Department of Orthopedic Surgery, School of Medicine, University of Oviedo, Julian Claveria, s/n, 33006, Oviedo, Spain.
Hospital San Agustin de Aviles, Aviles, Spain.
Int Orthop. 2022 Apr;46(4):815-821. doi: 10.1007/s00264-021-05263-3. Epub 2021 Nov 24.
In complex and deformed knees, soft tissue release (STR) is required to obtain symmetry in the femorotibial gap. The objective of this study was to attempt to predict the need for soft tissue release using surgical navigation in total knee replacement (TKR).
Prospective and non-randomized study. One hundred thirty knees. At the start of navigation, an attempt was made to correct the femorotibial mechanical axis by applying force to the medial or lateral side of the knee (varus-valgus stress angle test). A gap balanced technique with computer-assisted surgery (CAS) was performed in all cases. The ligaments were tensioned, and using CAS visualization and control, progressive STR was performed in the medial or lateral side until a symmetry of the femorotibial gap was achieved.
Eighty-two patients had a varus axis ≥ 3° and 38 had a valgus axis (P < 0.001). STR was performed under navigation control in 38.5% of cases, lateral release (LR) in 12 cases, and medial release (MR) in 38 cases. After performing the varus-valgus stress angle test (VVSAT), the axis of 0° could be restored at some point during the manoeuvre in 28 cases. STR was required in 44.6% of varus cases and 27% of valgus cases (P = 0.05). A significant relationship was found between the previous deformity and the need for MR (P < 0.001) or LR (P = 0.001). STR was more common in male patients (P = 0.002) and as obesity increased.
This study shows that pre-operative factors favouring the need to perform STR in a TKR implant can be defined.
在复杂和畸形的膝关节中，需要进行软组织松解（STR）以获得股骨-胫骨间隙的对称性。本研究的目的是尝试通过在全膝关节置换（TKR）中使用手术导航来预测软组织松解的需求。
前瞻性、非随机研究。共 130 例膝关节。在导航开始时，通过向膝关节内侧或外侧施加力（内翻-外翻应力角试验）尝试纠正股骨-胫骨机械轴。在所有病例中都采用了计算机辅助手术（CAS）的间隙平衡技术。在 CAS 的可视化和控制下，对内侧或外侧的韧带进行拉紧，并逐步进行 STR，直到股骨-胫骨间隙达到对称。
82 例患者的外翻轴≥3°，38 例患者的内翻轴（P<0.001）。在导航控制下进行 STR 的病例占 38.5%，外侧松解（LR）的病例占 12 例，内侧松解（MR）的病例占 38 例。在进行内翻-外翻应力角试验（VVSAT）后，在操作过程中的某个时刻，0°的轴可以在 28 例中得到恢复。在 44.6%的内翻病例和 27%的外翻病例中需要进行 STR（P=0.05）。发现术前畸形与需要进行 MR（P<0.001）或 LR（P=0.001）之间存在显著的关系。STR 在男性患者中更为常见（P=0.002），并且随着肥胖程度的增加而增加。
本研究表明，可以确定 TKR 植入物中需要进行 STR 的术前因素。
