Table 1.
Soft tissue release techniques described for valgus knee correction in TKA and their clinical outcomes
| Author | No. of patients | Years of follow-up | Soft tissue release technique | Clinical outcomes |
|---|---|---|---|---|
| Insall (1979) [21] | 220 | 3–5 years | ITB, lateral capsule, LCL, POP, and posterior capsule along with lateral retinaculum | Postoperative HSS score: (62%) excellent; (28%) good; (4.5%) fair; (5.5%) poor |
| Whiteside (1999) [24] | 231 | 6 years | LCL, POP, ITB, Posterior capsule | None |
| Clarke (2004) [26] | 24 | 24–69 months | Pie crust technique of the posterolateral capsule and ITB |
mKSS: 97 (range 87–100) mROM: 121° (range 100°–145°) |
| Ranawat (2005) [6] | 35 | 5 years | “Inside-out” technique PCL, Pie crust technique of the posterolateral capsule and ITB |
Modified mKSSc score: 93 points postoperatively mKSSf: 81 points mROM: 110° both preoperatively and postoperatively The mean coronal alignment was corrected from 15° of valgus preoperatively to 5°of valgus postoperatively |
| Aglietti (2007) [28] | 48 | 5 years | Posterolateral capsule, LCL, ITB |
KSSc: 90 points KSSf: 83 points |
| McAuley (2008) [30] | 100 knees | Mean 8.2 years; range 0.1–18.2 years |
“Outside-in” releases (LCL and popliteus from the lateral epicondyle followed by deeper structures) in 46 knees “Inside-out” like Ranawat technique in 32 knees |
KSS (89 ± 13) when LCL and popliteus tendon preserved KSS (76 ± 24) when both released LCL and POP release increased the revision by 19.9 times LCL and POP release had lower KSS mediolateral laxity (more laxity) than those that had release of neither or one of the two structures |
| Politi and Scott (2004) [31] | 35 knees | Averaged 41.6 months (range 24–67 months) | Cruciform release of lateral retinaculum, PCL partially release only if excessive tight in flexion, release of the ITB and posterolateral capsule |
Preoperative valgus averaged 17°, and ROM averaged 10°–107° Postoperative valgus averaged 4.8°, average postoperative ROM was 2° to 110° Stable flexion and extension gaps were achieved in all cases |
| Mayer (2012) [32] | 47 patients (51 knees) | Mean follow-up time was 42 ± 23 months (range 19–107 months) | Excision of the menisci and cruciate ligaments, Posterolateral capsular release as the sole method of lateral release |
Preoperative Valgus angle 17.5 ± 4.6 (range 11–31 degrees) Postoperative 6.3 ± 2.2 (range 2–11 degrees) (p < 0.0001) Knee score improved from 5.4 ± 17.7 (range 20–61 points) preoperatively to 88.2 ± 15.8 (range 45–100 points) (p < 0.0001) Functional score improved from 24.8 ± 24.7 (range 20–80 points) preoperatively to 70 ± 30 (range 20–100 points) (p < 0.0001) |
| Peters (2013) [33] | 238 valgus knees | Selective release of the popliteus and PCL. Selective release of the ITB. Rarely release of the lateral posterior capsule and release of the LCL |
Valgus knees required more releases than neutral or varus knees (p < 0.001) Greater preoperative deformity required a greater number of releases KSS values in valgus knees with zero releases were greater compared with valgus knees with one or two releases |
ITB Ilio-tibial band, LCL Lateral collateral ligament, PCL Posterior cruciate ligament, POP Popliteus tendon, HSS Hospital for special surgery score, KSS Knee Society Score, KSSc Knee Society Score clinical, KSSf Knee Society Score functional, mKSS mean Knee Society Score