03. 11, 2020
Both medial and lateral approaches are used during total knee arthroplasty of the valgus knee.
Standard medial parapatellar approach includes insall anterior approach, subvastus approach, medvastus approach, which can correct most valgus deformities(Krakow I, II).
Structures needed to be released in classic medial approach are the lateral collateral ligament(LCL), the iliotibial band(ITB) and the posterolateral capsule(PLC). Multiple stabs punctures ("pie crust" technique) is popular in relesing of ITB and PLC.
A. The PLC can be releasd either in flexed knee from the distal part of the femur, by using a curved osteotome; or in fully extended knee by fractionally lengthening with multiple stabs punctures.
B. In flexed knee, patellar tendon is retracted, lateral patellofemoral synovial ligament is severed, lateral structures such as 1TB insertion at Gerdy's tubercle，capsule and LCL are subperiosteally released in turn till posterolateral tibia.