Medial Varus Proximal Tibial Resection is Superior to Pie-Crusting of the Medial Collateral Ligament During Primary Total Knee Arthroplasty.

Background: Medial varus proximal tibial (MPT) resection or soft tissue releases (STRs) of the medial collateral ligament (MCL) in the form of pie-crusting can be performed to achieve a balanced knee in a varus deformity. Studies comparing the 2 modalities have not been addressed within the literature. Therefore, the aims of this study were to assess the following: (1) compartmental changes between the 2 methods and (2) changes in patient-reported outcome measurements. Methods: Using our institution's total joint arthroplasty registry, patients who underwent primary total knee arthroplasty from January 1, 2017, to December 31, 2019, were identified. The MPT resection and STR patients were 1:1 matched with baseline parameters yielding 196 patients. Outcomes of interest included: changes in compartmental pressures at 10, 45, and 90 degrees degrees and change to the Short-Form 12, Western Ontario and McMaster Universities Osteoarthritis Index, and Forgotten Joint Scores (FJSs) at the 2-year follow-up period. A P value less than.05 was used as our threshold for statistical difference. Results: The MPT resection led to significant reductions in compartmental pressures at 10 degrees [43 versus 19 pounds (lbs.), P <.0001], 45 degrees (43 versus 27 lbs., P <.0001), and 90 inverted perpendicular degrees (27 versus 16 lbs., P <.0001) compared to STR. MPT resection also had significantly improved Short-Form 12 (47 versus 38, P <.0001), Western Ontario and McMaster Universities Osteoarthritis Index (9 versus 21, P <.0001), and Forgotten Joint Score (79 versus 68, P =005). Conclusion: Bone modification was superior to pie-crusting of the MCL in achieving consistent pressure balancing and improved outcomes. The investigation can guide surgeons on the preferred method to achieve a well-balanced knee. (c) 2023 Elsevier Inc. All rights reserved.