Abstract
Soft tissue balance is an essential step in total knee arthroplasty by providing a good knee stability and an even distribution of load over the prosthesis components. During surgery, because of the need of having a good balance in most cases is necessary to do some soft tissue release in the medial compartment. Lateral release is far more rare and is generally needed for patients with valgus knees after high tibial osteotomy. Our purpose is to evaluate the complications that arise during soft tissue release and how to manage this unfortunate events for getting the best functional results for the patients. In this study, we analyzed 434 knee arthroplasties that were operated in our clinic in the past 8 years by the same knee team (2005–2012). Average age was 64.8 years. Eight of this patients had medial collateral ligament injuries during surgery, and two had lateral collateral ligament rupture. Average age of patients who suffered from medial collateral ligaments injuries was 62.8 years and for lateral collateral ligaments was 72.5 years. Body mass index was 34 for both groups. We used for evaluation the knee society pain and functional scores, and X-rays obtained after the surgery with a calibrated Siemens machine. Seven patients with MCL repair were satisfied with after surgery (Knee Society score was 87.7, and functional score was 80). One complained of knee instability associated with pain and needed revision. In LCL group, all patients had excellent results (Knee Society score was 91.5, and functional score was 85). We found that repair to collateral ligaments injuries must be obtained during surgery, especially complete ruptures of the MCL. There are several approaches to collateral ligaments ruptures during total knee arthroplasty that will be discussed during the article.
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References
Ewald FC (1989) The Knee Society total knee arthroplasty—roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
Hofmann S (2003) Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty. Orthopade 32:469–476
Sparmann M et al (2003) Positioning of the total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg [Br] 85:830–835
Victor J et al (1994) Femoral intramedullary instrumentation in total knee arthroplasty: the role of pre-operative X-ray analysis. Knee 1:123–125
Krackow KA, Jones MM, Teeny SM, Hungerford DS (1991) Primary total knee arthroplasty in patients with severe varus deformity. A comparative study. Clin Orthop Relat Res 273:19
Easley ME, Insall JN, Scuderi GR, Bullek DD (2000) Primary constrained condylar knee arthroplasty for the arthritic valgus knee. Clin Orthop Relat Res 380:58
Luring C, Hunter T, Perlick L, Bathis H, Krettek C, Grifka J (2006) The effectiveness of sequential medial soft tissue release on coronal alignment in total knee arthroplasty using a computer navigation model. J Arthroplasty 21:428–434
Naudie DDR, Rorabeck CH (2004) Managing instability in total knee arthroplasty with constrained and linked implants. Instr Course Lect 53:207
Scuderi GR (2001) Revision total knee arthroplasty. Clin Orthop Relat Res 392:300
Koo MH, Choi CH (2009) Conservative treatment for the intraoperative detachment of medial collateral ligament from the tibial attachment site during primary total knee arthroplasty. J Arthoplasty 24:1249–1253
Leopold SS, McStay C, Klafeta K, Jacobs JJ, Berger RA, Rosenberg AG (2001) Primary repair of intraoperative disruption of the medial collateral ligament during total knee arthroplasty. J Bone Joint Surg Am 83:86
Whiteside LA (1993) Correction of ligament and bone defects in total knee arthroplasty of the severely valgus knee. Clin Orthop Relat Res 288:234
Sculco TP (1989) Total condylar III prosthesis in ligament instability. Orthop Clin North Am 20:221
Lee GC, Lotke PA (2011) Management of intraoperative medial collateral ligament injury during tka. Clin Orthop Realt Res 469(1):64–68
Cameron HU, Hunter GA (1982) Failure in total knee arthroplasty. Mechanisms, revisions, and results. Clin Orthop Relat Res 170:141
Puloski SK, McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB (2001) Tibial post wear in posterior stabilized total knee arthroplasty: an unrecognized source of polyethylene debris. J Bone Joint Surg Am 83:390
Lachiewicz P, Soileau E (2006) Ten year survival of and clinical results of constrained components in total knee arthroplasty. J Arthroplasty 21:803
Hartford JM, Goodman SB, Schurman DJ, Knoblick G (1998) Complex primary and revision total knee arthroplasty using the condylar constrained prosthesis. An average 5 year follow up. J Arthroplasty 13:380
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Dragosloveanu, S., Cristea, S., Stoica, C. et al. Outcome of iatrogenic collateral ligaments injuries during total knee arthroplasty. Eur J Orthop Surg Traumatol 24, 1499–1503 (2014). https://doi.org/10.1007/s00590-013-1330-y
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DOI: https://doi.org/10.1007/s00590-013-1330-y