{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:19:57Z","timestamp":1790086797631,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The concept of medial stabilizing technique total knee arthroplasty (MST\u2010TKA) is to minimize the medial release without the superficial layer of medial collateral ligament (MCL). However, it is unclear at what stage the proper medial laxity is obtained during surgery. The purpose of this study was to investigate the implication of deep layer of MCL (dMCL) and osteophyte resection on medial laxity during MST\u2010TKA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 103 consecutive patients who underwent cruciate\u2010retaining TKA using the navigation system were included. The intraoperative hip\u2013knee\u2013ankle (HKA) angle was recorded under three conditions (no stress, valgus, and varus stress) at four time points after the resection of the anterior cruciate ligament (ACL) and meniscus (1st evaluation), after the dMCL release (2nd evaluation), and after osteophyte resection on both the femoral and tibial side (3rd evaluation). To assess valgus laxity, the differences in intraoperative HKA angle between 1st and 2nd evaluation (stage 1) and between 2nd and 3rd evaluation (stage 2) were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Under the valgus stress condition, the intraoperative HKA angle change in stage 2 was significantly larger than that in stage 1\u00a0in full extension (stage 1; \u2212 0.5\u2009\u00b1\u20091.0\u00b0, stage 2; \u2212 2.0\u2009\u00b1\u20091.3\u00b0, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and 30\u00b0 flexion (stage 1; \u2212 0.8\u2009\u00b1\u20091.4\u00b0, stage 2; \u2212 1.5\u2009\u00b1\u20092.0\u00b0, <jats:italic>p<\/jats:italic>\u2009=\u20090.008). There were no significant differences at 60\u00b0 and 90\u00b0 of knee flexion. Under the no stress and varus stress conditions, there were no significant differences in knee flexion at all angles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The medial laxity during MST\u2010TKA increased significantly more after dMCL release and osteophyte resection than after just dMCL release at full extension and 30\u00b0 flexion, and it was, therefore, considered that osteophyte resection is a key procedure for a successful MST\u2010TKA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level II, therapeutic prospective cohort study.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06257-1","type":"journal-article","created":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T11:04:13Z","timestamp":1599044653000},"page":"3418-3425","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Effect of medial collateral ligament release and osteophyte resection on medial laxity in total knee arthroplasty"],"prefix":"10.1002","volume":"29","author":[{"given":"Shizuka","family":"Sasaki","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine 5 Zaifu\u2010cho 036\u20108562 Hirosaki Aomori Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiji","family":"Sasaki","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine 5 Zaifu\u2010cho 036\u20108562 Hirosaki Aomori Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Kimura","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine 5 Zaifu\u2010cho 036\u20108562 Hirosaki Aomori Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harehiko","family":"Tsukada","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Aomori City Hospital Aomori Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironori","family":"Otsuka","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Department of Orthopaedic Surgery Japan Community Health Care Organization Akita Hospital Noshiro Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine 5 Zaifu\u2010cho 036\u20108562 Hirosaki Aomori Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichi","family":"Tsuda","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Rehabilitation Medicine Hirosaki University Graduate School of Medicine Hirosaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuyuki","family":"Ishibashi","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine 5 Zaifu\u2010cho 036\u20108562 Hirosaki Aomori 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June 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the ethical committee of our institution.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the 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