Department of Orthopaedic Surgery, Putrajaya Hospital, Putrajaya, Malaysia.
Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, South Korea.
J Arthroplasty. 2020 Feb;35(2):380-387. doi: 10.1016/j.arth.2019.09.005. Epub 2019 Sep 11.
The aims of this study were to (1) describe our functional stepwise multiple needle puncturing (MNP) technique as the final step in medial ligament balancing during total knee arthroplasty (TKA) and (2) evaluate whether this technique can provide sufficient medial release with safety.
A total of 137 patients with 212 consecutive knees who underwent TKAs with or without functional stepwise MNP of superficial medial collateral ligament was recruited in this prospective cohort. Eighty-one patients with 129 knees who performed serial stress radiographs were enrolled in the final assessment. Superficial medial collateral ligament was punctured selectively (anteriorly or posteriorly or both) and sequentially depending on the site and degree of tightness. Mediolateral stability was assessed using serial stress radiographs and comparison was performed between the MNP and the non-MNP groups at postoperative 6 months and 1 year. Clinical outcomes were also evaluated between 2 groups.
Fifty-five TKAs required additional stepwise MNP (anterior needling 19, posterior needling 3, both anterior and posterior needling 33). Preoperative hip-knee-ankle angle and the difference in varus-valgus stress angle showed significant difference between the MNP and the non-MNP groups, respectively (P = .009, P = .037). However, there was no significant difference when comparing the varus-valgus stress angle between the MNP and the non-MNP groups during serial assessment. Clinical outcomes including range of motion also showed no significant differences between the 2 groups.
Functional medial ligament balancing with stepwise MNP can provide sufficient medial release with safety in TKA with varus aligned knee without clinical deterioration or complication such as instability.
Level II, Prospective cohort study.
本研究旨在：（1）描述我们的功能分步多针穿刺（MNP）技术作为全膝关节置换术（TKA）中内侧韧带平衡的最后步骤；（2）评估该技术是否可以安全地提供充分的内侧松解。
本前瞻性队列研究共纳入了 137 例 212 例连续膝关节 TKA 患者，其中部分患者行功能分步 MNP 治疗。共纳入 81 例患者（129 膝）进行连续应力位 X 线检查以进行最终评估。根据紧张部位和程度选择性（前、后或前后均）和顺序穿刺浅层内侧副韧带。采用连续应力位 X 线片评估内外稳定性，并在术后 6 个月和 1 年时比较 MNP 组和非 MNP 组之间的差异。还比较了 2 组之间的临床结果。
55 例 TKA 需要额外的分步 MNP（前针 19 例，后针 3 例，前后均针 33 例）。MNP 组和非 MNP 组的术前髋膝踝角和内翻外翻应力角差异均有统计学意义（P=0.009，P=0.037）。然而，在连续评估中，MNP 组和非 MNP 组之间的内翻外翻应力角差异无统计学意义。2 组之间的临床结果（包括活动范围）也无显著差异。
在对线内翻的膝关节 TKA 中，功能内侧韧带平衡伴分步 MNP 可安全提供充分的内侧松解，且无不稳定等临床恶化或并发症。
Ⅱ级，前瞻性队列研究。
