This 2009 review by Mihalko et al. presents a stepwise operative approach to soft-tissue balancing in the varus knee during primary TKA — covering intraoperative gap assessment methods, anatomy-guided sequential medial release, PCL management, and salvage options for severe deformity.
When you encounter a varus knee in TKA, always remove osteophytes first — this alone may balance the joint.
Then match your release to the gap pattern: tight in flexion → release anterior SMCL; tight in extension → release POL then semimembranosus; tight in both → start with SMCL and progress posteriorly, reassessing after each step.
This 2009 review by Mihalko et al. presents a stepwise operative approach to soft-tissue balancing in the varus knee during primary TKA — covering intraoperative gap assessment methods, anatomy-guided sequential medial release, PCL management, and salvage options for severe deformity.
When you encounter a varus knee in TKA, always remove osteophytes first — this alone may balance the joint.
Then match your release to the gap pattern: tight in flexion → release anterior SMCL; tight in extension → release POL then semimembranosus; tight in both → start with SMCL and progress posteriorly, reassessing after each step.