title: Primary total knee arthroplasty in the valgus knee: creating a balanced soft tissue envelope.
abstract: Lateral tissue releases in valgus total knee arthroplasty frequently produce asymmetric flexion-extension gaps and ligamentous instability. This study compared 2 lateral-release sequences and quantified the effects of sequential lateral capsular ligamentous structure release. One knee from 7 paired specimens was released according to a 4-step sequence: posterior cruciate ligament (PCL), ibiotibial tract (IT band), popliteus tendon/lateral collateral ligament (PT/LCL), and biceps femoris tendon. The contralateral knees were released according to a 5-step sequence: PCL, posterolateral capsule, IT band, PT, and LCL. After each release step, flexion and extension gaps were measured and recorded for the medial and lateral aspects. The 5-step sequence produced more symmetric flexion-extension gaps, whereas the absolute magnitudes of correction were lower than with the 4-step sequence. LCL sacrifice in both sequences produced marked lateral flexion-extension gap asymmetry.
authors.affiliation: Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah 84112, USA. chris.peters@hsc.utah.edu
authors.forename: C L
authors.initials: CL
authors.lastname: Peters
authors.forename: R A
authors.initials: RA
authors.lastname: Mohr
authors.forename: K N
authors.initials: KN
authors.lastname: Bachus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D001696:Biomechanical Phenomena; D017760:Bone Malalignment / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D008023:Ligaments, Articular / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome