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Constitutional alignment predicts medial ligament balancing in mechanically aligned total knee arthroplasty for varus knees

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to identify if constitutional alignment and preoperative radiologic parameters determined whether medial gap balancing was required in mechanically aligned total knee arthroplasty (TKA).

Methods

Two hundred and sixty three patients with 394 consecutive knees who underwent primary TKAs were retrospectively analysed in this study. Selective sequential multiple needle puncturing (MNP) was performed for medial ligament balancing when required. Constitutional alignment, which was determined using the Coronal Plane Alignment of the Knee (CPAK) classification, as well as preoperative and postoperative radiologic parameters was evaluated to identify factors which predicted the need for MNP.

Results

One hundred and fifty eight (40.1%) knees required medial ligament balancing with MNP. Patients who required MNP during surgery had significantly more constitutional varus, more varus preoperative mechanical Hip–Knee–Ankle angle (mHKA), smaller preoperative medial proximal tibial angle (MPTA) and a larger change in mHKA and MPTA after surgery than those who did not. Patients with constitutional varus also had a higher incidence of having had MNP to both anterior and posterior superficial medial collateral ligament (sMCL) fibres. There was no significant difference in preoperative lateral distal femoral angle (LDFA), posterior tibial slope (PTS) and varus–valgus difference (VVD) between groups.

Conclusion

Ligament balancing using MNP was determined by constitutional alignment rather than medial soft tissue contracture. Patients with constitutional varus who had a larger medio-lateral gap difference in extension also had a higher incidence of having had MNP to both anterior and posterior sMCL fibres.

Level of evidence

Retrospective comparative study, level IV.

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Data Availability

Not applicable.

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Funding

This work was supported by the grant funded by the National Research Foundation of Korea (No.2021R1A2C1092657). Institutional Review Board approval was obtained before performing the study (B-2212-796-101).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia

    Jade Pei Yuik Ho

  2. Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    Joon Hee Cho, Hee Seung Nam, Seong Yun Park & Yong Seuk Lee

Authors
  1. Jade Pei Yuik Ho
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  2. Joon Hee Cho
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  3. Hee Seung Nam
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  4. Seong Yun Park
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  5. Yong Seuk Lee
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Corresponding author

Correspondence to Yong Seuk Lee.

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Conflict of interest

The authors declare no conflict of interest in performing this work.

Ethical approval statement

The study protocol was approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB No. B-2212-796-101) prior to commencement. This study was designed and conducted following the STROBE guidelines and in agreement with the Declaration of Helsinki.

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Ho, J.P.Y., Cho, J.H., Nam, H.S. et al. Constitutional alignment predicts medial ligament balancing in mechanically aligned total knee arthroplasty for varus knees. Knee Surg Sports Traumatol Arthrosc 31, 5940–5949 (2023). https://doi.org/10.1007/s00167-023-07660-0

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  • DOI: https://doi.org/10.1007/s00167-023-07660-0

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