{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:43:58Z","timestamp":1782827038128,"version":"3.54.5"},"reference-count":14,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":180,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Advances in Orthopedics"],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Background<\/jats:title>\n Total knee arthroplasty (TKA) in the fixed valgus knee is technically demanding due to lateral soft\u2010tissue contractures and the risk of peroneal nerve injury. This study evaluates the clinical and radiographic outcomes of a manual \u201cinside\u2010out\u201d soft\u2010tissue balancing algorithm for Ranawat Grade II and III valgus deformities.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n We prospectively evaluated 30 knees (24 patients) with advanced arthritis and valgus deformity (>\u200910\u00b0) treated between 2016 and 2019. Surgical correction followed a sequential \u201cinside\u2010out\u201d protocol: posterior cruciate ligament (PCL) resection, posterolateral capsule (PLC) release, and selective iliotibial band (ITB) pie\u2010crusting within a strict 1\u2010cm safety zone. Clinical outcomes were measured using the Knee Society Score (KSS). Radiographic analysis focused on the tibiofemoral angle and component alignment. Results were compared with traditional manual techniques and novel robotic\u2010assisted data.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The mean KSS improved significantly from 19.63 preoperatively to 87.17 at the final follow\u2010up (\n p<\/jats:italic>\n < 0.001). The mean tibiofemoral valgus angle was corrected from 24.28\u00b0 to 4.97\u00b0. Absolute medial stability was achieved in 96.6% of cases. Notably, in our series, no cases of peroneal nerve palsy were observed (0%; 95% CI: 0.0%\u201311.6%), suggesting a high safety profile for the inside\u2010out technique. Two intraoperative periprosthetic fractures (6.6%) occurred and were managed successfully.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Our manual algorithm achieved safety and alignment outcomes comparable to novel robotic\u2010assisted TKA series. The \u201cinside\u2010out\u201d approach provides excellent exposure and controlled lengthening of contracted structures while protecting neurovascular anatomy.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The manual \u201cinside\u2010out\u201d technique is a safe, reproducible, and cost\u2010effective method for correcting severe valgus deformity. It provides high precision in gap balancing and effectively eliminates the risk of peroneal nerve palsy in Ranawat Grade II and III cases. It ensures high precision in gap balancing and effectively minimizes the risk of peroneal nerve palsy, providing a reliable alternative in settings where robotic technology is inaccessible.<\/jats:p>\n <\/jats:sec>","DOI":"10.1155\/aort\/7006795","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T12:47:03Z","timestamp":1782823623000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Short\u2010Term Clinical Outcomes of a Manual \u201cInside\u2010Out\u201d Algorithm for Correcting Ranawat Grade II and III Valgus Deformity in Total Knee Arthroplasty"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4183-2084","authenticated-orcid":false,"given":"Medhat Mohamed","family":"Hassan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molham Mahmood","family":"Mohammad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid Mohamed Abdelhaleem","family":"Hafez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa El-din Mohy El-din","family":"Soliman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.2106\/jbjs.e.00308"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199112000-00004"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/jbjs.k.00607"},{"key":"e_1_2_12_4_2","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1533\/9781782420385.2.69","volume-title":"Surgical Techniques in Total Knee Arthroplasty and Alternative Procedures","author":"Fosco M.","year":"2015"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v6.i6.469"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-013-2227-4"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200412002-00010"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199110000-00008"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199303000-00030"},{"key":"e_1_2_12_10_2","first-page":"390","article-title":"Robotic-Assisted Total Knee Arthroplasty in the Valgus Knee: Impact on Soft-Tissue Release and Alignment","volume":"36","author":"Redmond J. M.","year":"2023","journal-title":"Journal of Knee Surgery"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.2106\/jbjs.24.00207"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12585"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2010.06.008"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200201000-00004"}],"container-title":["Advances in Orthopedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/aort\/7006795","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/aort\/7006795","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/aort\/7006795","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T12:47:04Z","timestamp":1782823624000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/aort\/7006795"}},"subtitle":[],"editor":[{"given":"Shashank","family":"Kaushik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/aort\/7006795"],"URL":"https:\/\/doi.org\/10.1155\/aort\/7006795","archive":["Portico"],"relation":{},"ISSN":["2090-3464","2090-3472"],"issn-type":[{"value":"2090-3464","type":"print"},{"value":"2090-3472","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-05-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"7006795"}}