By Leo A. Whiteside
The varus knee has a gaggle of bone and ligament abnormalities that needs to be addressed to right the deformity. The mechanical axis of the femur is tilted medially relative to the lengthy axis of the tibia. The distal femoral floor often is still in valgus alignment to the lengthy axis of the femur. lots of the varus deformity is brought on by deficiency within the medial tibial plateau. The deep and superficial medial collateral ligaments are gotten smaller and deformed by means of osteophytes.
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An anterior stylus is used to position the resection guide so that the anterior surface cut aligns flush with the anterior cortex of the femur. Posterior paddles are used to engage the posterior femoral condyles. These posterior paddles are used to confirm the anterior-posterior size of the femur and also to serve as a guide for rotational alignment (varusvalgus alignment in flexion) of the femoral component. Fig. 55. Varus-valgus alignment of the femoral component in flexion (rotational alignment) is determined by the anterior-posterior axis.
Fxtension only Occasionally, after full medial collateral ligament release, the knee is excessively loose on the medial side in extension, and tight laterally. Compensatory lateral release corrects the imbalance, and a thicker tibial component brings the knee to correct stability. Fig. 93. After medial collateral ligament release, the knee gapes medially and is tight laterally in extension. Fig. 94. To correct this imbalance, the iliotibial band is released to create more space in extension 56 Fig.
65. The anterior portion of the medial collateralligament is excessively tight in flexion. The medial femoral condyle sits further posteriorly than does the lateral femoral condyle and the tibia tends to pivot around the medial collateral ligament. Otherwise the knee is well aligned, and the anteriorposterior axis and long axis of the tibia align well with one another. The posterior cruciate ligament is soft to palpation, and is not a deforming structure. Fig. 66. The posterior portion of the medial collateralligament is loose in flexion, and does not contribute to the ligament imbalance.