title: How effective is multiple needle puncturing for medial soft tissue balancing during total knee arthroplasty? A cadaveric study.
abstract: We investigated the quantitative effect and risk factors for over-release during multiple needle puncturing (MNP) for medial gap balancing in varus total knee arthroplasty (TKA). Of the ten pairs of cadaveric knees, one knee from each pair was randomly assigned to undergo MNP in extension (E group), while the other knee underwent MNP in flexion (F group). The increased extension and 90° flexion gaps after every five needle punctures were measured until over-release occurred. The extension gap (< 4mm) and the 90° flexion gap (< 6mm) gradually increased in both groups. The 90° flexion gaps increased more selectively than did the extension gaps. MNP in the flexed knee, a narrow MCL, and severe osteoarthritis were associated with a smaller number of MNPs required to over-release.
authors.affiliation: Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, Uijeongbu-si, Gyeonggi-do, Korea; Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: In Jun
authors.initials: IJ
authors.lastname: Koh
authors.affiliation: Catholic Institute for Applied Anatomy, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Dai-Soon
authors.initials: DS
authors.lastname: Kwak
authors.affiliation: Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
authors.forename: Tae Kyun
authors.initials: TK
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, Uijeongbu-si, Gyeonggi-do, Korea; Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: In Joo
authors.initials: IJ
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: Yong
authors.initials: Y
authors.lastname: In
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002102:Cadaver; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D009339:Needles; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011677:Punctures / Q000295:instrumentation*
keywords: gap balancing; medial collateral ligament; multiple needle puncturing; total knee arthroplasty; varus