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Medial soft tissue release is also related to the anterior stability of cruciate-retaining total knee arthroplasty: a cadaveric study

Background Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral...

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Published in:Knee surgery & related research 2024-01, Vol.36, p.1
Main Authors: Sayako Sakai, Shinichiro Nakamura, Takahiro Maeda, Shinichi Kuriyama, Kohei Nishitani, Yugo Morita, Yusuke Yamawaki, Yuki Shinya, Shuichi Matsuda
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container_title Knee surgery & related research
container_volume 36
creator Sayako Sakai
Shinichiro Nakamura
Takahiro Maeda
Shinichi Kuriyama
Kohei Nishitani
Yugo Morita
Yusuke Yamawaki
Yuki Shinya
Shuichi Matsuda
description Background Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA. Methods Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension and 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability were compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed. Results Medial joint gap significantly increased from stages 1 to 3 by 3.2 mm, 6.8 mm, and 7.2 mm at extension, 45° flexion, and 90° flexion, respectively, and from stages 2 to 3 by 3.5 mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (-2.7° to 0.8°, -2.2° to 4.3°, and -5.5° to 2.5° at extension, 45° flexion, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5 mm and 8.2 mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495). Conclusions Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension.
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This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA. Methods Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension and 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability were compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed. Results Medial joint gap significantly increased from stages 1 to 3 by 3.2 mm, 6.8 mm, and 7.2 mm at extension, 45° flexion, and 90° flexion, respectively, and from stages 2 to 3 by 3.5 mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (-2.7° to 0.8°, -2.2° to 4.3°, and -5.5° to 2.5° at extension, 45° flexion, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5 mm and 8.2 mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495). Conclusions Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension.</description><identifier>ISSN: 2234-0726</identifier><language>kor</language><publisher>대한슬관절학회</publisher><subject>Anterior posterior stability ; Knee ; Ligament balancing ; Medial release ; Mediolateral gap ; Total knee arthroplasty</subject><ispartof>Knee surgery &amp; related research, 2024-01, Vol.36, p.1</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784</link.rule.ids></links><search><creatorcontrib>Sayako Sakai</creatorcontrib><creatorcontrib>Shinichiro Nakamura</creatorcontrib><creatorcontrib>Takahiro Maeda</creatorcontrib><creatorcontrib>Shinichi Kuriyama</creatorcontrib><creatorcontrib>Kohei Nishitani</creatorcontrib><creatorcontrib>Yugo Morita</creatorcontrib><creatorcontrib>Yusuke Yamawaki</creatorcontrib><creatorcontrib>Yuki Shinya</creatorcontrib><creatorcontrib>Shuichi Matsuda</creatorcontrib><title>Medial soft tissue release is also related to the anterior stability of cruciate-retaining total knee arthroplasty: a cadaveric study</title><title>Knee surgery &amp; related research</title><addtitle>Knee Surgery and Related Research (Knee Surg Relat Res)</addtitle><description>Background Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA. Methods Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension and 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability were compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed. Results Medial joint gap significantly increased from stages 1 to 3 by 3.2 mm, 6.8 mm, and 7.2 mm at extension, 45° flexion, and 90° flexion, respectively, and from stages 2 to 3 by 3.5 mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (-2.7° to 0.8°, -2.2° to 4.3°, and -5.5° to 2.5° at extension, 45° flexion, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5 mm and 8.2 mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495). Conclusions Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension.</description><subject>Anterior posterior stability</subject><subject>Knee</subject><subject>Ligament balancing</subject><subject>Medial release</subject><subject>Mediolateral gap</subject><subject>Total knee arthroplasty</subject><issn>2234-0726</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9jkFuwkAMRWfRSqCWE7DxBSKlk0AoW1TEprvukZk4xMo0g2ynUg7QezNIXXdlWX7_-T-5pfdVXZSN3y7cSpUv5aZsqrrx9dL9flLLGEFTZ2CsOhEIRUIlYAWMmh47GrVgCawnwNFIOAmo4YUj2wypgyBT4IwVQoY88njNvGXzMFLOiPWSbhHV5j0gBGzxJ1tClkzt_Oqeu_yKVn_zxa2PH1-HUzHkRueb8DfKfK7f_O693FX_X-9EpE32</recordid><startdate>20240101</startdate><enddate>20240101</enddate><creator>Sayako Sakai</creator><creator>Shinichiro Nakamura</creator><creator>Takahiro Maeda</creator><creator>Shinichi Kuriyama</creator><creator>Kohei Nishitani</creator><creator>Yugo Morita</creator><creator>Yusuke Yamawaki</creator><creator>Yuki Shinya</creator><creator>Shuichi Matsuda</creator><general>대한슬관절학회</general><scope>HZB</scope><scope>Q5X</scope></search><sort><creationdate>20240101</creationdate><title>Medial soft tissue release is also related to the anterior stability of cruciate-retaining total knee arthroplasty: a cadaveric study</title><author>Sayako Sakai ; Shinichiro Nakamura ; Takahiro Maeda ; Shinichi Kuriyama ; Kohei Nishitani ; Yugo Morita ; Yusuke Yamawaki ; Yuki Shinya ; Shuichi Matsuda</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-kiss_primary_41289083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>kor</language><creationdate>2024</creationdate><topic>Anterior posterior stability</topic><topic>Knee</topic><topic>Ligament balancing</topic><topic>Medial release</topic><topic>Mediolateral gap</topic><topic>Total knee arthroplasty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sayako Sakai</creatorcontrib><creatorcontrib>Shinichiro Nakamura</creatorcontrib><creatorcontrib>Takahiro Maeda</creatorcontrib><creatorcontrib>Shinichi Kuriyama</creatorcontrib><creatorcontrib>Kohei Nishitani</creatorcontrib><creatorcontrib>Yugo Morita</creatorcontrib><creatorcontrib>Yusuke Yamawaki</creatorcontrib><creatorcontrib>Yuki Shinya</creatorcontrib><creatorcontrib>Shuichi Matsuda</creatorcontrib><collection>KISS</collection><collection>Korean Studies Information Service System (KISS) B-Type</collection><jtitle>Knee surgery &amp; related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sayako Sakai</au><au>Shinichiro Nakamura</au><au>Takahiro Maeda</au><au>Shinichi Kuriyama</au><au>Kohei Nishitani</au><au>Yugo Morita</au><au>Yusuke Yamawaki</au><au>Yuki Shinya</au><au>Shuichi Matsuda</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Medial soft tissue release is also related to the anterior stability of cruciate-retaining total knee arthroplasty: a cadaveric study</atitle><jtitle>Knee surgery &amp; related research</jtitle><addtitle>Knee Surgery and Related Research (Knee Surg Relat Res)</addtitle><date>2024-01-01</date><risdate>2024</risdate><volume>36</volume><spage>1</spage><pages>1-</pages><issn>2234-0726</issn><abstract>Background Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA. Methods Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension and 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability were compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed. Results Medial joint gap significantly increased from stages 1 to 3 by 3.2 mm, 6.8 mm, and 7.2 mm at extension, 45° flexion, and 90° flexion, respectively, and from stages 2 to 3 by 3.5 mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (-2.7° to 0.8°, -2.2° to 4.3°, and -5.5° to 2.5° at extension, 45° flexion, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5 mm and 8.2 mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495). Conclusions Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension.</abstract><pub>대한슬관절학회</pub><tpages>10</tpages></addata></record>
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subjects Anterior posterior stability
Knee
Ligament balancing
Medial release
Mediolateral gap
Total knee arthroplasty
title Medial soft tissue release is also related to the anterior stability of cruciate-retaining total knee arthroplasty: a cadaveric study
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