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Selective Ligament Release in Total Knee Arthroplasty of the Knee in Valgus

Whiteside, Leo, A.

Clinical Orthopaedics and Related Research: October 1999 - Volume 367 - Issue - p 130–140
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An approach to the valgus knee based on anatomic function of ligaments in flexion and extension consistently yields a knee that is balanced in flexion and extension when the implants have been positioned correctly. Two hundred thirty-one knees had a valgus deformity (range, 12°–45°) and were corrected with valgus alignment to 5° by resecting the intact joint surfaces to match implant thickness. Femoral joint surfaces were aligned in 5° valgus to the long axis of the femur and parallel to the epicondylar axis of the femur in flexion and extension. The tibial surfaces were aligned perpendicular to the long axis of the tibia. For knees that were tight in flexion and extension, the lateral collateral ligament and popliteus tendon were released. Those knees that remained tight only in extension had release of the iliotibial band. Posterior capsular release was done only when necessary for persistent lateral ligament tightness. Neither ligament advancement procedures nor varus or valgus stabilized implant systems were needed to achieve stability with this procedure. The knees with ligament releases all fell within a range of 4° to 7° mean varus and valgus laxity, and were not significantly different from one another. No cases of clinical instability occurred, and joint stability did not deteriorate with time.

From Biomechanical Research Laboratory, Missouri Bone and Joint Center, Barnes—Jewish West County Hospital, St. Louis, MO.

© 1999 Lippincott Williams & Wilkins, Inc.