As part of the highly visual operative techniques series, it boasts brief bulleted descriptions and a clean layout for ease of use, while clinical pearls help you optimize outcomes and. Cruciateretaining total knee arthroplasty intechopen. The knee joint is called mobile because the femur and lateral meniscus move 17. As part of the development and optimization of an anatomic medial knee reconstruction technique, we performed biomechanical studies that included static sectioning studies of the posterior oblique ligament, proximal and distal divisions of the superficial medial collateral ligament, and meniscofemoral and meniscotibial divisions of the deep medial collateral ligament and measurement of the forces present on the proximal and distal divisions of the superficial medial collateral ligament and. That is why valgus knee surgeons always have plane a and plane b in the prosthesis. The medial rotation knee was developed using clinical experience gained since the first condylar knee replacement was performed at the royal london hospital in 1968 1, 2. Medial knee injuries those to the inside of the knee are the most common type of knee injury. Kneealign 2 system surgical technique manual kneealign 2 system surgical technique manual 8 femur femur attach sensors attach navigation unit and sensor to microblock. It replaces the following paragraphs in the conventional surgical technique documents. This contributes to patellar tracking because at 15 of knee flexion the patella engages the trochlear groove and this is the stress point where the patella needs to be centrally located to prevent lateral dislocation or subluxation. Align ball in center of rectangular box on side of screen by changing angle of femur until box turns green. Tria thlon pkr pa rtial knee resu rfacing surgical protocol.
An international panel of renowned authors have worked on this didactic fully illustrated book. Transepicondylar axis is defined by a line connecting the surgical medial and. Reconstruction of the mcl and posteromedial corner is indicated in the setting of a multiligamentous knee injury. Medial knee injuries are those to the medial side the inside of the knee are the most common. For correcting this deformity, a stepwise approach is used by surgeons during tka. A good landmark for rotation is to align the anterior aspect of the tibial component with the medial of the patellar tendon. Measured femoral sizing and rotation 24 balanced femoral sizing and rotation 29 femoral preparation 36. It is used to determine the presence of a displaceable meniscal tear within. Other approaches may be used depending on the surgeons practice. With such knowledge, the pathologic condition, anatomy, and planned. Verasense tm quantifies softtissue instability, tibialfemoral rotation, and alignment in total knee arthroplasty.
Pushed by the progress of biology, technology and biomechanics, knee surgery has dramatically evolved in the last decades. Medial collateral ligament advancement is not commonly required for knee replacement surgery. Copublished with the arthroscopy association of north america, the knee. In the medial compartment, the rotation of the resection is estimated by rotating the saw blade such that it points toward the center of. Always use the most lateral scar blood supply comes from medial aspect want to avoid a large lateral flap of dubious quality cross transverse scars at 90 o minimum 7 cm skin bridge.
Rotational alignment in total knee arthroplasty sciencedirect. Total knee arthroplasty radiology reference article. This surgical technique provides guidelines for the implantation of the attune knee system family of fixed bearing knees with the attune intuition instrumentation. Set fixation arm on proximal end of tibial jig to left or right for leg being operated on. With the knee in full extension, axial images are obtained through the knee. Medial reconstruction during total knee arthroplasty for. Preoperative planning and meticulous surgical technique are essential to achieve optimum results. Navigation unit on mounting bracket should be attached. The knee is more complex than a simple hinge joint. Knowledge regarding the anatomy, biomechanics, and diagnosis of injuries to the lateral and medial sides of the knee has expanded greatly during the last few decades.
As with other surgical procedures, errors of technique are more likely when the method is being learned. Surgical techniques and instrumentation in total knee. The main static stabilizers of the medial knee are the superficial medial collateral and posterior oblique ligaments. Medial rotation definition of medial rotation by medical. As in all total knee techniques, a primary goal is to achieve balanced flexion and extension gaps. Oxford unicompartmental knee manual of the surgical. A long term clinical outcome of the medial pivot knee. Some authors also used the meo technique in the past, but their method involves subsequently reattaching the medial epicondyle with screws, sutures, or anchors in an optimal position for balancing the prosthetic knee, which will not allow early rehabilitation after surgery. The medial rotation knee mrk is the original medial ballandsocket knee and has been in clinical use for over 25 years.
Chapter 105 surgical techniques and instrumentation in total knee arthroplasty thomas parker vail, jason e. Triathlon knee system surgical protocol acknowledgments stryker orthopaedics wishes to thank the global triathlon knee system surgeon panel for their dedication to the development and refinement of the triathlon knee system and instrumentation. Advanced functional biomechanical analysis of medial rotation. Total knee arthroplasty tka is one of the most costeffective and consistently. However, the orthopedic surgeon may face anatomical variants associated with knee types that may complicate the classic approach. Two wellknown knee experts have assembled a group of giants in the field to present a book. There are several approach options available to the surgeon, the most common are. This video demonstrates patellar mobilization with medial and lateral rotation.
The authors also found a significant increase in internal rotation at 0 degrees, 20 degrees, 30 degrees, and 60 degrees of knee flexion after sectioning the medial knee structures, which was. A long term clinical outcome of the medial pivot knee arthroplasty system. The knee joint surgical techniques and strategies michel. Surgical technique legion hk hinge knee system introduction. A torn meniscus is the most common cause of mechanical symptoms in the knee.
Tibial component rotation in total knee arthroplasty. If the tibial component is internally rotated, the tibia bone is now relatively externally rotated compared to the femur, which will rotate the tibial tubercle laterally. Successful total knee arthroplasty depends in part on. First, unlock the slope adjustment lock and then translate the tibial slope adjuster anteriorly until the desired angle is reached. Medialpivot knee system surgical technique distal cut. Rotational alignment is important for a good functional outcome and the longterm success of total knee arthroplasty tka. Position the pin guide on the distal femur figure 8 until the trocar pins align under the carm and appear as a spot located at the center of rotation figure 9.
Malalignment can cause patellofemoral complications such as subluxation, dislocation, and wear. The rotation is set referencing the medial onethird of the tibial tubercle. An extensile exposure proximally such as a quadriceps snip, or distally such as a tibial tubercle. Indications the general principles of good patient selection and sound surgical judgment apply to the total knee procedure. As part of the development of an anatomic medial knee reconstruction technique, we measured the forces present on the proximal and distal divisions of the superficial medial collateral ligament and the posterior oblique ligament to applied loads 5. When the gold standard is a bit rubbish posted by simon talbot the gold standard for femoral component rotation following total knee arthroplasty is a line parallel to the surgical epicondylar axis sea on a threedimensional ct reconstruction of the knee. Studies show that this procedure maintains a high level of performance, longevity and patient satisfaction for all age groups. Medialpivot knee system surgical technique distal cut first. How to achieve mechanical alignment, dial in rotation, restore the joint line.
Old surgical scars can affect the planned surgical approach. Mobile bearing total knee prosthesis anterior stabilized magnitude of flexion encountered the new wave mobile bearing total knee prosthesis was designed to. The medial collateral ligament mcl, also known as the tibial collateral ligament, is the most commonly injured ligament in the knee. Medial epicondyle osteotomy for balancing severe varus knee. Clinically relevant biomechanics studies on the medial knee. The mako makoplasty tka application displays coronal rotation values with. Tap or drill the trocar pin wires into the femur approximately 2 to 3cm figure 10. The main criticisms of the surgical technique are that the distal attachment of the. Varus malalignment is the most common deformity leading to total knee arthroplasty tka for knee arthritis.
The damaged meniscus is then evaluated to determine the applicability of the cmi. Physiologically, the knee also undergoes axial rotation and femoral rollback. These ligaments have also been called the medial collateral ligament mcl, tibial collateral ligament. Sep 10, 2011 thus, we found this anatomic medial knee reconstruction technique restored nearnormal stability to a knee with complete superficial medial collateral ligament and posterior oblique ligament injuries and, at the same time, avoided overconstraint of the reconstructed ligament grafts. What is the resting position for the tibiofemoral joint. This book is distributed under the terms of the creative commons. Before mis can become an accepted surgical technique for tka, a clear understanding of the unique. A novel surgical technique to perform total knee arthroplasty in. If replacing the patella, use a genesis ii biconvex or round resurfacing implant. Surgical technique, advantages and complications will also be discussed. The medial side of the muscle is retracted laterally, sparing the aponeurosis of the sartorius in. Dec 28, 2015 injuries to the medial collateral ligament mcl and posteromedial corner can occur in isolation or in the setting of multiligamentous knee injuries.
Sep 10, 2011 clinically relevant biomechanics studies on the medial knee. The following guidelines are furnished for information purposes only. Jan 02, 2017 only 10% of knee deformities that require tka are done for the valgus knee. Anatomy and biomechanics of the medial side of the knee and their surgical implications. A significant increase was found in valgus angulation and external rotation after sectioning the medial knee structures at all tested knee flexion angles.
Do not use the journey bcs total knee patellar component. The mrk design was based on the principle that by providing natural functional and anatomical asymmetry in all three knee compartments medial tibiofemoral, lateral tibiofemoral and patellofemoral articulations, better function and increased patient satisfaction can be achieved without the compromises of traditional tkrs. Medial pivot knee system surgical technique distal cut first instrumentation proper surgical procedures and techniques ar e the responsibility of the medical professional. Total knee replacement tkr techniques statpearls ncbi. Chapter 104 surgical approaches in total knee arthroplasty standard and mis techniques nilesh patil, michael p. A tight pcl may also cause the knee to hinge open like a book fig. Triathlon knee system surgical protocol femoral preparation 8. Journal of bone and joint surgery 2007 while the anatomy of the medial part of the knee has been described qualitatively, quantitative descriptions of the attachment sites of the main medial knee structures have not been reported.
Our institution haspublishedextensively onthe subject of knee anatomy, and the reader is urged to explore more in. A comparison between the medial pivot knee and a posterior stabilised implant. This book is a state of the art concerning all aspects of knee surgery from ligament reconstruction to total knee arthroplasty. This surgical technique provides instruction on the implantation of the lcs complete knee system family of knee implants. Surgical approaches for total knee arthroplasty intechopen.
Knee surgery offers all the stepbystep guidance you need to perform the latest techniques in knee surgery. Figure 1 table 1 size compatibility tibial insert 12 34 56 femoral. The described deformities can lead to a tibial external rotation and to a patellar. This surgical technique is based on the brainlab knee3 software. Resect the condyles and check the surface for accuracy.
In general, a standard medial parapatellar arthrotomy is used when feasible. To reduce these to a minimum, surgeons are strongly recommended to attend an instructional course on the oxford knee before attempting the operation. Total knee arthroplasty tka, or total knee replacement tkr, is an orthopedic procedure whereby the three articular surfaces of the knee femoral, tibial, and patellar are replaced by prosthetic components. This surgical technique supplement describes the use of the 5in1 computerassisted surgery software for implanting amplitudes total knee arthroplasty tka systems. The purpose of the present study was to verify the qualitative anatomy of medial knee structures and to. Over the years, there have been many advancements in surgical technique and even more so in implant design. The knee permits flexion and extension about a virtual transverse axis, as well as a slight medial and lateral rotation about the axis of the lower leg in the flexed position. Total knee replacement procedures have been steadily growing over the last 2. The capsule is entered through a medial parapatellar approach. There is also a gap balancing technique to bone cuts the difference is discussed here. Sometimes surgeons will intentionally change the depth of the distal.
The terminology used describes this motion according to its direction relative to the anatomical position of the joints. Isolated cases failing nonoperative treatment may also undergo surgical treatment. Total knee arthroplasty tka techniques statpearls ncbi. Ideal for orthopaedic residents, fellows, and practicing surgeons alike, operative techniques. Open the joint using your standard midline or slightly medial parapatellar incision, which is approximately 1 proximal to your incision for tka. During this test, the athletic trainer grasps the great toe and lifts the leg off the table.
A number of reconstructive techniques have been advocated including one we describe here. The ranawat classification 1 uses 3 grades to describe valgus deformity severity. Motion includes movement of organs, joints, limbs, and specific sections of the body. This test is intended to reveal laxity of the medial and lateral stabilizing complexes. In the medial compartment, the rotation of the resection is estimated by rotating the. Along with novel implant designs, new prosthetic materials and refined surgical techniques. Options can do trial sham incision down to capsule can perform skin expansion prior to surgery. Scuderi critical to exposing the knee during total knee arthroplasty is a complete understanding of the local anatomy, which is described in chapter 1. Current techniques for hip reconstruction focus on restoring the anatomical geometry of the hipplacing the acetabular component in a low and medial position to restore the center of rotation and selecting a femoral stem that will restore offset maximizing tension of the abductors and leg length. Acl, pcl, and medialsided injuries of the knee request pdf.
Compensatory external rotation of the foot is a mechanism of. It is performed with the knee flexed at 90 degrees and the foot in neutral. When a severe varus malalignment is present, there are some concerns regarding balancing procedure, meaning that aggressive release of medial structures could lead to instability and need for a more. A hinge knee prosthesis with axial rotation approximating the function of the natural knee has been developed by noiles.
Advanced functional biomechanical analysis of medial rotation knee arthroplasty. Ensure that varusvalgus and posterior slope levers. One of the more recent technological breakthroughs in total knee arthroplasty is the use of a robotic assisted arm for enhanced preoperative planning and intraoperative guidance with dynamic joint balancing and bone preparation. Amis surgical technique 8 hip knee spine navigation 4. Surgical technique place the pin guide on the knee. Triathlon knee system surgical protocol stryker meded. The attune intuition instrumentation is intended for use with the attune knee system implants only and should not be considered interchangeable with any other instrumentation.
Draw line a through the surgical epicondylar axis which connects the lateral epicondylar prominence arrow and the medial sulcus of the medial epicondyle arrowhead. Jun 28, 2017 the gold standard for femoral component rotation following total knee arthroplasty is a line parallel to the surgical epicondylar axis sea on a threedimensional ct reconstruction of the knee. The best way to understand our knee motion is to first understand that it is controlled by three things. The trivector approach for minimally invasive total knee arthroplasty. During the surgical procedure, accessory portals may be required for better view or access. Motion occurs not only in flexionextension, but also involves rotation, pivot, and gliding movements. Aana advanced arthroscopic surgical techniques is a comprehensive technique based book that presents the. Normal anatomy and biomechanics of the knee fred flandry, md, facsw and gabriel hommel, md. Medial reconstruction during total knee arthroplasty for sev. Myknee surgical technique 8 hip knee spine navigation surgical approach the most commonly used surgical approach is the medial parapatellar approach. Orthopaedic surgery surgical techniques for the knee. Anatomy and biomechanics of the lateral and medial sides of. Aug 15, 2012 in this episode of eorthoodtv, orthopaedic surgeon randale sechrest, md narrates an animated tutorial on the anatomy of the knee.
Medial aspect of the knee studies robert laprade, md. Take care to not release medial collateral ligament mcl during initial exposure. The majority of this external rotation occurs in the first 15 of knee flexion. Valgus forces can be applied with external rotation of the tibia on a fixed femur.
Femoral component rotation is determined as follows. The trivector approach for minimally invasive total knee. Chapter 105 surgical techniques and instrumentation in total knee arthroplasty. She comes to you with reduced range of motion especially in flexion. For a typical varus knee reconstructed with 8 mm thick distal and posterior femoral condyles on the femoral component, the thickness of the distal medial resection should be 5 mm, the posterior. Currently, younger and more active patients with arthritis, trauma and other joint diseases are getting predictable and durable results from total knee arthroplasty. The mako is indicated for use in surgical knee procedures in which the use of. The mrk design was based on the principle that by providing natural functional and anatomical asymmetry in all three knee compartments medial tibiofemoral, lateral tibiofemoral and patellofemoral articulations.
Open anatomic reconstruction of the medial collateral. Attune knee system implants are available in one configuration. Primary total knee arthroplasty in valgus deformity intechopen. Tka is the most common joint arthroplasty performed in the united states, with an estimated 672,000 tkas performed in 2009. Oxford unicompartmental knee manual of the surgical technique. Kneealign 2 system surgical technique manual kneealign 2 system surgical technique manual 4 set up set up assemble t ibial jig assemble tibial jig as follows. Knee injuries may result in isolated or combined meniscal lesions. Using the rom technique the tibial component was externally rotated by a mean 4. This book is distributed under the terms of the creative commons attribution 4.
The medial ligament complex of the knee is composed of the superficial medial collateral ligament smcl, deep medial collateral ligament dmcl, and the posterior oblique ligament pol. It gives you the essential details of preoperative planning, technique, and postoperative management for more than 55 procedures for sports medicine injuries, adult knee reconstruction, and trauma. Surgical techniques and instrumentation in total knee arthroplasty. Surgery was performed to stabilize the knee and the leg was cast for 6 weeks. The two with the longest followup, out to one year, include. This book is a concise instructional guide to surgical treatment of common knee injuries.
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