{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:25:27Z","timestamp":1789770327227,"version":"4.0.1"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Total knee arthroplasty is a challenging task in patients with severe varus deformity. In most of these patients, an extensive medial release is needed that may lead to instability. Medial epicondylar osteotomy may be a better substitute for complete medial collateral release. Fourteen patients with bilateral knee osteoarthritis and severe varus deformity were enrolled in this study. In one side, the patients underwent medial epicondylar osteotomy for mediolateral imbalance if the only option was superficial medial collateral ligament (MCL) release. In contralateral side, the extensive medial release was performed and MCL was released either by pie-crusting technique or by subperiosteally release. The results of the two sides were compared. Patients were followed up for 12\u2009months after the operation. Physical examination, clinical questionnaires, and radiography findings were recorded. Union of the osteotomies fragment and complications was evaluated. The mean varus angle before surgery was 21.6\u2009\u00b1\u20094.7\u2009degrees, which was corrected to 8.6\u2009\u00b1\u20092.9\u2009degrees after operation with an extensive medial release. The mean varus angle of contralateral side was 22.6\u2009\u00b1\u20091.7\u2009degrees, which was corrected to 7.5\u2009\u00b1\u20092.3\u2009degrees following medial femoral epicondyle osteotomy. There was no significant difference in varus correction (p\u2009=\u20090.1). Medial joint line opening in valgus stress test was 2.7\u2009\u00b1\u20090.4\u2009mm in the osteotomized side and 3.5\u2009\u00b1\u20090.9\u2009mm in contralateral side. Mean range of motion for the osteotomized side was 97.8\u2009\u00b1\u20094.3\u2009degrees and 100.7\u2009\u00b1\u20092.7\u2009degrees for contralateral side (p\u2009=\u20090.6). Nonunion occurred in a case in the osteotomized side and no medial instability was observed in medial release or osteotomies sides. No statistical difference was recorded based on clinical questionnaires (Oxford and WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index] scores). Medial epicondylar osteotomy is a safe technique with the well-controlled medial extensive release in the patients with severe varus deformity during total knee arthroplasty.<\/jats:p>","DOI":"10.1055\/s-0039-1694047","type":"journal-article","created":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T22:39:10Z","timestamp":1565303950000},"page":"142-146","source":"Crossref","is-referenced-by-count":8,"title":["Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement"],"prefix":"10.1055","volume":"34","author":[{"given":"Fardin","family":"Mirzatolooei","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Urmia University of Medical Sciences, Urmia, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4385-6445","authenticated-orcid":false,"given":"Ali","family":"Tabrizi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Taleb","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Urmia University of Medical Sciences, Urmia, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Khalegi","family":"Hashemian","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Surgery, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mir Bahram","family":"Safari","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Surgery, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2019,8,8]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"766","DOI":"10.5435\/00124635-200912000-00005","article-title":"Soft-tissue balancing during total knee arthroplasty in the varus knee","volume":"17","author":"W M Mihalko","year":"2009","journal-title":"J Am Acad Orthop Surg"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1007\/s11999-012-2773-x","article-title":"Surgical technique: computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA","volume":"471","author":"A B Mullaji","year":"2013","journal-title":"Clin Orthop Relat Res"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1007\/s00167-009-0755-7","article-title":"Soft tissue balancing in varus total knee arthroplasty: an algorithmic approach","volume":"17","author":"P C Verdonk","year":"2009","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1186\/s13018-017-0681-1","article-title":"Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty","volume":"12","author":"Q Tang","year":"2017","journal-title":"J Orthop Surg Res"},{"issue":"07","key":"ref5","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.arth.2010.03.007","article-title":"A new surgical technique for medial collateral ligament balancing: multiple needle puncturing","volume":"25","author":"J Bellemans","year":"2010","journal-title":"J Arthroplasty"},{"issue":"09","key":"ref6","doi-asserted-by":"crossref","first-page":"e510","DOI":"10.3928\/01477447-20110714-48","article-title":"Multiple needle puncturing: balancing the varus knee","volume":"34","author":"J Bellemans","year":"2011","journal-title":"Orthopedics"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"61","DOI":"10.5792\/ksrr.2014.26.2.61","article-title":"Diagnosis, causes and treatments of instability following total knee arthroplasty","volume":"26","author":"M J Chang","year":"2014","journal-title":"Knee Surg Relat Res"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"347","DOI":"10.3109\/17453674.2010.483992","article-title":"Correction of axial and rotational alignment after medial and lateral releases during balanced gap TKA. A clinical study of 54 patients","volume":"81","author":"P J Heesterbeek","year":"2010","journal-title":"Acta Orthop"},{"issue":"367","key":"ref9","first-page":"141","article-title":"Results of total knee arthroplasty with medial epicondylar osteotomy to correct varus deformity","author":"G A Engh","year":"1999","journal-title":"Clin Orthop Relat Res"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1007\/s00167-009-0755-7","article-title":"Soft tissue balancing in varus total knee arthroplasty: an algorithmic approach","volume":"17","author":"P C Verdonk","year":"2009","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1302\/0301-620X.91B4.21862","article-title":"The intra-operative joint gap in cruciate-retaining compared with posterior-stabilised total knee replacement","volume":"91","author":"T Matsumoto","year":"2009","journal-title":"J Bone Joint Surg Br"},{"issue":"463","key":"ref12","first-page":"208","article-title":"An ABJS best paper: dynamic intraoperative ligament balancing for total knee arthroplasty","volume":"463","author":"D D D'Lima","year":"2007","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1007\/s11999-012-2773-x","article-title":"Surgical technique: computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA","volume":"471","author":"A B Mullaji","year":"2013","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1302\/0301-620X.83B1.0830033","article-title":"Femoral condylar lift-off in vivo in total knee arthroplasty","volume":"83","author":"D A Dennis","year":"2001","journal-title":"J Bone Joint Surg Br"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"287","DOI":"10.4055\/cios.2013.5.4.287","article-title":"Comparison of complete distal release of the medial collateral ligament and medial epicondylar osteotomy during ligament balancing in varus knee total knee arthroplasty","volume":"5","author":"J A Sim","year":"2013","journal-title":"Clin Orthop Surg"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0039-1694047.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,25]],"date-time":"2022-09-25T10:27:34Z","timestamp":1664101654000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0039-1694047"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,8]]},"references-count":15,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2021,1,21]]},"published-print":{"date-parts":[[2021,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0039-1694047","relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,8]]}}}