The mako is indicated for use in surgical knee procedures in which the use of. This surgical technique provides guidelines for the implantation of the attune knee system family of fixed bearing knees with the attune intuition instrumentation. Knee brace influences on the tibial rotation and torque. Normal anatomy and biomechanics of the knee fred flandry, md, facsw and gabriel hommel, md. Acute grade iii injuries with concomitant multiligament injuries or knee dislocation involving medial side injury should undergo surgical treatment. Motion occurs not only in flexionextension, but also involves rotation, pivot, and gliding movements. Kneealign 2 system surgical technique manual kneealign 2 system surgical technique manual 8 femur femur attach sensors attach navigation unit and sensor to microblock. Whereas the posterolateral corner has been referred to as the dark side of the knee by some authors owing to widespread lack of knowledge of its complex anatomy, even less is written.
Set fixation arm on proximal end of tibial jig to left or right for leg being operated on. This book is a state of the art concerning all aspects of knee surgery from ligament reconstruction to total knee arthroplasty. The best way to understand our knee motion is to first. Align the proximal central marking on the tibia cutting block with the medial one third of the tibial tubercle to set rotation. Triathlon knee system surgical protocol stryker meded. Treatment of patellar dislocation in the skeletally immature patient is presented with speci. Medial rotation definition of medial rotation by medical. Ensure that varusvalgus and posterior slope levers. During the surgical procedure, accessory portals may be required for better view or access. Anatomy and biomechanics of the medial side of the knee and. 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. Novel anatomicalbased surgical technique for positioning of. Pdf knee rotation and loading during spin and step turn. The posterior positioning of its single center of rotation ensures frontal.
Using headless pins, pin the tibial drill guide to the proximal tibia figure 17. The video also demonstrates the influence of simulated semimembranosus contraction on the kinematics of the posterior horn of the medial meniscus and other structures of the posteromedial corner. The primary stabilizer of external tibial rotation. Medial pivot knee system surgical technique distal cut first instrumentation proper surgical procedures and techniques ar e the responsibility of the medical professional. 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. However, the orthopedic surgeon may face anatomical variants associated with knee types that may complicate the classic approach. Aug 15, 2012 in this episode of eorthoodtv, orthopaedic surgeon randale sechrest, md narrates an animated tutorial on the anatomy of the knee. Transepicondylar axis is defined by a line connecting the surgical medial and. Three important ligaments maintain primary medial knee stability. 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. Surgical techniques using bone landmarks allow independent bone cuts and are defined measured resection technique, figure 3 shows the cuts obtained by the use of this technique.
Align the proximal central marking on the tibia cutting block with the medial one third of the tibial tubercle to set rotation figure. A good exposure also allows optimal placement of the components. The mako makoplasty tka application displays coronal rotation values with. The terminology used describes this motion according to its direction relative to the anatomical position of the joints. The ranawat classification 1 uses 3 grades to describe valgus deformity severity. Place the ankle clamp proximal to the malleoli figure 12. Femoral component rotation is determined as follows. A significant increase was found in valgus angulation and external rotation after sectioning the medial knee structures at all tested knee flexion angles. Jan 02, 2017 only 10% of knee deformities that require tka are done for the valgus knee. Successful total knee arthroplasty depends in part on.
The following guidelines are furnished for information purposes only. Before mis can become an accepted surgical technique for tka, a clear understanding of the unique. 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. Surgical techniques in total knee arthroplasty giles r. Familiarity with and attention to appropriate surgical technique for total knee replacement is essential for success of the procedure. Medial knee injuries those to the inside of the knee are the most common type of knee injury. The consensus of many studies is that isolated grade i, ii, and iii injuries are usually well suited to nonoperative treatment protocols.
Surgical technique, advantages and complications will also be discussed. Acl, pcl, and medialsided injuries of the knee request pdf. The oxford ukr was developed at the nuffield orthopaedic centre in the 1970s and has been routinely used for the treatment of medial knee. After entering the synovium, elevating a subperiosteal flap off the medial plane of the tibia, and freeing the patellar tendon, the knee is maximally flexed. The medial collateral ligament mcl, also known as the tibial collateral ligament, is the most commonly injured ligament in the knee. An additional objective is to provide equal medial.
The procedure will be identified as mako makoplasty tka in this. The knee is more complex than a simple hinge joint. Triathlon knee system surgical protocol indications general total knee arthroplasty tka indications include. The knee joint surgical techniques and strategies michel. 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. 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. While it is the designers objective to develop accurate, easytouse instrumentation, each surgeon must evaluate the appropriateness of the following technique based on his or her medical training. Drill and insert two pins through the locator holes of the sizing guide. 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. Pdf the main static stabilizers of the medial knee are the superficial medial collateral and posterior oblique ligaments. Surgical approaches for total knee arthroplasty intechopen.
Surgical technique to accurately perform the posteromedial incision, the semitendinosus tendon. All surgical techniques should be referenced at the time of surgery. Femoral component external rotation affects knee biomechanics. This book is distributed under the terms of the creative commons.
Navigation unit on mounting bracket should be attached. Preoperative assessment and planning are described extensively. Attune knee system surgical technique depuy synthes companies 5 pinning the attune knee system has 3. Chapter 105 surgical techniques and instrumentation in total knee arthroplasty thomas parker. Several studies have used knee mobilizations for treatment of knee. Persona the personalized knee surgical technique 19 side designation figure 37 figure 38 figure 36 size femur and establish external rotation if the 3 degrees external rotation holes are to be used rotate the feet of the anterior referencing femoral to set external rotation, the etched line on the sizer sizing guide so the appropriate left. A long term clinical outcome of the medial pivot knee arthroplasty. Adjust external rotation of the sizing guide by turning the rotational adjustment knob clockwise 06. Total knee arthroplasty tka is a reliable procedure for the relief of pain and. Medialpivot knee system surgical technique distal cut first. Sep 11, 2019 video 1 video demonstrating the surgical technique for arthroscopic dissection of the distal semimembranosus tendon in a right knee. Replace the tibial offset bushing assembly over the reamer figure 15.
This anatomic reconstruction technique consisted of reconstruction of the proximal and distal. Rotate the tibial offset bushing about the tibia until proper tibial coverage is achieved figure 16. All options for the surgeons preferred technique are provided for seamless, efficient. This manual is informational only and is not intended as medical advice or a. Novel anatomicalbased surgical technique for positioning of the patellar component in total knee arthroplasty chahine assi1, nadim kheir1, camille samaha1, moussa chamoun2, and kaissar yammine1,3, 1 lebanese american university medical centerrizk hospital, department of orthopedic surgery, beirut, lebanon 2 hopital libanofrancais, zahle. The goal was to develop a hinged knee which transitioned seamlessly from a condylar constrained component to a hinged assembly while minimizing the number of new instruments and implants required. This book, dedicated to john insall, is a broad description of the technique of implantation of a total knee prosthesis. It is assumed that the surgeon is already familiar with the fundamentals of total knee arthroplasty tka. Sep 19, 2014 techniques in primary total knee arthroplasty. Chapter 104 surgical approaches in total knee arthroplasty standard and mis techniques nilesh patil, michael p.
Gastrocnemius rotation flap technique orthopaedicsone. Flexion and rotation of the rotational knee prosthesis take place in a cross joint. Amis surgical technique 8 hip knee spine navigation 4. It is important not to exclude the assistance that other ligaments of the medial knee provide, including support of patellar stability by the. This manual describes the mako total knee arthropl asty tka surgical technique assisted by the stryker robotic arm system mako. This book is a state of the art concerning all aspects of knee surgery from ligament. Place the knee in 90 degrees of flexion with the tibia translated anteriorly and stabilized. The surgical technique involves the use of reusable metal instruments gmk ultimate instruments and single use. A tight pcl may also cause the knee to hinge open like a book fig. 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.
Valgus forces can be applied with external rotation. Scuderi critical to exposing the knee during total knee arthroplasty is a complete understanding of the local anatomy, which is described in chapter 1. Scuderi critical to exposing the knee during total knee. Surgical techniques and instrumentation in total knee arthroplasty. 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. A hinge knee prosthesis with axial rotation approximating the function of the natural knee has been developed by noiles. Medial rotation knee matortho pdf catalogs technical. The anatomy and biomechanics of the medial collateral ligament and posteromedial corner of the knee. It documents how knee3 may be used in a clinical setting, but it is not meant as a replacement to the knee3 software user guide. 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.
Oxford partial knee manual of the surgical technique. Surgical approach the preferred anterior approaches to the knee are represented in figure 3. Transepicondylar axis is defined by a line connecting the surgical medial. The system is designed to accommodate either a minimally invasive or standard surgical incision and exposure. Mpfl reconstruction techniques that do not involve drilling or disruption of the periosteum near the femoral physes are safe for the skeletally immature knee. Implant geometries were virtually installed using hiptoankle ct scans through measured resection and anterior referencing surgical techniques. Grade i is knee in full extension, axial images are obtained through the knee.
An international panel of renowned authors have worked on this didactic fully illustrated book. Medial patellofemoral ligament mpfl insufficiency is confirmed by lateral subluxation of the patella with the knee flexed at 30 and compared with the normal contralateral knee. This surgical technique follows the same intuitive flow as the legion revision technique and utilizes the same cutting instruments. Figure 1 table 1 size compatibility tibial insert 12 34 56 femoral.
The trivector approach for minimally invasive total knee arthroplasty. Consult matorthos medial rotation knee brochure on medicalexpo. Only 10% of knee deformities that require tka are done for the valgus knee. 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. Motion includes movement of organs, joints, limbs, and specific sections of the body. Each patient represents an individual case that may require modification of the technique. Jul 14, 2015 the posteromedial corner of the knee pmc is an important anatomic structure that is easily seen but often overlooked on magnetic resonance mr images. As with other surgical procedures, errors of technique are more likely when the method is being learned. Arthroscopic dissection of the distal semimembranosus tendon. Surgical reports indicated that five of the subjects had lesions in. This surgical technique is based on the brainlab knee3 software. This study used 3d motion analysis to obtain the rotation of tibia relative to the femur and knee rotation moment during stance phase of level walking, stair ascentdescent, step and spin turn for. The bearings have been redesigned to reduce the risk impingement and rotation which can lead to dislocation. Open anatomic reconstruction of the medial collateral.
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. To reduce these to a minimum, surgeons are strongly recommended to attend an instructional course on the oxford knee before attempting the operation. Motion, the process of movement, is described using specific anatomical terms. However, with the advent of better surgical instrumentation and technique, the management of combined anterior and posterior cruciate ligament aclpcl tears associated with medial or lateral collateral ligament mcllcl disruption has become primarily surgical. Oxford unicompartmental knee manual of the surgical. Resources on gastrocnemius rotation flap technique. The new wave mobile bearing total knee prosthesis was designed to reduce early mechanical complications. Compensatory external rotation of the foot is a mechanism of unloading a. Draw line a through the surgical epicondylar axis which connects the lateral epicondylar prominence arrow and the medial sulcus of the medial. Pushed by the progress of biology, technology and biomechanics, knee surgery has dramatically evolved in the last decades. Physiologically, the knee also undergoes axial rotation and femoral rollback in.
Patellar complications after total knee arthroplasty. Knee mobilizations may be beneficial for individuals with a variety of conditions, including postoperative rehab and knee osteoarthritis oa. Anatomy and biomechanics of the lateral and medial sides. When autoplay is enabled, a suggested video will automatically. One of the key factors for a successful outcome after ukr surgery is the number of ukr cases carried out by the hospital. However, with the advent of better surgical instrumentation and technique, the management of combined anterior and posterior cruciate ligament aclpcl tears associated with medial or lateral. As in all total knee techniques, a primary goal is to achieve balanced flexion and extension gaps. Gmk revision system surgical technique hip knee spine navigation indication of use gmk revision the gmk revision knee prosthesis is designed for cemented use in total knee arthroplasty, if there is evidence of sufficient sound bone to seat and support the components. Clinical evaluation is detailed with the most used knee scores. Total knee replacement tkr techniques statpearls ncbi.
Rotational alignment of the femoral component in total. The medial side of the muscle is retracted laterally, sparing the aponeurosis of the sartorius in. Adult reconstruction and joint replacement hospital for special surge slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. A vertical medial parapatellar skin incision is carried out. Despite a decrease in frequency related to improvements in implant design and surgical technique, they still. This article presents the basic knee anatomy, mechanisms and classi. Pdf total knee replacement tkr techniques researchgate. Pdf the trivector approach for minimally invasive total.
The medial capsule is released to the posteromedial corner to allow subluxation of. The success of this intervention consists in part in the realignment of the lower extremitys anatomical axis, adequate implant orientation and design, good implant fixation, proper soft tissue balancing, and stability. Oxford unicompartmental knee manual of the surgical technique. Patellar complications of total knee arthroplasty tka are fairly common.
Anatomy and biomechanics of the lateral and medial sides of. Reconstruction of the mcl and posteromedial corner is indicated in the setting of a multiligamentous knee injury. 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. Our institution haspublishedextensively onthe subject of knee anatomy, and the reader is urged to explore more in. This book is a state of the art concerning all aspects of knee surgery from.
Total knee arthroplasty surgery is a current practice in orthopedic surgery. Medialpivot knee system surgical technique distal cut. Sep 10, 2011 clinically relevant biomechanics studies on the medial knee. The intuition instruments are designed to be used with the singleuse pin pack 254400111 that contains universal pins and threaded headed pins. Align ball in center of rectangular box on side of screen by changing angle of femur until box turns green. The knee joint is called mobile because the femur and lateral meniscus move 17. This surgical technique follows the same intuitive flow as the legion revision technique.
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