title: Biomechanical validation of medial pie-crusting for soft-tissue balancing in knee arthroplasty.
abstract: Balancing a varus knee is traditionally accomplished by releasing the medial soft-tissue sleeve off the tibia. Recently, "pie-crusting" (PC) medial structures has been described. In a biomechanical cadaver study we compared PC to traditional release (TR) to determine their effects on flexion and extension gaps. PC was done in five specimens along the anterior half of the medial soft-tissue sleeve and five along the posterior half, followed by a traditional release. In 90° flexion, valgus laxity after TR was significantly greater than after PC alone. PC of the anterior or posterior aspect of the medial soft-tissue sleeve can effect changes more in flexion than in extension, respectively. Complete TR did not provide more gap opening than PC in extension, but produced more effect in flexion.
authors.affiliation: University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical, Engineering, Memphis, Tennessee.
authors.forename: William M
authors.initials: WM
authors.lastname: Mihalko
authors.affiliation: University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical, Engineering, Memphis, Tennessee.
authors.forename: Erik L
authors.initials: EL
authors.lastname: Woodard
authors.affiliation: University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical, Engineering, Memphis, Tennessee.
authors.forename: Casey T
authors.initials: CT
authors.lastname: Hebert
authors.affiliation: University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical, Engineering, Memphis, Tennessee.
authors.forename: John R
authors.initials: JR
authors.lastname: Crockarell
authors.affiliation: University of Memphis Department of Biomedical Engineering, 330 Engineering Technology Building, Memphis, Tennessee.
authors.forename: John L
authors.initials: JL
authors.lastname: Williams
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001696:Biomechanical Phenomena; D060750:Bone Anteversion / Q000503:physiopathology / Q000601:surgery*; D002102:Cadaver; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control; D007717:Knee / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000601:surgery; D016059:Range of Motion, Articular; D013977:Tibia / Q000503:physiopathology / Q000601:surgery*
keywords: cadaver biomechanical study; gap balancing; pie-crusting technique; total arthroplasty; varus knee