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Weakening of the knee ligament complex due to sequential medial release in total knee arthroplasty.

Authors :
Völlner F
Fischer J
Weber M
Greimel F
Benditz A
Renkawitz T
Grifka J
Craiovan B
Source :
Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2019 Jul; Vol. 139 (7), pp. 999-1006. Date of Electronic Publication: 2019 Apr 08.
Publication Year :
2019

Abstract

Purpose: The purpose of this study was to investigate the effects of sequential medial release on the stiffness and collateral stability of the ligament complex of the knee. Irrespective of the implantation technique used, varus deformity frequently requires release of the capsular ligament complex. Yet, no data are available on how stiffness and stability of the knee ligament complex are weakened by such release.<br />Methods: After total knee arthroplasty, ten healthy Thiel-fixed knee joints were subjected to sequential medial release consisting of six release steps. After each step, stiffness and stability were determined at 0°, 30°, 60°, and 90°.<br />Results: Sequential medial release increasingly weakened the ligament complex. In extension, release of the anteromedial tibial sleeve 4 cm below the joint line already weakened the ligament complex by approximately 13%. Release 6 cm below the joint line reduced stiffness and stability by 15-20% over the entire range of motion. After detachment of the medial collateral ligament, stability was only about 60% of its initial value.<br />Conclusion: Our study showed for the first time the association between medial release and stiffness and stability of the knee ligament complex. To maintain stability, vigorous detachment of the knee ligament complex should be avoided. Release of the anteromedial tibial sleeve already initiates loss of stability. The main stabiliser is the medial ligament, which should never be completely detached.<br />Level of Evidence: IV.

Details

Language :
English
ISSN :
1434-3916
Volume :
139
Issue :
7
Database :
MEDLINE
Journal :
Archives of orthopaedic and trauma surgery
Publication Type :
Academic Journal
Accession number :
30963234
Full Text :
https://doi.org/10.1007/s00402-019-03181-z