INTRODUCTION: The inside-out technique is a safe and reproducible method to effectively correct a fixed varus-flexion deformity during total knee arthroplasty by performing a posteromedial capsular release and so-called pie-crust lengthening of the superficial medial collateral ligament (sMCL). STEP 1 PREOPERATIVE PLANNING: Analyze preoperative radiographs as a key step in planning the surgery for the required amount of osseous cuts and soft-tissue release. STEP 2 EXPOSURE: Obtain adequate exposure for proper visualization and assessment. STEP 3 TIBIAL AND FEMORAL CUTS: Adequate bone cuts with proper alignment are an essential step of this technique. STEP 4 POSTEROMEDIAL CAPSULOTOMY: This is the most important step for extension balancing in knees with flexion contracture; the posteromedial aspect of the capsule in varus deformity should be safely incised at the level of the tibial cut. STEP 5 PIE-CRUSTING OF THE SMCL: Perform pie-crusting followed by serial manipulations in a controlled manner to avoid overrelease of the sMCL. STEP 6 FLEXION GAP BALANCING: This is a key step for proper balancing, femoral sizing, rotation, lateralization, and patellofemoral tracking. RESULTS: From October 2006 to December 2009, thirty-one consecutive patients (thirty-four knees) with a severe fixed varus-flexion deformity (varus alignment of ≥15° and flexion contracture of ≥5°) underwent total knee arthroplasty with the inside-out technique. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: The inside-out technique is a safe and reproducible method to effectively correct a fixed varus-flexion deformity during total knee arthroplasty by performing a posteromedial capsular release and so-called pie-crust lengthening of the superficial medial collateral ligament (sMCL). STEP 1 PREOPERATIVE PLANNING: Analyze preoperative radiographs as a key step in planning the surgery for the required amount of osseous cuts and soft-tissue release. STEP 2 EXPOSURE: Obtain adequate exposure for proper visualization and assessment. STEP 3 TIBIAL AND FEMORAL CUTS: Adequate bone cuts with proper alignment are an essential step of this technique. STEP 4 POSTEROMEDIAL CAPSULOTOMY: This is the most important step for extension balancing in knees with flexion contracture; the posteromedial aspect of the capsule in varus deformity should be safely incised at the level of the tibial cut. STEP 5 PIE-CRUSTING OF THE SMCL: Perform pie-crusting followed by serial manipulations in a controlled manner to avoid overrelease of the sMCL. STEP 6 FLEXION GAP BALANCING: This is a key step for proper balancing, femoral sizing, rotation, lateralization, and patellofemoral tracking. RESULTS: From October 2006 to December 2009, thirty-one consecutive patients (thirty-four knees) with a severe fixed varus-flexion deformity (varus alignment of ≥15° and flexion contracture of ≥5°) underwent total knee arthroplasty with the inside-out technique. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: Morteza Meftah; Yossef C Blum; Dhanasekara Raja; Amar S Ranawat; Chitranjan S Ranawat Journal: J Bone Joint Surg Am Date: 2012-05-16 Impact factor: 5.284