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we usually excise both ACL & PCL, still it is possible to retain more soft tissue. Both PCLretaining & sacrificing Require intact collaterals for stability. Superficial MCL & LCL shouldbe preserved, if possible.after PCL removal the following advantages could obtain : More correction of fixed varus orvalgus deformity , More surgical exposure . but there are no proved disadvantages like ;increasing in stress & loosening of bone-cement-prosthesis interface , specific clinicaldifference in ROM , forward lean during stepping up , proprioception inferiority . in otherhand Over tight PCL cause excessive rollback of tibia & knee hinges open ,preventing flexion(booking) , and Severe posteromedial poly wear in poor balance PCL might be happened .Mid range laxity when Post.Capsule is tight ,even with correct tensioning in full extension &90 degree flexion , may occur ( and secondary collateral ligaments imbalance throughoutROM) . There is a major effect of capsular contracture in coronal mal alignment with flexioncontracture. Full MCL releases not only correct fixed varus but also open the medial space inflexion. MCL & post. Capsule has combined valgus resistant effect in extension. PCL releaseincrease flexion gap more, May be necessary to release something that affect extension gap ascompensated balancing ( Post.medial capsule) .Any flexion contracture need to posteriorcapsulotomy & post. Condyle osteophyte removal before femoral recut.So it is possible to perform posteromedial capsulotomy prior to superficial MCL release.Method :From May to Dec. 2009 ,22 patients ( 23 knees ) with primary DJD and varus deformity ofknees were operated by myself with joint replacement . most patients had some degree ofvarus correction in flexion , passively . the varus angle was less than 25* , means mild to severebut not decompensated . For soft tissue balancing during Total knee arthroplasty I consider thefollowing steps;Medial capsule & deep MCL release, PCL release, Posteromedial capsulotomy ,semimembranous release , Superficial MCL release , Pes anserinous release . Post.medialcapsulotomy was done in all cases.The Average Age was 64.74 years, 19 patients were female (83%) and one of them hadbilateral TKA simultaneously. Lt Knee was operated in 14 cases (70% of 24). Spinalanesthesia was applied in 82%. 10 patients were operated with MIS technique and 13 patientswith Standard medial parapatellar incision. Semi membranous release was necessary in 4cases ( preop varus 17,20,24,25*) . MCL release was mandatory in 2 cases ( preop varus 17, 24 * & No Flexibility in 30* flexion).for checking balanced medial and lateral subtle laxity (playing), I have used simple blade with 1 & 2 mm thickness in each ends for younger patients ,and the other one with 3&4 mm thickness in elder cases .Results:Average follow up period is 234.45 days. Average Operating time was 1 : 32 (h:m) . AverageTransfusion = 1.22 unit packed cell . No Flexibility in 30* flexion was seen in 3 patients.Average varus malalignment =15.29* (2-25*) / Av. Valgus angle = 7.19* (5-10 *) / Av.DLFA = 90.47* (87-93*) / Av. PMTA = 83.41* (77-88.5*) / Av. Ext. rotation cut =3.11*Stage l + PCL + Post.Med. Capsular release was performed in 82.61% . / Av. Post opalignment : 1.8 * varus ( 0 -6 *) ( worse in medial pivot knee) .Av. Polyethylen size : 12.4 (9 in oxynium -19 in plus) / Semi membranous release wasnecessary in 4 cases ( preop varus 17,20,24,25*) ( Post.Op varus 1,6,4,2) . / S.MCL releasefile:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]