Ranawat et al. describe the 'inside-out' soft-tissue release technique for TKA in severe valgus deformity and report outcomes in 42 knees followed a minimum of five years. The study asks whether this intra-articular release approach can reliably correct fixed valgus deformity without resorting to constrained implants or producing late instability.
When you encounter a type-I or type-II fixed valgus knee in TKA, use the inside-out release sequence — posterolateral capsule release with electrocautery (peroneal nerve is <1 cm away), then pie-crusting of the ITB. Combined with a 3° distal femoral valgus cut and conservative tibial resection (6–8 mm medial side) to achieve a rectangular gap without constrained implants.
If the medial sleeve is incompetent after prior osteotomy (type III), pivot to a constrained or hinged design.
Ranawat et al. describe the 'inside-out' soft-tissue release technique for TKA in severe valgus deformity and report outcomes in 42 knees followed a minimum of five years. The study asks whether this intra-articular release approach can reliably correct fixed valgus deformity without resorting to constrained implants or producing late instability.
When you encounter a type-I or type-II fixed valgus knee in TKA, use the inside-out release sequence — posterolateral capsule release with electrocautery (peroneal nerve is <1 cm away), then pie-crusting of the ITB. Combined with a 3° distal femoral valgus cut and conservative tibial resection (6–8 mm medial side) to achieve a rectangular gap without constrained implants.
If the medial sleeve is incompetent after prior osteotomy (type III), pivot to a constrained or hinged design.