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Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty

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Clinical Orthopaedics and Related Research®



In TKA, soft tissue balance (the joint gap) depends on the amount of resected bone and soft tissue release. Some studies report preoperative bony deformity correlates with soft tissue balance evaluated intraoperatively and that the medial tissues are contracted with varus deformity. However, these studies did not take into account the amount of resected bone and did not describe whether the soft tissue was tight or loose. Therefore, it remains unclear whether in varus deformity the soft tissues on the medial side are contracted.


We compared (1) intraoperative joint gap, (2) amount of resected bone, and (3) intraoperative soft tissue laxity on the lateral and medial sides according to severity of preoperative varus deformity.


We retrospectively reviewed 70 patients with osteoarthritis and varus deformities who underwent 90 TKAs. We retrospectively divided the 90 knees into three groups according to degree of preoperative alignment: mild varus group (< 10°), moderate varus group (10°–20°), and severe varus group (> 20°). To evaluate intraoperative soft tissue tension, we calculated the soft tissue gap by subtracting the thickness of the resected bone from the joint gaps on the medial and lateral sides, respectively. We then explored the relationship between the soft tissue gap and preoperative alignment.


The lateral soft tissue gap was larger in the severe varus group than in the mild and moderate varus groups. The medial soft tissue gap was larger in the severe varus group than in the mild varus group, but there were no differences in the medial joint gaps among the groups.


After the bone is resected, the soft tissue on the lateral side is more lax; however, the soft tissue on the medial side is not shorter with greater preoperative varus deformity.

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We thank Shinya Kawahara MD and Hiroyuki Nakahara MD who crosschecked the data.

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Correspondence to Ken Okazaki MD, PhD.

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The institution of one or more of the authors (KO) received funding, during the study period, from the Japanese Society for the Promotion of Science Grants-in Aid Scientific Research Program (Grant Number 23000011). The study was funded by internal sources from the Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution has approved the human protocol for this investigation, all investigations were conducted in conformity with ethical principles of research, and informed consent for participation in the study was obtained.

This work was performed at Kyushu University, Fukuoka, Japan.

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Okamoto, S., Okazaki, K., Mitsuyasu, H. et al. Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty. Clin Orthop Relat Res 471, 1334–1342 (2013).

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