Comparison of Subperiosteal Elevation and Multiple Needle Puncturing of Superficial Medial Collateral Ligament during Ligament Balancing in Total Knee Arthroplasty of Varus Knee
10.4055/jkoa.2024.59.6.415
- Author:
KiWon LEE
1
;
Young-Joon CHOI
;
Joo-Yul BAE
;
Sungyoon CHO
;
Taehwan AHN
Author Information
1. Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
- Publication Type:Original Article
- From:The Journal of the Korean Orthopaedic Association
2024;59(6):415-421
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Medial soft tissue release in knee varus deformities during total knee arthroplasty (TKA) is necessary for adequate gap balancing.This study compared the clinical outcomes and complications of subperiosteal elevation (SE) and multiple needle puncturing (MNP) for superficial medial collateral ligament (sMCL) release and evaluated the effectiveness and safety of MNP.
Materials and Methods:This study retrospectively analyzed 152 patients who underwent both TKA and sMCL release for degenerative osteoarthritis with varus alignment; one knee from each patient underwent SE and the other underwent MNP between April 2018 and April 2020. In SE, subperiosteal release was performed on the proximal tibia of the anterior portion of the sMCL using a curved osteotome. For MNP, an 18-gauge needle was used to puncture the sMCL. The clinical outcomes, including knee further flexion (FF), flexion contracture (FC), range of motion (ROM) and Knee Society (KS) scores, were compared. Surgical complications, including sMCL overrelease, were also evaluated.
Results:For the SE and MNP groups, the preoperative KS scores (31.05 vs. 31.78), knee alignment (varus angle, 4.22° vs. 3.76°), FF (125.86° vs. 126.48°), FC (6.09° vs. 5.69°) and ROM (119.77° vs. 120.79°) did not differ preoperatively. At one-year follow-up, postoperative KS scores, FF, FC and ROM were similar in the two groups (93.01 vs. 92.64 points; 134.24° vs. 134.64°; 0.36° vs. 0.49°; 133.88° vs. 134.14°;p=0.662, 0.749, 0.493 and 0.835 respectively), and no statistically significant differences in terms of postoperative pain and KS pain score were observed between the two groups (66 vs. 58 patients and 43.31 vs. 43.04 points; p=0.473 and 0.745, respectively). In the SE group, five cases showed intraoperative over-release of the sMCL and a significant difference from the MNP group (p=0.024) but showed no medial instability at the final follow-up.
Conclusion:Compared with the SE technique, MNP showed no significant difference in the clinical outcomes and fewer complications, such as over-release of the sMCL, and could be a safer alternative to achieve a balanced TKA.
