Knee

Question 1

Bones of the Knee

Answer 1

Femur
Tibia
Patella
Fibula

Question 2

Knee Ligament Functions

Answer 2

ACL
1. Anterior Tibial Displacement
2. Internal Rotation

PCL
1. Posterior Tibial Displacement
2. External Rotation

MCL
Abduction

LCL
Adduction

Question 3

3 Diagnostic ACL Tests

Answer 3

Lachman Test
15-20degrees Anterior Translation of tibia

Anterior Drawer Test
90 degrees as above

Pivot Shift
Varus/Valgus + Internal Rotation

Question 4

ACL Graft choices

Answer 4

1. Hamstring
   (Semi-Tendinosus & Gracillis)
2. BTB
3. Quads Tendon

Question 5

Hamstring Graft (Advs & Disadvs)

Answer 5

+ve: Smaller Incision
+ve: low donor site morbidity

-ve: slower fixation healing
-ve: variable size & length

Question 6

BTB Graft (Advs & Disadvs)

Answer 6

+ve: Faster fixation healing
+ve: Higher initial stiffness

-ve: Large skin incision
-ve: Donor site morbidity / pain on kneeling

Question 7

ACL Construction Techniques (x3)

Answer 7

Trans Tibial
AM Portal
Retroreaming

Question 8

ACL Portals

Answer 8

ALP - Viewing
AMP - Working & viewing
AAMP - Accessory Portal

Question 9

6 steps to ACL Construction

Answer 9

1. Notch prep
2. Graft Harvest
3. Femoral Tunnel
4. Tibial Tunnel
5. Pass Graft
6. Fixations

Question 10

Step 1 - Notch Prep

Answer 10

Resect Mid-section of ACL, preserve fibres at Fem & Tib.
Use Incisor Plus Plat / Flow 50
If remove bone - Notchblaster or curette Notchmaster

Question 11

Step 2 - Graft Harvest

Answer 11

3 fingers below JL = Pes Anserinus (midway between Tib Tub & Post Medial border of tibia)
2-3cm incision
Expose Hamstrings & identify
Hamstring Stripper to origin and detach
Whipstitch, doubled over an EB loop
Measure thickness

Question 12

Step 3 - Femoral Tunnel

Answer 12

Native ACL footprint if ST present OR
Trukor template OR
X-Ray OR
Offset guides

Hyperflex Knee
1. Pilot hole with 45deg Microfracture Awl
2. 2.4mm passing pin , Insert then lateralise hand - oblique hole (more anatomic)
3. 4.5 EB drill
4. Measure tunnel (TEGS)
5. Drill with sized drill
6. Pass suture loops (tails through tunnel)

Question 13

Step 4 - Tibial Tunnel

Answer 13

70-90deg flexion
Elbow or tip aimer 55deg,
Tip at central fibres of ACL footprint, parallel with tibial plateau
Bullet at hamstring hqrvest incision
2.4 passing pin
Sized drill
Retrieve suture loop through tunnel

Question 14

Step 5 - Pass Graft

Answer 14

Loop EndoButton sutures through suture loop and pull through
Use white #5 EB lead suture to lead EB through
Use green suture to flip
Cycle the knee several times

Question 15

Step 6 - Fixation

Answer 15

Femur - EB / UB / Screw
Tib - Screw / UB

RCI = 1.5/2.0 cannuflex
Biosure = 1.2 guidewire
SoftSilk - 1.5 cannuflex

Question 16

EndoButton Info
Size?
Loop material / sizes?
No holes?
Sutures

Answer 16

4x12mm Titanium
Polyester Loop 10-60mm
4 holes
Lead: White UB#5
Flip: Green UB #5

Question 17

EndoButton Benefits (x4)

Answer 17

Highest Load to Failure
Simple, single Incision tech
Excellent tunnel placement
Easy to Revise

GOLD STANDARD

Question 18

Screw fixation - BIOSURE PK

Answer 18

10+ years
Bio-inert
Strong, stiff and tough
Radiolucent
24 sizes
All grafts

Question 19

Screw Fixation - BIOSURE RG

Answer 19

Open Architecture
Replaces bone in 24m
PLGA - 65% (24m)
B-TCP - 15% (18m)
CaSo - 20% (4-12w)

Question 20

Screw Fixation - RCI

Answer 20

Deep, blunt thread = reduces ‘pushing’ graft into tunnel

Round Head = reduces stress on graft as graft exits

Question 21

Screw Fixation - SOFTSILK

Answer 21

BTB only
Deep- rounded thread = reduces laceration
Corkscrew tip = self starting

Question 22

Meniscal Function

Answer 22

Load Transmission
Lubrication
Shock Absorption
Stability
Proprioception

Question 23

Fibrous Structure of Meniscus

Answer 23

1. Circumferential Hoop Fibres
2. Radial Tie Fibres
3. Superficial Random Fibres

Question 24

Classification of Meniscal Tears

Answer 24

RED-RED - Peripheral
RED-WHITE - Mid substance
WHITE-WHITE - Central

Question 25

3 types of meniscal tear

Answer 25

Vertical (leads to Bucket Handle)
Radial (Parrot Beak)
Horizontal (Flap)

Question 26

Paper on repair of White-White tears?

Answer 26

Gallagher 2010
Suceesfully repaired if:
1. Reducible
2. Appropriately held

Question 27

Resection / Menisectomy
4 x Handles
4 x Shapes
4 x Families

Answer 27

Loop Handle
ACUFEX Pro Handle
Grasper Handle
Cigar Handle

Straight
Upbiter
Upswept
Lt or Rt

DUCKBILL - max resection
DUCKLING - Smaller
Oval Punch - Lowest profile
STINGRAY - Back bite for Anterior

Question 28

What tears do we recommend repairing?

Answer 28

ANY acute repairable tear

(Older tears, with rounded edges = less success)

Question 29

Meniscal Repair Options (x3)

Answer 29

All inside - Fastfix family
Outside-In - Meniscal Mender 2 (Anterior)
Inside-Out - Meniscal Stitcher (Post Incision)

Question 30

Fast Fix 360 F&B x4

Answer 30

1. Stiffer Needle Shaft - Better CONTROL
2. Lower profile Needle - Less TRAUMA
3. Active Deployment - More CONTROL
4. 360 Trigger - Better DEPLOYMENT

Question 31

FastFix 360 Product Features

Answer 31

1. Laser marked needle
2. Smaller Implants & UB2-0
3. S / C / RC
4. Enhance suture management
5. Adjustable Depth Limiter
6. Auditory Confirmation
7. Ergo handle

Question 32

Fastfix 360 & Flex Steps

Answer 32

1. Unwrap not pull out
2. Slide down slotted cannula
3. Penetrate Meniscus and deploy T1, withdraw
4. Keep needle in field of view
5. Penetrate, deploy T2, withdraw from joint
6. KP/SC

Question 33

Flex Differentiators vs 360

Answer 33

1. Implant alignment (in the same plane)
2. Implant deployment - throw
3. Needle exposure / shroud
4. Enhanced accesibility to mid & ant
   Curved: 24/35/80
   Rev Curved: -12/-22/80

Question 34

Advantages of Flex vs competition

Answer 34

1, Highest needle curvature out of box
2. Only dev with Bend tool
3. Smallest capsule contact area
Rev Curved / smallest needle (joint with Stryker)

Question 35

Acufex Advantages

Answer 35

Pinless Hinge (withstand force)
Acufex Edge - sharpening, no tearing cuts