Selective ligament release in total knee arthroplasty of the knee in valgus

An approach to the valgus knee based on anatomic function of ligaments in f lexion and extension consistently yields a knee that is balanced in flexion and extension when the implants have been positioned correctly, Two hundre d thirty-one knees had a valgus deformity (range, 12 degrees-45 degrees) an d were corrected with valgus alignment to 5 degrees by resecting the intact joint surfaces to match implant thickness. Femoral joint surfaces were ali gned in 5 degrees valgus to the long axis of the femur and parallel to the epicondylar axis of the femur in flexion and extension, The tibial surfaces were aligned perpendicular to the long axis of the tibia, For knees that w ere tight in flexion and extension, the lateral collateral ligament and pop liteus tendon mere released. Those knees that remained tight only in extens ion had release of the iliotibial band. Posterior capsular release was done only when necessary for persistent lateral Ligament tightness. Neither lig ament advancement procedures nor varus or valgus stabilized implant systems were needed to achieve stability with this procedure. The knees with ligam ent releases all fell within a range of 4 degrees to 7 degrees mean varus a nd valgus laxity, and were not significantly different from one another. No cases of clinical instability occurred, and joint stability did not deteri orate with time.