Soft tissue Balancing In Varus Knee

Yazdi HR MD

Fellowship of Knee surgery

Associated Professor of IUMS

Do you do tis patient?What is your approach?How do you balance the knee?Which implant do you prefer?

• Techniques : gap technique

and the measured resection

technique

• Gap technique may result

in residual varus alignment

in flexion( Whiteside et al)

• Bone resections :according to

the preoperative template on

the long WB films

• Tibial cutting jig :according to

the talus center distally and

the plateau-to-anatomic axis

intersection proximally.

• In constitutional metaphyseal

varus deformities: usually

facing the lateral tibial plateau

spine

initial medial release

• medial flap of tissue, which includes the meniscotibial fibers of the deep medial collateral ligament

• sublux the tibia forward in flexion and external rotation (RanSall maneuver)

• violating the posterior tibial osteophyte(pagoda)

• tibial and femoral osteophytes are removed

• Do proximal tibial and distal femoral cuts

• Anteror and posterior femoral cuts

• Medial pivot if needed

Tight soft tissue structures in varus knees

•PCL

•Posterior capsule

• Posteromedial corner with

the posterior oblique

Ligament

(POL)

• Semimembranosus

(direct tibial insertion)

• Posterior fibers of the

superficial MCL

• All these structures can be

released with the knee in

Flexion

Release

posterior capsule can be

addressed by a

periosteal elevator

from the femoral side.

figure four” position to

release SM and POL

Release

• MCL

Pie-crusted with a 16 Gauge needle with multiple Punctures

Distal release

Shift and resect technique

Medial epicondylar Ost.

Effect of medial epicondylar osteotomy on soft tissue balancing in total knee arthroplasty. Mihalko WM, Saeki K, Whiteside LA.

• findings of this study question the need for an epicondylar osteotomy in severe varus osteoarthritic knees. Because the knee remains unstable in flexion after this technique, an implant with higher constraint should be used.

Orthopedics. 2013 Nov 1;36(11):e1353-7

Results of total knee arthroplasty with medial epicondylar osteotomy to correct varus deformity.Engh GA, Ammeen D.• The results show that epicondylar osteotomy

for varus knee deformity provides excellent patient satisfaction, knee stability, motion, and deformity correction.

Clin Orthop Relat Res. 1999 Oct;(367):141-8.

Medial epicondyle osteotomy: a method of choice in severe varus knee arthroplasty Horia Orban Gabriel Stan Mihaela Dragusanu Razvan Adam

Using medial epicondyle osteotomy for varus knee when performing total knee arthroplasty could be a useful ligament-balancing technique to achieve medial stability of the knee. In addition, it could have considerable advantages towards the additional resection of the tibial medial plateau.

European Journal of Orthopaedic Surgery & Traumatology 2012 | 22 | 7 | 579-583

Fibular Ost.

A 65 Y/o FSever Bi varus deformity

End Results

Thank you