ReviewKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2014
Lack of evidence to support present medial release methods in total knee arthroplasty.
Review in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 55 citations in OpenAlex.
- Reduction Osteotomy versus Extensive Release on Clinical Outcome Measures in Simultaneous Bilateral Total Knee Arthroplasty.Medical science monitor : international medical journal of experimental and clinical research · 2017Trial
- Predictive Radiographic Factors for Soft Tissue Release and Distal Femoral Cut Angle for Appropriate Biomechanics in Total Knee Arthroplasty.The archives of bone and joint surgery · 2026Article
- Anatomical relationship between the anterior arm of the semimembranosus tendon and the medial collateral ligament: A cadaveric study.Journal of experimental orthopaedics · 2025Article
- Article
- Outcomes following functionally aligned total knee arthroplasty in severe varus deformity.Journal of clinical orthopaedics and trauma · 2025Article
- Precision soft tissue balancing: grid-assisted pie-crusting in total knee arthroplasty.Frontiers in surgery · 2024Article
- Current concept of kinematic alignment total knee arthroplasty and its derivatives.Bone & joint open · 2022Article
- Intraoperative repair for iatrogenic MCL tear due to medial pie-crusting in TKA yields satisfactory mid-term outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Article
- Posteromedial Corner Release with the Knee in Figure-of-Four Position vs Conventional Position for Varus Knee Arthroplasty.Orthopaedic surgery · 2021Article
- Load imbalances existed as determined by a sensor after conventional gap balancing with a tensiometer in total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- Improved mediolateral load distribution without adverse laxity pattern in robot-assisted knee arthroplasty compared to a standard manual measured resection technique.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- [Adjusted mechanical alignment: operative technique-Tips and tricks].Der Orthopade · 2020Review
- Bone resection for mechanically aligned total knee arthroplasty creates frequent gap modifications and imbalances.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2019Article
- Preoperative Varus-Valgus Stress Angle Difference Is Valuable for Predicting the Extent of Medial Release in Varus Deformity during Total Knee Arthroplasty.Knee surgery & related research · 2019Article
- Step-wise medial collateral ligament needle puncturing in extension leads to a safe and predictable reduction in medial compartment pressure during TKA.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2018Article
- Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty.Journal of orthopaedic surgery and research · 2017Article
- Concurrent femoral and tibial osteotomies versus soft tissue balance in total knee arthroplasty: A technical case report.Journal of orthopaedics · 2017Article
- What Factors Are Associated With Femoral Component Internal Rotation in TKA Using the Gap Balancing Technique?Clinical orthopaedics and related research · 2017Article
- Varus-valgus stress radiograph as a predictor for extensive medial release in total knee arthroplasty.International orthopaedics · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe aim of this review was to identify a reliable sequential medial release protocol for restoration of soft tissue balance in total knee arthroplasty of the varus osteoarthritic knee and to allow for improved intraoperative decision-making.
methodCurrent medial release sequences and applicability based upon pre-operative deformity have been reviewed. Furthermore, risks associated with over release, and the necessity of medial release, are discussed.
resultsThe different medial release sequences are discussed in relation to pre-operative deformity, along with potential complications associated with medial release. It was found that release sequences may include the deep and superficial components of the medial collateral ligament, the posteromedial capsule, the posterior oblique ligament, the pes anserinus (pes A), and tendons of the semimembranosus and medial gastrocnemius muscle. The sequences described were found to vary substantially between studies, and very few studies had systematically quantified the effect of each release on balance.
conclusionWhile medial release is the standard intraoperative mode of balancing, there is a lack of evidence to support current methods. The correct method for defining intraoperatively the sequence, extent and magnitude of releases required remains ill-defined. It could be argued that the classic extensive medial release may be unnecessary and may be associated with iatrogenic injury to the pes A and saphenous nerve, instability and abnormal knee kinematics. Minimal medial release may allow for improved soft tissue balancing leading ultimately to improved functional outcome. LEVEL OF EVIDENCE: V (expert opinion).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.