Semimembranosus release as the second step of soft tissue balancing in varus total knee arthroplasty.

There have been limited clinical data on the effect of semimembranosus release in patients with varus knees treated with total knee arthroplasty (TKA). The purposes of this study were to determine the effect of semimembranosus release and to evaluate the effectiveness of our release technique based on the three-step algorithm which consisted of sequential release of 1) deep medial collateral ligament (MCL), 2) semimembranosus, 3) superficial MCL in 104 consecutive varus knees treated with TKA. Semimembranosus release had the desired effect on gap balancing in varus knees and our algorithmic medial release approach to the varus knee has shown to be favorable in correcting varus deformities during TKA.