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J Knee Surg 2022; 35(11): 1192-1198
DOI: 10.1055/s-0040-1721787
Original Article

Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

Mohammadreza Minator Sajjadi
1   Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Mohammad Ali Okhovatpour
1   Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Yaser Safaei
1   Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Behrooz Faramarzi
1   Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Reza Zandi 
1   Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract

The aim of this study was to assess the predictive value of the femoral intermechanical-anatomical angle (IMA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), femorotibial or varus angle (VA), and joint line convergence angle (CA) in predicting the stage of the medial collateral ligament (MCL) during total knee arthroplasty (TKA) of varus knee. We evaluated 229 patients with osteoarthritic varus knee who underwent primary TKA, prospectively. They were categorized in three groups based on the extent of medial soft tissue release that performed during TKA Group 1, osteophytes removal and release of the deep MCL and posteromedial capsule (stage 1); Group 2, the release of the semimembranosus (stage 2); and Group 3, release of the superficial MCL (stage 3) and/or the pes anserinus (stage 4). We evaluated the preoperative standing coronal hip-knee-ankle alignment view to assessing the possible correlations between the knee angles and extent of soft tissue release. A significant difference was observed between the three groups in terms of preoperative VA, CA, and MPTA by using the Kruskal–Wallis test. The extent of medial release increased with increasing VA and CA as well as decreasing MPTA in preoperative long-leg standing radiographs. Finally, a patient with a preoperative VA larger than 19, CA larger than 6, or MPTA smaller than 81 would need a stage 3 or 4 of MCL release. The overall results showed that the VA and MPTA could be useful in predicting the extent of medial soft tissue release during TKA of varus knee.

Keywords

standing coronal hip-knee-ankle alignment view - total knee arthroplasty - medial collateral ligament - soft tissue balancing - varus knee


Publication History

Received: 25 June 2020

Accepted: 12 November 2020

Article published online:
22 January 2021

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