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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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.

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Acknowledgements

We thank the following orthopedic surgeons for collecting data: Hiroyuki Akimoto, MD, Hirosaki National Hospital, Akira Fukuda, MD, Mutsu General Hospital, and Shugo Maeda, MD, Aomori Rosai Hospital.

Funding

The authors declare that they have no funding.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan

    Shizuka Sasaki, Eiji Sasaki, Yuka Kimura, Yuji Yamamoto & Yasuyuki Ishibashi

  2. Department of Orthopaedic Surgery, Aomori City Hospital, Aomori, Japan

    Harehiko Tsukada

  3. Department of Orthopaedic Surgery, Japan Community Health Care Organization Akita Hospital, Noshiro, Japan

    Hironori Otsuka

  4. Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    Eiichi Tsuda

Authors
  1. Shizuka Sasaki
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  2. Eiji Sasaki
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  4. Harehiko Tsukada
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  5. Hironori Otsuka
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  8. Yasuyuki Ishibashi
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Contributions

Contributors SS was responsible for the organization and coordination of this study. All authors contributed to the management of this study, acquisition, analysis, and interpretation of data. All authors approved the manuscript to be published.

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Correspondence to Shizuka Sasaki.

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The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the ethical committee of our institution.

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Informed consent was obtained from all individual participants included in the study.

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Sasaki, S., Sasaki, E., Kimura, Y. et al. Effect of medial collateral ligament release and osteophyte resection on medial laxity in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 29, 3418–3425 (2021). https://doi.org/10.1007/s00167-020-06257-1

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