Medial Tibial Reduction Osteotomy is Associated with Excellent Outcomes and Improved Coronal Alignment


  • J. Ryan Martin Colorado Joint Replacement, Denver, Colorado
  • Daniel Levy Colorado Joint Replacement, Denver, Colorado
  • Todd Miner Colorado Joint Replacement, Denver, Colorado
  • David Conrad Thedacare Orthopedics, Appleton, WI
  • Jason Jennings Colorado Joint Replacement, Denver, Colorado
  • Douglas Dennis Colorado Joint Replacement



varus deformity, medial release, total knee replacement, alignment, stability


Background: The medial tibial reduction osteotomy (MTRO) was introduced to achieve coronal ligamentous balance in total knee arthroplasty (TKA) patients with substantial preoperative varus deformity. Limited data exists on the outcomes of patients requiring an MTRO. This study compares outcomes of a matched cohort of patients that either required or did not require an MTRO during TKA.

Methods: A retrospective review was performed on 67 patients that underwent an MTRO during primary TKA to achieve coronal balance. This patient population was matched 1:1 to another cohort of TKA patients by age, gender, and BMI that did not require an MTRO. A clinical and radiographic evaluation was utilized to compare the two cohorts.

Results: Preoperatively, the tibiofemoral angle was 3.42° valgus versus 6.12° varus in the control and MTRO cohorts respectively (p=0.01). Mean postoperative tibiofemoral angles were 3.40° versus 2.43° valgus respectively. Postoperative Knee Society Scores were superior in the MTRO cohort (183.84 versus 174.58; p=0.04). Intraoperatively, no superficial MCL releases were required to achieve coronal balance in either cohort. Complications were similar and limited in both groups.  Medial tibial bone resorption was observed in 64% of MTRO subjects averaging 2.02mm versus only 0.3mm in the control cohort ( p=0.01).

Conclusion: Patients requiring an MTRO achieved similar alignment and superior knee scores compared to a control cohort with less varus deformity. This procedure eliminated the need for release of the superficial MCL.  Resorption of medial tibial bone was commonly observed, possibly secondary to saw-induced thermal necrosis associated with performing an MTRO.

Author Biographies

J. Ryan Martin, Colorado Joint Replacement, Denver, Colorado


Daniel Levy, Colorado Joint Replacement, Denver, Colorado


Todd Miner, Colorado Joint Replacement, Denver, Colorado


David Conrad, Thedacare Orthopedics, Appleton, WI


Jason Jennings, Colorado Joint Replacement, Denver, Colorado


Douglas Dennis, Colorado Joint Replacement



Whiteside LA. Soft tissue balancing: the knee. J Arthroplasty. 2002;17(4 Suppl 1):23-27. Accessed August 9, 2015.

Teeny SM, Krackow KA, Hungerford DS, Jones M. Primary total knee arthroplasty in patients with severe varus deformity. A comparative study. Clin Orthop Relat Res. 1991;(273):19-31. Accessed August 9, 2015.

Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kurosaka M, Kuroda R. The influence of preoperative deformity on intraoperative soft tissue balance in posterior-stabilized total knee arthroplasty. J Arthroplasty. 2011;26(8):1291-1298. doi:10.1016/j.arth.2011.01.003.

De Muylder J, Victor J, Cornu O, Kaminski L, Thienpont E. Total knee arthroplasty in patients with substantial deformities using primary knee components. Knee Surg Sports Traumatol Arthrosc. September 2014. doi:10.1007/s00167-014-3269-x.

Seo J-G, Moon Y-W, Jo B-C, Kim Y-T, Park S-H. Soft Tissue Balancing of Varus Arthritic Knee in Minimally Invasive Surgery Total Knee Arthroplasty: Comparison between Posterior Oblique Ligament Release and Superficial MCL Release. Knee Surg Relat Res. 2013;25(2):60-64. doi:10.5792/ksrr.2013.25.2.60.

Meloni MC, Hoedemaeker RW, Violante B, Mazzola C. Soft tissue balancing in total knee arthroplasty. Joints. 2(1):37-40. Accessed August 9, 2015.

Dixon MC, Parsch D, Brown RR, Scott RD. The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone. J Arthroplasty. 2004;19(1):19-22. Accessed August 9, 2015.

Krackow KA, Raju S, Puttaswamy MK. Medial over-resection of the tibia in total knee arthroplasty for varus deformity using computer navigation. J Arthroplasty. 2015;30(5):766-769. doi:10.1016/j.arth.2014.11.034.

Niki Y, Harato K, Nagai K, Suda Y, Nakamura M, Matsumoto M. Effects of Reduction Osteotomy on Gap Balancing During Total Knee Arthroplasty for Severe Varus Deformity. J Arthroplasty. July 2015. doi:10.1016/j.arth.2015.06.061.

Ahn JH, Back YW. Comparative Study of Two Techniques for Ligament Balancing in Total Knee Arthroplasty for Severe Varus Knee: Medial Soft Tissue Release vs. Bony Resection of Proximal Medial Tibia. Knee Surg Relat Res. 2013;25(1):13-18. doi:10.5792/ksrr.2013.25.1.13.

Matsueda M, Gengerke TR, Murphy M, Lew WD, Gustilo RB. Soft tissue release in total knee arthroplasty. Cadaver study using knees without deformities. Clin Orthop Relat Res. 1999;(366):264-273. Accessed August 9, 2015.

Mullaji AB, Shetty GM. Correction of varus deformity during TKA with reduction osteotomy. Clin Orthop Relat Res. 2014;472(1):126-132. doi:10.1007/s11999-013-3077-5.

Skyttä ET, Haapamäki V, Koivikko M, Huhtala H, Remes V. Reliability of the hip-to-ankle radiograph in determining the knee and implant alignment after total knee arthroplasty. Acta Orthop Belg. 2011;77(3):329-335. Accessed September 29, 2015.

Meneghini RM, Daluga AT, Sturgis LA, Lieberman JR. Is the pie-crusting technique safe for MCL release in varus deformity correction in total knee arthroplasty? J Arthroplasty. 2013;28(8):1306-1309. doi:10.1016/j.arth.2013.04.002.




How to Cite

Martin, J. R., Levy, D., Miner, T., Conrad, D., Jennings, J., & Dennis, D. (2017). Medial Tibial Reduction Osteotomy is Associated with Excellent Outcomes and Improved Coronal Alignment. Reconstructive Review, 7(1).



Original Article