A Novel Medial Soft Tissue Release Method for Varus Deformity during Total Knee Arthroplasty: Femoral Origin Release of the Medial Collateral Ligament

ABSTRACT

INTRODUCTION: Numerous methods of medial soft tissue release for severe varus deformity during total knee arthroplasty (TKA) have been reported. These include tibial stripping of the superficial medial collateral ligament (MCL), pie-crusting technique, and medial epicondylar osteotomy. However, there are inherent disadvantages in these techniques. Authors hereby present a novel quantitative method: femoral origin release of the medial collateral ligament (FORM). SURGICAL TECHNIQUE: For medial tightness remaining even after the release of the deep MCL and semimembranosus, the FORM is initiated with identification of the femoral insertion area of the MCL with the knee in flexion. Starting from the most posterior part of the femoral insertion, one third of the MCL femoral insertion is released from its attachment. If necessary, further sequential medial release is performed. MATERIALS AND METHODS: Seventeen knees that underwent the FORM were evaluated for radiological and clinical outcomes. RESULTS: Regardless of the extent of the FORM, no knees showed residual valgus instability at 24 weeks after surgery. CONCLUSIONS: As the FORM is performed in a stepwise manner, fine adjustment during medial release might be beneficial to prevent inadvertent over-release of the medial structures of the knee.