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Thongpulsawasdi N, Achawakulthep C, Intiyanaravut T, Anusitviwat C, Yuenyongviwat V. Predictive factors for deep medial collateral ligament release in adjusted mechanical alignment total knee arthroplasty. J Orthop Surg Res 2024; 19:594. [PMID: 39342361 PMCID: PMC11437786 DOI: 10.1186/s13018-024-05046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 09/01/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) demands precision in achieving optimal alignment and soft tissue balance, especially in cases of medial compartment osteoarthritis where the need for medial soft tissue release is critical yet challenging to ascertain. OBJECTIVE This study aims to systematically investigate the relationship between preoperative data, initial knee conditions and the necessity for deep collateral ligament (MCL) release in adjusted mechanical alignment total knee arthroplasty. METHODS We conducted a retrospective study involving 61 TKA patients who underwent adjusted mechanical alignment robotic-assisted procedures. Soft tissue release was carried out when clinically indicated. We collected and statistically analyzed patient demographics, initial knee conditions, and surgical details. RESULTS Among the patients, 52% required deep MCL release. Notably, patients without soft tissue release exhibited lower initial hip-knee-ankle (HKA) angles, reduced varus-valgus stress test angles, and a greater range of flexion. We identified a predictive threshold HKA angle of 6.250 degrees, demonstrating high sensitivity and specificity for determining the need for deep MCL release. CONCLUSION This study underscores the significance of the initial HKA angle and varus-valgus stress tests in predicting deep MCL release during TKA. The established HKA angle threshold simplifies surgical decision-making, reducing the likelihood of unnecessary soft tissue release.
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Affiliation(s)
- Nimit Thongpulsawasdi
- Golden jubilee medical center, Faculty of Medicine Siriraj hospital, Mahidol university, Nakhon Pathom, 73170, Thailand
| | - Chaiwat Achawakulthep
- Golden jubilee medical center, Faculty of Medicine Siriraj hospital, Mahidol university, Nakhon Pathom, 73170, Thailand
| | - Tawan Intiyanaravut
- Golden jubilee medical center, Faculty of Medicine Siriraj hospital, Mahidol university, Nakhon Pathom, 73170, Thailand
| | - Chirathit Anusitviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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Ichiyanagi K, Kuriyama S, Sakai S, Maeda T, Yamawaki Y, Nishitani K, Nakamura S, Matsuda S. Small medial proximal tibial angle is a radiographic finding strongly associated with less coronal alignment correction under valgus stress in medial knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2024; 32:645-655. [PMID: 38409922 DOI: 10.1002/ksa.12095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE The degree to which varus knees can be corrected manually is important when considering total versus unicompartmental knee arthroplasty (UKA). The primary aim was to clarify the relationship between the degree of coronal alignment correction and radiographic parameters involved in UKA prognosis using preoperative full-length lower extremity valgus stress radiography. The secondary aim was to identify the factors affecting alignment correction. METHODS This retrospective observational study included 115 knees with medial osteoarthritis that underwent knee osteotomy or arthroplasty. Percent mechanical axis without valgus stress (%MA: neutral, 50%; varus, <50% and valgus, >50%), mechanical lateral distal femoral angle, lateral bowing femoral angle, medial proximal tibial angle (MPTA), joint line convergence angle, medial and lateral joint space width (LJSW) and medial femoral and tibial joint osteophyte size were measured using preoperative full-length weight-bearing radiographs. Correlation and multiple linear regression analyses were used to assess associations between parameters and %MA with valgus stress or amount of %MA change (%MA with valgus stress minus %MA without valgus stress). RESULTS %MA with valgus stress was correlated with all radiographic parameters. %MA change was correlated with parameters except for MPTA and LJSW. Multiple regression analyses showed that %MA without valgus stress and MPTA were associated with both %MA with valgus stress and %MA change. When %MA with valgus stress was set at 30%, 40% and 50%, MPTA cutoff values were 81.6°, 83.5° and 84.9°, and cutoffs for %MA without valgus stress were 10.7%, 17.1% and 25.1%, respectively. CONCLUSION Small MPTA is strongly associated with less alignment correction under valgus stress in varus knees. The finding is useful in surgical planning, especially to avoid undercorrection with UKA when valgus stress radiographs are unavailable. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kazuki Ichiyanagi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayako Sakai
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahiro Maeda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Yamawaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Sappey-Marinier E, Meynard P, Shatrov J, Schmidt A, Cheze L, Batailler C, Servien E, Lustig S. Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs. Knee Surg Sports Traumatol Arthrosc 2022; 30:2915-2921. [PMID: 35013747 DOI: 10.1007/s00167-021-06832-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The alignment goal in total knee arthroplasty (TKA) remains debated. Two major strategies have emerged based on recreating the native knee: kinematic and functional alignment (KA and FA). Recently a new Coronal Plane Alignment of the Knee (CPAK) classification for KA, based on bony landmarks, was described considering joint line obliquity and the arithmetic HipKneeAnkle angle (aHKA). Valgus corrected HKA medial angle (vcHKA) was measured on distractive valgus preoperative radiographs compensating for cartilage wear and ligament balance in varus osteoarthritis. The purpose of this study was to determine if aHKA accounts for differences in medial laxity for the extension gap by comparing vcHKA to aHKA. The hypothesis was that no significant difference would be observed between the two measurements. METHODS This is a retrospective analysis of 749 knees in consecutive patients presenting to a single-centre with primary medial osteoarthritis. Patients underwent standardized weight bearing long-leg and valgus stress radiographs. Tibial mechanical angle (TMA), femoral mechanical angle (FMA) and vcHKA were measured using digital software. aHKA and vcHKA were compared to determine differences due to soft tissue balancing. RESULTS The mean FMA was 91.3 ± 2.2° (range 82°-97°), the mean TMA was 85.7 ± 2.5° (range 75°-98°), the mean aHKA was 177.0 ± 3.0° (range 164°-185°) and the mean vcHKA was 176.6 ± 3.1° (range 165°-192°). No significant difference was observed between aHKA and vcHKA (p = 0.06). A significant correlation was found between vcHKA and TMA (ρ = 0.3; p < 0.001) and between vcHKA and FMA (ρ = 0.41; p < 0.001). CONCLUSION This study showed that vcHKA was similar to aHKA confirming that aHKA accounts for ligamentous medial laxity. Therefore, kinematic alignment based on the CPAK classification matches the pre-arthritic coronal alignment of the knee for the extension gap. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France. .,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France.
| | - P Meynard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France
| | - J Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.,University of Notre Dame Australia, Sydney, Australia.,Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - A Schmidt
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France
| | - L Cheze
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - C Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - E Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - S Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
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Sajjadi MM, Okhovatpour MA, Safaei Y, Faramarzi B, Zandi R. Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty? J Knee Surg 2022; 35:1192-1198. [PMID: 33482674 DOI: 10.1055/s-0040-1721787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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.
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Affiliation(s)
- Mohammadreza Minator Sajjadi
- Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Okhovatpour
- Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yaser Safaei
- Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrooz Faramarzi
- Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Zandi
- Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zan P, Fan L, Liu K, Yang Y, Hu S, Li G. Reduction Osteotomy versus Extensive Release on Clinical Outcome Measures in Simultaneous Bilateral Total Knee Arthroplasty. Med Sci Monit 2017; 23:3817-3823. [PMID: 28781360 PMCID: PMC5560193 DOI: 10.12659/msm.905815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background During total knee arthroplasty (TKA) in varus knee deformities, reduction osteotomy (RO) and medial soft tissue release are alternative techniques to aid in achieving deformity correction. In this study, we investigated the effect of RO compared to extensive medial soft tissue release (ER) on clinical outcome measures in simultaneous bilateral TKA. Material/Methods We prospectively enrolled 24 patients (48 knees) with bilateral varus knee deformity from July 2014 to December 20l5. For each patient, one knee was assigned to the RO group and the contralateral knee was assigned to ER group. One year postoperative, follow-up outcomes were collected and analyzed. Results Time to 90° flexion of the knee was significantly different in the RO group (1.6±0.3 days) compared to the ER group (2.0±0.4 days) (p<0.001). Using a 10-item patient reported outcome questionnaire, total scores were significantly different between the RO group (86.3±3.2) and the ER group (82.4±2.7) (p<0.001). Analysis of variance showed a significant difference on the visual analogue scale (VAS) score (p<0.001) but no significant difference in the range of motion (ROM) of the knee (p>0.05) during the follow-up year. Conclusions Knees treated with RO were associated with greater improvements in pain and function than knees treated with conventional ER technique. Additionally, RO technique did not confer an increased risk for adverse clinical outcomes. RO may therefore by a safe method to decrease postoperative pain, achieve earlier functional recovery, and increase patients’ subjective satisfaction after TKA.
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Affiliation(s)
- Pengfei Zan
- Department of Orthopedic Surgery, The Tenth People's Hospital Affiliated to Tongji University, Shanghai, China (mainland)
| | - Lin Fan
- Department of Orthopedic Surgery, The Tenth People's Hospital Affiliated to Tongji University, Shanghai, China (mainland)
| | - Kaiyuan Liu
- Department of Orthopedic Surgery, The Tenth People's Hospital Affiliated to Tongji University, Shanghai, China (mainland)
| | - Yong Yang
- Department of Orthopedic Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China (mainland)
| | - Shuo Hu
- Department of Orthopedic Surgery, The Tenth People's Hospital Affiliated to Tongji University, Shanghai, China (mainland)
| | - Guodong Li
- Department of Orthopedic Surgery, The Tenth People's Hospital Affiliated to Tongji University, Shanghai, China (mainland)
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