Multiple needle puncturing may provide sufficient medial ligament balancing after TKA
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Published results showed patients with varus aligned knees who underwent total knee arthroplasty experienced safe and sufficient medial release with functional medial ligament balancing with stepwise, multiple needling puncturing.
Yong Seuk Lee, MD, PhD, and colleagues assessed mediolateral stability using serial stress radiographs which were postoperatively compared at 6 months and 1 year between 81 patients with 129 knees that underwent TKA either with or without functional stepwise, multiple needle puncturing of the superficial medial collateral ligament. Researchers also evaluated clinical outcomes between patients who did and did not undergo multiple needle puncturing. Depending on the site and degree of tightness, researchers performed multiple needle puncturing of the superficial MCL selectively and sequentially.
Results showed additional stepwise, multiple needle puncturing was needed in 55 TKAs, including anterior needling in 19 knees, posterior needling in three knees and both anterior and posterior needling in 33 knees. Researchers found a significant difference between the multiple needle puncturing and the non-multiple needle puncturing groups for preoperative hip-knee-ankle angle and varus-valgus stress angle. However, during serial assessment, the varus-valgus stress angle was not significantly different between the two groups, according to results. Researchers also noted no significant differences between the two groups in clinical outcomes, including range of motion.
“Functional stepwise, multiple needle puncturing for medial ligament balancing in varus total knee arthroplasty is a safe and effective method. Our study demonstrated the safety of this procedure with no compromise to the medial and lateral stability,” Lee told Healio Orthopedics. “This technique could be adopted with different strategies according to the site and degree of tightness and it is reproducible and predictable intraoperatively.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Brian P. Gladnick, MD
The authors provide a rational and straightforward approach to fine-tuning the balance of the medial collateral ligament during TKA in a varus knee. The algorithm they use is easy to follow and allows for a safe, controlled medial release in a stepwise fashion. While similar needle-puncture or pie-crusting techniques have been previously reported, the present study is interesting in that the authors were able to specifically quantify how many millimeters of release can be expected for a given number of needle punctures, allowing for a precise level of balancing.
Another important learning point from this article is the authors’ appropriate use of a preoperative stress radiograph. Obtaining a stress radiograph prior to TKA aids immensely with preoperative planning and guides the surgeon as to how much medial release is to be expected. An easily correctable deformity often requires relatively minimal effort to balance, while severe fixed varus deformities may require a more formal medial release or medial reduction osteotomy.
W.B. Carrell Memorial Clinic
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