater than 1 degree of valgus orientation of the tibial component relative to the OA tibial joint line. Twenty-six patients had a radiographic anatomic tibiofemoral angle greater than 10 degrees of valgus (range of OA deformity: 11–23 degrees of valgus). Seventy-six had an OA deformity ≤10 degrees of valgus (10-degree valgus to –14-degree varus). No patient had MCL elongation or a ligament release, or required constrained components. The median FJS of 78, OKS of 42, and KOOS JR of 76, and the 85% satisfaction rate of the patients with greater than 10 degrees of OA valgus deformity were not significantly different from those with ≤10 degrees of OA valgus deformity (p ≥ 0.17). Because MCL elongation was not detected in OA deformities up to 23 degrees of valgus, the risk of under-correcting the valgus deformity leading to instability and poor outcome scores is low when performing KA TKA using primary components without releasing the LCL and/or PCL.

Level of Evidence: IV.

Keywords

knee replacement - kinematic alignment - valgus deformity - patient-reported outcomes

Ethical Approval

This study was approved by the Institutional Review Board.


Authors Contributions

All the authors have made substantial contributions to all of the following: (1) the conception and design of the study, acquisition of data and analysis and interpretation of data; (2) drafting the article; and (3) final approval of the version submitted.




Publikationsverlauf

Eingereicht: 13. Juni 2024

Angenommen: 19. August 2024

Accepted Manuscript online:
20. August 2024

Artikel online veröffentlicht:
27. September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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