Abstract：Objective To analyze the efficacy and safety of the multiple needle puncture technique for soft tissue balance in total knee arthroplasty(TKA) of moderate varus knee by releasing the medial collateral ligament(MCL).Methods To review fifty-five patients of moderate varus knee osteoarthritis with the technique of multiple needle puncture in TKA in Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiaotong University from January to June 2013, including 19 males and 35 females. The average age was 63.4 years (range, 57-79 years). Fifty-five patients were treated with KTA and the multiple needle puncture technique for soft tissue balance in operation of moderate varus knee by releasing the MCL. Postoperative rehabilitation exercises were carried out strictly. Clinical follow-up included range of motion of knee and standard Knee Society knee and functional scoring, as well as evaluation of mediolateral stability using maximal manual stress testing. Full leg standing radiographs were obtained 3 weeks after the operation and standard standing radiographs of the knee at each follow-up visit of 3 months, 6 months and 1 year. The average follow-ups were fourteen months. Preoperative and postoperative knee alignment, American knee society score(KSS)and the range of motion of knee were analyzed.Results All 55 patients obtained satisfying soft tissue balance intra-operatively, with none over-releasing medially. Mechanical alignment as measured on standing full leg radiographs improved from 13.5°±3.36° varus (range, 9°-25° varus) preoperatively to 0.8°±1.07° varus (range, 3.5° varus to 2° valgus) postoperatively. The average KSS improved from 39.9±7.84 (range, 20-65) preoperatively to 94.0±7.27(range, 65-100) at final follow-up, and the function score improved from 35.2±10.51(range, 20-80) preoperatively to 85.0±10.84 (range, 50-100) at final follow-up. Average flexion improved from 90.0°±9.87° (range, 65°-110°) preoperatively to 115.0°±10.08° (range, 95°-135°) at final follow-up. Full extension of the knee was restored in all except 2 cases, where a passive extension deficit of less than 5° was present at final follow-up. During follow-ups, no instability of knee was found and no other complications occurred.Coclusions MCL can be progressively stretched until a correct ligament balance is achieved by multi needle puncture. The technique is proved to be safe and effective in total knee arthroplasty of moderate varus knee deformity.
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2014, Vol. 19 
