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

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 29; no. 10; pp. 3418 - 3425
• Main Authors: Sasaki, Shizuka, Sasaki, Eiji, Kimura, Yuka, Tsukada, Harehiko, Otsuka, Hironori, Yamamoto, Yuji, Tsuda, Eiichi, Ishibashi, Yasuyuki
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2021; Springer Nature B.V
• Subjects: Ankle; Anterior cruciate ligament; Arthroplasty (knee); Biomedical materials; Evaluation; Joint replacement surgery; Joint surgery; Knee; Ligaments; Medicine; Medicine & Public Health; Meniscus; Navigation systems; Orthopaedic implants; Orthopedics; Sports Medicine; Stress; Medial and lateral laxity; Clinical outcome; Total knee arthroplasty; Hip–knee–ankle angle; Medial stabilizing technique
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-020-06257-1

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.