Valgus Knee Deformity

Valgus Knee Deformity

Kapil Mehrotra

Mark W. Pagnano

Key Concepts

  • Mild to moderate valgus knee deformities often can be corrected with soft tissue balancing by selectively releasing tight structures on the lateral side.

  • A very pragmatic approach to lateral releases is the inside-out multiple-puncture or “pie-crust” release. This is further simplified if the surgeon tensions the lateral side in extension, palpates the lateral structures to identify the tightest, and sequentially punctures the tightest remaining structure with a #15 blade until adequately released.

  • Severe valgus deformities result in stretching of the medial collateral ligament (MCL) and may require a constrained knee prosthesis.

  • A tiny subgroup of patients with large, fixed deformity may require a lateral epicondyle wafer osteotomy.

  • In contemporary practice, about 95% of valgus knees are amenable to the multiple-puncture technique; 5% of patients, particularly the elderly, are better served with deliberate undercorrection and use of a constrained knee; and a rare subset of younger patients with large, fixed deformity may require epicondylar osteotomy.

Sterile Instruments and Implants


  • Routine knee retractors (e.g., bent Hohmann retractors, Z retractors, Chandler retractors, Pickle fork)

  • Large and small oscillating saw

  • Osteotome (3/4 inches curved, broad straight)

  • Lamina spreaders

  • Spacer blocks and alignment rods

  • Patella caliper

  • Cobb elevator


  • Cemented femoral, tibial, and patellar components (with instrumentation)

  • Constrained condylar implant design should be available for fixed deformities


  • Supine

  • Thigh tourniquet

Surgical Approaches

  • Anterior midline incision starting 3 to 5 cm above the proximal pole of the patella to the distal end of the tibial tubercle.

  • Median parapatellar arthrotomy or a midvastus arthrotomy if correctable deformity.

  • Lateral parapatellar arthrotomy is not used in our practice but is described by others for use in the valgus knee.

Preoperative Planning


  • Measure the tibiofemoral angle (angle created between the anatomic axis of the tibia and femur) to determine the severity of the valgus deformity (Figure 54.1).

  • In the valgus knee a weight-bearing posteroanterior flexed-knee radiograph will often reveal more substantial arthritis than the standard anteroposterior radiograph (Figure 54.2A and B).

  • Look for medial joint space widening, which may indicate MCL laxity.

    Figure 54.1 ▪ A full-length standing radiograph that includes the hip-knee-ankle is useful in assessing the overall limb alignment and the presence or absence of extra-articular deformity.

    Figure 54.2 ▪ A, A typical standing anteroposterior radiograph often underestimates the extent of lateral compartment degenerative arthritis. B, A weight-bearing posteroanterior view of the same knee reveals advanced lateral compartment degenerative arthritis with grade 4 bone-on-bone changes laterally.

  • Evaluate for lateral femoral condyle or lateral tibial plateau bone deficiencies.

  • Many patients with valgus deformity will also have substantial concomitant patellofemoral degenerative arthritis visible on a merchant or skyline radiograph.

  • Identify posterior osteophytes on the lateral radiograph.

  • Template femoral and tibial component size.

  • Consider the need for augments, stems, or constrained implants.

Bone, Implant, and Soft Tissue Techniques


  • Median parapatellar approach (see Section III B, Chapter 1 for details of the surgical exposure).

  • Limited subperiosteal elevation of the medial soft tissue should be performed. Extensive medial release will contribute to the medial-sided laxity and will add to the complexity of soft tissue balancing.

Bone Cuts

Dec 14, 2019 | Posted by in ORTHOPEDIC | Comments Off on Valgus Knee Deformity

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