A 55-year-old woman with severe knee OA (Kellgren-Lawrence Grade IV) fails conservative management. At TKR, valgus deformity of 18° is noted. Which additional soft tissue release is required over the standard medial approach release for correction of this valgus deformity?

• A Medial collateral ligament pie-crusting
• B Posterior cruciate ligament release
• C Lateral structure release: iliotibial band, lateral capsule, popliteus tendon ✓
• D Pes anserinus release

Explanation

In valgus knee deformity during TKR, the tight structures are lateral: the iliotibial band (IT band), lateral capsule, popliteus tendon, and sometimes lateral collateral ligament and posterolateral corner. Sequential lateral release from posterior to anterior — starting with posterior capsule, then popliteus, then IT band — corrects valgus alignment. MCL pie-crusting is used for fixed varus deformity (tight medial structures). Pes anserinus is a medial structure. PCL release may be needed in severe flexion contracture but is not specific to valgus correction.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.