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The computer-assisted sequential lateral soft-tissue release in total knee arthroplasty for valgus knees

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Abstract

Soft-tissue management is a critical factor in total knee arthroplasty, especially in valgus knees. The stepwise release has been based upon surgeon’s experience. Computer-assisted surgery has gained increasing scientific interest in recent times and allows the intraoperative measurement of leg axis and gap size in extension and flexion. We therefore aimed to analyse the effect of sequential lateral soft-tissue release and the resulting change in the a.p. limb axis on the one hand and the tibiofemoral gaps on the other hand in extension as well as in flexion in eight cadaveric knees. Measurements were obtained using a CT-free navigation system. In extension the highest increase compared to the previous release step was found for the first (iliotibial band, P = 0.002), second (popliteus muscle, P = 0.0003), third (LCL, 0.007) and the sixth (entire PCL, P = 0.001) release step. In 90° flexion all differences of the lateral release steps were statistically significant (P < 0.004). Massive progression of the lateral gap in flexion was found after the second (popliteus muscle, P = 0.004) and third (LCL, 0.007) release step. Computer-assisted surgery allows measurement of the effect of each release step of the sequential lateral release sequence and helps the surgeon to better assess the result.

Résumé

La libération des tissus mous lors de la réalisation d’une prothèse totale du genou est un facteur important notamment dans les génu valgum. Les techniques de «releases» sont bien connues des chirurgiens. La chirurgie assistée par ordinateur permet de mesurer en peropératoire les axes et les espaces en flexion et en extension. Pour cela nous avons mesuré tous ces paramètres lors d’une expérimentation sur 8 genoux de cadavre, utilisant un système de navigation avec en extension, libération de la bandelette iliotibiale (P = 0.002) puis du muscle poplité (P = 0.003) et enfin, du ligament collatéral (P = 0.007), en sixième position libération du ligament croisé postérieur (P = 0.001). A 90° de flexion toutes les étapes de la libération tissulaire sont importantes. L’étape importante pour redonner de l’espace est atteinte après libération du muscle poplité puis du ligament collatéral. La chirurgie assistée par ordinateur permet de mesurer les effets de chaque étape de cette libération tissulaire et permet donc aux chirurgiens d’améliorer leurs résultats.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Germany

    C. Luring, F. Oczipka, J. Grifka & L. Perlick

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  1. C. Luring
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  2. F. Oczipka
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  3. J. Grifka
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  4. L. Perlick
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Correspondence to C. Luring.

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Luring, C., Oczipka, F., Grifka, J. et al. The computer-assisted sequential lateral soft-tissue release in total knee arthroplasty for valgus knees. International Orthopaedics (SICO 32, 229–235 (2008). https://doi.org/10.1007/s00264-006-0314-5

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  • DOI: https://doi.org/10.1007/s00264-006-0314-5

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