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Correction of Severe Varus Deformity During Total Knee Arthroplasty: Usefulness of Pie-Crusting Technique

February 10, 2018

Contributors: Hansol Jeong; Dong-Hyun Kim; Jae-Hyung Kim; Kim Kyu-Hwang; Dong-Hoon Lee; Jae Sung Lee, M.D,PhD; Yong-Beom Park, MD; Beoung-Il Yun Sr, MD; Han-Jun Lee, MD; Han-Jun Lee, MD

2018 HONORABLE MENTION Several methods can be used to manage a severe varus deformity during total knee arthroplasty (TKA). The tibial subperiosteal stripping of the superficial medial collateral ligament (MCL) often leads to excessive release. Traditional pie-crusting of the superficial MCL with the use of a blade knife may lead to excessive release or iatrogenic transection. The authors of this video created a selective and sequential medial release technique that involves pie-crusting with the use of multiple needle puncturing and investigated the effectiveness and safety of the technique during primary TKA. The deep MCL was released during exposure. First, medial tightness in extension was balanced by release of the posterior portion of the superficial MCL and the posteromedial corner structures. Then, medial tightness in flexion was balanced by pie-crusting with the use of multiple needle puncturing the anterior portion of the superficial MCL with the trial implant or gap block in situ. Eighty-eight knees with varus alignment of 15° were effectively balanced using this technique. No complications, such as hematoma, conversion to a constrained implant, or late instability, occurred. The selective and sequential technique described in this video is safe, reproducible, and effective for the management of severe varus deformity during primary TKA.