Valgus Deformity Correction 
- ▪
During exposure of a knee with a valgus deformity take care not to compromise the medial soft tissue sleeve, which may already be attenuated.
- ▪
Make the bone cuts using your preferred technique (intramedullary or extramedullary guide, computer navigation, custom cutting blocks).
- ▪
Remove osteophytes to the level of the native articular margins to avoid tenting of the soft tissues.
- ▪
During exposure, release the lateral capsule from the tibia.
- ▪
The order of soft tissue release on the lateral side of the knee varies depending on the extent of fixed contracture and associated deformity.
- ▪
The structure released first depends on whether both the extension and flexion gaps are tight on the lateral side. If both are tight, release the lateral collateral ligament off the lateral epicondyle taking care to leave the insertion of the popliteus tendon intact.
- ▪
The posterior cruciate ligament (PCL) is a more medial structure and may be involved in coronal plane deformity in a varus knee; it less likely acts as a central tether in valgus deformity because of its more medial location. If it is involved in more severe valgus deformities, it may need to be released ( Figure 12-1 ).
