Tightening medial collateral ligament during total knee arthroplasty for patients with fixed valgus deformity: A novel technique

Common peroneal nerve palsy after TKA in valgus deformities; a systematic review

PURPOSE

The aim of this systematic review is to investigate the prevalence of Common Peroneal Nerve Palsy after total knee arthroplasty in valgus deformities. Furthermore, the effectiveness of a peroneal nerve release prior to arthroplasty to prevent the palsy will be investigated.

METHODS

PubMed and Google Scholar were searched. Search terms regarding valgus deformity and total knee arthroplasty were used. Data analysis and extraction were performed using the web application 'Rayyan QCRI' according to PRISMA guidelines and screened according to the inclusion and exclusion criteria.

RESULTS

Twenty-seven studies were included, representing 1397 valgus knees. Knee balancing was performed in 19 studies with lateral soft tissue releases (1164 knees) and 8 studies (233 knees) with an additional osteotomy. Two studies (41 knees) in the lateral soft tissue release group conducted a peroneal nerve release simultaneous to arthroplasty. Common peroneal nerve palsies occurred in 26 cases (1.9%). Overall, no significant difference in palsy ratio between studies was found by using a peroneal nerve release (p = 0.90), between lateral soft tissue releases and osteotomies (p = 0.11) or between releases of specific ligaments.

CONCLUSION

Common peroneal nerve palsies occur in 1.9% of the cases after total knee arthroplasty in valgus deformities. No difference in the number of palsies was seen when using a peroneal nerve release or using different balancing techniques. However, literature about peroneal nerve releases was very limited, therefore, the effectiveness of a peroneal nerve release remains unclear.

LEVEL OF EVIDENCE

LEVEL III: Systematic review.

[Prevention and treatment of iatrogenic medial collateral ligament injuries in total knee arthroplasty]

Objective

To summarize the prevention and treatment of iatrogenic medial collateral ligament (MCL) injuries in total knee arthroplasty (TKA).

Methods

The relevant literature about iatrogenic MCL injuries in TKA was summarized, and the symptoms, causes, preventions, and treatments were analyzed.

Results

Preventions on the iatrogenic MCL injuries in TKA is significantly promoted. With the occurrence of MCL injuries, the femoral avulsion can be fixed with the screw and washer or the suture anchors; the tibial avulsion can be treated with the suture anchors fixation, bone staples fixation, or conservative treatment; the mid-substance laceration can be repaired directly; the autologous quadriceps tendon, semitendinosus tendon, or artificial ligament can be used for the patients with poor tissue conditions or obvious residual gap between the ligament ends; the use of implant with greater constraint can be the last alternative method.

Conclusion

No consensus has been reached to the management of iatrogenic MCL injuries in TKA. Different solutions and strategies can be integrated and adopted flexibly by surgeons according to the specific situation.