A 55-year-old woman with long-standing RA undergoes total knee replacement. Intraoperatively the surgeon notes valgus deformity of 20° with lateral subluxation of the tibia and fixed flexion contracture. Which soft-tissue release should be performed FIRST to correct the valgus deformity?
- A Pie-crusting of the lateral structures including iliotibial band, lateral capsule, and posterolateral corner in a stepwise fashion ✓
- B Release of the medial collateral ligament
- C Lateral collateral ligament transection
- D Posterior capsule release for flexion contracture before any lateral releases
Explanation
Valgus deformity in TKR is corrected through sequential lateral release following the principle of releasing tight lateral structures while preserving the medial ligamentous complex. The standard sequence is: iliotibial band (most commonly tight) → lateral capsule → lateral collateral ligament (sparingly, only if needed) → posterolateral corner. 'Pie-crusting' (multiple small perforations) of the iliotibial band allows incremental release with controlled valgus correction. The medial ligament should not be released as it is already relatively lax in valgus deformity. Posterior capsule release addresses flexion contracture as an additional step.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.