A 58-year-old woman with severe bilateral knee OA is planned for total knee arthroplasty. Pre-operative X-ray shows a varus deformity of 18 degrees with medial joint space obliteration and lateral joint preservation. During TKA, the primary soft tissue release performed FIRST on the tight medial side for varus correction is:

• A Deep medial collateral ligament (MCL) subperiosteal release from the tibia, including pes anserinus and posteromedial capsule ✓
• B Iliotibial band (ITB) release at Gerdy's tubercle
• C Posterior cruciate ligament (PCL) sacrifice with a posterior-stabilised implant
• D Lateral retinacular release to balance the joint by loosening the opposite side

Explanation

In varus TKA, the tight medial side requires sequential soft tissue release to achieve balanced flexion and extension gaps. The first and most important structure to release is the deep MCL (superficial MCL in some descriptions), typically via subperiosteal stripping from the medial tibial flare, along with the pes anserinus insertion and posteromedial capsule. This 'pie-crusting' or formal release corrects moderate varus. For severe varus (>15–20°), additional semimembranosus and posteromedial corner release may follow. ITB release is for valgus deformity, not varus. PCL management depends on implant design choice, not primary varus correction.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.