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Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty

BACKGROUND: To obtain the correct coronal alignment and balancing in flexion and extension, we established a selective medial release technique and investigated the effectiveness and safety of the technique during primary total knee arthroplasty (TKA). METHODS: Four hundred sixty-six primary TKAs wi...

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Autores principales: Tang, Qian, Yu, Hua-chen, Shang, Ping, Tang, Shang-kun, Xu, Hua-zi, Liu, Hai-xiao, Zhang, Yu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686887/
https://www.ncbi.nlm.nih.gov/pubmed/29137667
http://dx.doi.org/10.1186/s13018-017-0681-1
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author Tang, Qian
Yu, Hua-chen
Shang, Ping
Tang, Shang-kun
Xu, Hua-zi
Liu, Hai-xiao
Zhang, Yu
author_facet Tang, Qian
Yu, Hua-chen
Shang, Ping
Tang, Shang-kun
Xu, Hua-zi
Liu, Hai-xiao
Zhang, Yu
author_sort Tang, Qian
collection PubMed
description BACKGROUND: To obtain the correct coronal alignment and balancing in flexion and extension, we established a selective medial release technique and investigated the effectiveness and safety of the technique during primary total knee arthroplasty (TKA). METHODS: Four hundred sixty-six primary TKAs with varus deformity were prospectively evaluated between June 2013 and June 2015. A knee joint position similar to Patrick’s sign was used to release the medial structure. The medial release technique consisted of release of the capsule and the deep medial collateral ligament (dMCL) (step1), selective release of superficial medial collateral ligament (sMCL) or posterior oblique ligament (POL) (step 2), and selective tibial reduction osteotomy (step 3). Improvement of medial joint gap at each step and other clinical outcomes were evaluated. RESULTS: Among the 466 knees, symmetrical gaps could be achieved by the limited release of the capsule and the dMCcL in 276 (59%) knees. One hundred fifty-two (33%) required additional sMCL release with 2–5 cm from the joint line distally or POL release. Thirty-eight (8%) necessitated an additional tibial reduction osteotomy. Anterior-medial release and 4-mm medial osteotomy contributed to more improvement of medial gap in flexion than in extension (each p < 0.01). Posteromedial release and posteromedial osteotomy contributed to more improvement in extension than in flexion (each p < 0.01). No specific complication related to our technique was identified. CONCLUSION: The technique of the tibial reduction osteotomy combined with medial soft structure release using Patrick’s sign is effective, safe, and minimally invasive to obtain balanced mediolateral and extension-flexion gaps in primary TKA.
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spelling pubmed-56868872017-11-21 Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty Tang, Qian Yu, Hua-chen Shang, Ping Tang, Shang-kun Xu, Hua-zi Liu, Hai-xiao Zhang, Yu J Orthop Surg Res Research Article BACKGROUND: To obtain the correct coronal alignment and balancing in flexion and extension, we established a selective medial release technique and investigated the effectiveness and safety of the technique during primary total knee arthroplasty (TKA). METHODS: Four hundred sixty-six primary TKAs with varus deformity were prospectively evaluated between June 2013 and June 2015. A knee joint position similar to Patrick’s sign was used to release the medial structure. The medial release technique consisted of release of the capsule and the deep medial collateral ligament (dMCL) (step1), selective release of superficial medial collateral ligament (sMCL) or posterior oblique ligament (POL) (step 2), and selective tibial reduction osteotomy (step 3). Improvement of medial joint gap at each step and other clinical outcomes were evaluated. RESULTS: Among the 466 knees, symmetrical gaps could be achieved by the limited release of the capsule and the dMCcL in 276 (59%) knees. One hundred fifty-two (33%) required additional sMCL release with 2–5 cm from the joint line distally or POL release. Thirty-eight (8%) necessitated an additional tibial reduction osteotomy. Anterior-medial release and 4-mm medial osteotomy contributed to more improvement of medial gap in flexion than in extension (each p < 0.01). Posteromedial release and posteromedial osteotomy contributed to more improvement in extension than in flexion (each p < 0.01). No specific complication related to our technique was identified. CONCLUSION: The technique of the tibial reduction osteotomy combined with medial soft structure release using Patrick’s sign is effective, safe, and minimally invasive to obtain balanced mediolateral and extension-flexion gaps in primary TKA. BioMed Central 2017-11-14 /pmc/articles/PMC5686887/ /pubmed/29137667 http://dx.doi.org/10.1186/s13018-017-0681-1 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Tang, Qian
Yu, Hua-chen
Shang, Ping
Tang, Shang-kun
Xu, Hua-zi
Liu, Hai-xiao
Zhang, Yu
Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty
title Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty
title_full Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty
title_fullStr Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty
title_full_unstemmed Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty
title_short Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty
title_sort selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686887/
https://www.ncbi.nlm.nih.gov/pubmed/29137667
http://dx.doi.org/10.1186/s13018-017-0681-1
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