Research Article
Volume 11 Issue 9 - 2020
Multiple Puncturing of Medial Collateral Ligament in Extension with Trial Implants and Valgus Stress: An Excellent Method for Coronal Plane Balancing in Severe Genu Varus
Sharath Kittanakere Ramanath1, Rahul Hemant Shah2*, Jay Palak3, Sandesh Patil2 and Sarayoo Ravishankar Vaidya4
1Associate Professor, Department of Orthopaedics, Ramaiah Medical College and Hospitals, Bengaluru, India
2Junior Resident, Department of Orthopaedics, Ramaiah Medical College and Hospitals, Bengaluru, India
3Arthroplasty Fellow, Department of Orthopaedics, Ramaiah Medical College and Hospitals, Bengaluru, India
4Intern, Department of Orthopaedics, Ramaiah Medical College and Hospitals, Bengaluru, India
*Corresponding Author: Rahul Hemant Shah, Junior Resident, Department of Orthopaedics, Ramaiah Medical College and Hospitals, Bengaluru, India.
Received: July 08, 2020; Published: August 29, 2020




Abstract

Background: Success of total knee arthroplasty (TKA) depends on lower limb alignment and soft tissue balancing. It is unusual to have higher degrees of genu varus deformity in the western countries unlike the Indian subcontinent. Here, we describe a method involving multiple puncturing of medial collateral ligament of the knee in patients with more than 20° varus.

Methods: We included 55 patients in the study (27 males and 28 females). Pre-operative varus deformity on radiographs, knee flexion and Knee Society Score (KSS) were compared with post-operative valgus, knee flexion and KSS in all the patients. Medial parapatellar approach was performed in all the patients. Puncturing of the MCL was performed after taking the bone cuts and inserting trial implants. Intra-operative stability and range of motion was checked.

Results: Minimum follow-up period was 3 years. There was a significant improvement in the deformity (from mean varus of 27.67° to mean valgus of 4.82°), range of motion (from mean flexion of 86.65° to mean flexion of 119.2°) and KSS (from mean score of 25.35 to 97.22) in all the patients. A ratio between the number of punctures to pre-operative varus (3.983) was noted. All the patients were operated using unconstrained and semi-constrained implants.

Conclusion: Multiple puncturing of the MCL is a reliable method to achieve correction and soft tissue balancing in genu varus > 20°. It helps to balance the knee in both flexion and extension so that the level of constrained can be kept to as minimum as possible.

Keywords: Total Knee Arthroplasty; Genu Varus; Osteoarthritis; Medial Collateral Ligament; Multiple Puncturing

References

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Citation: Rahul Hemant Shah., et al. “Multiple Puncturing of Medial Collateral Ligament in Extension with Trial Implants and Valgus Stress: An Excellent Method for Coronal Plane Balancing in Severe Genu Varus”. EC Orthopaedics 11.9 (2020): 14-23.

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