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Open posterior capsular release with an osteotome in total knee arthroplasty does not place important neurovascular structures at risk

  • Zachariah Pinter
  • Rucker Staggers
  • Sung Lee
  • Shelby Bergstresser
  • Ashish Shah
  • Sameer NaranjeEmail author
KNEE

Abstract

Purpose

Posterior capsular contracture is a potential consequence of osteoarthritis, post-traumatic arthritis, and surgical procedures of the knee. Many patients who undergo TKA will be found to have some degree of flexion contracture intraoperatively, which necessitates posterior capsular release. There is no information in the literature about the safety of posterior capsular release done during TKA. The present cadaveric study investigates the safety of posterior capsular release during TKA.

Methods

This study involved ten fresh-frozen cadaver specimens, each of which underwent three successive releases of the posterior capsule medially, laterally, and in the midline. One senior joint surgeon performed this procedure with a 1.27 cm curved osteotome, hugging the bone posteriorly on the distal aspect of the femur until the osteotome moved freely behind the bone without resistance. The distance from the distal aspect of the femur to the tip of the osteotome was then measured. Finally, the popliteal fossa was dissected, and the course of the neurovascular bundle was followed to assess for any macroscopic injury.

Results

The capsule was penetrated at a median depth of 13.6 cm (range 10.3–17.6). Even at this depth, no injuries to the popliteal artery, tibial nerve, or popliteal vein occurred in any of the 30 penetrating events.

Conclusion

This study suggests that posterior capsular release can be performed safely with this technique.

Keywords

Posterior capsular release Total knee arthroplasty Neurovascular structures Osteotome Popliteal fossa 

Notes

Funding

No external funding was used.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, Sameer Naranje states that there is no conflict of interest.

Ethic approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.University of Alabama at BirminghamBirminghamUSA

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