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Valgus Micropuncture

February 24, 2016

Contributors: Kirby Hitt, MD

This video shows the anatomical landmarks used during placement of the femoral component with appropriate rotation in a valgus knee. This is achieved using a combination of the posterior condylar axis, the transcondylar axis, and Whiteside’s line. Internal rotation, which can occur with a deficient lateral femoral condyle, is thus avoided.In managing the valgus knee, under-resection of the tibial plateau is encouraged due to the attenuation of the medial structures. This prevents the need for larger than normal polyethylene inserts. In all total knee replacements, any posterior condylar bone extending beyond the limits of the femoral implant should be removed to help facilitate extension. Any residual tightness in extension can be addressed by tensioning the medial and lateral soft tissue structures, utilizing a micropuncture technique with a 20 gauge needle to the affected structures, and confirming appropriate balancing. In flexion, this micropuncture technique can be performed on posterolateral structures to help facilitate flexion balance.

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