Knee Flashcards
Bones of the Knee
Femur
Tibia
Patella
Fibula
Knee Ligament Functions
ACL
1. Anterior Tibial Displacement
2. Internal Rotation
PCL
1. Posterior Tibial Displacement
2. External Rotation
MCL
Abduction
LCL
Adduction
3 Diagnostic ACL Tests
Lachman Test
15-20degrees Anterior Translation of tibia
Anterior Drawer Test
90 degrees as above
Pivot Shift
Varus/Valgus + Internal Rotation
ACL Graft choices
- Hamstring
(Semi-Tendinosus & Gracillis) - BTB
- Quads Tendon
Hamstring Graft (Advs & Disadvs)
+ve: Smaller Incision
+ve: low donor site morbidity
-ve: slower fixation healing
-ve: variable size & length
BTB Graft (Advs & Disadvs)
+ve: Faster fixation healing
+ve: Higher initial stiffness
-ve: Large skin incision
-ve: Donor site morbidity / pain on kneeling
ACL Construction Techniques (x3)
Trans Tibial
AM Portal
Retroreaming
ACL Portals
ALP - Viewing
AMP - Working & viewing
AAMP - Accessory Portal
6 steps to ACL Construction
- Notch prep
- Graft Harvest
- Femoral Tunnel
- Tibial Tunnel
- Pass Graft
- Fixations
Step 1 - Notch Prep
Resect Mid-section of ACL, preserve fibres at Fem & Tib.
Use Incisor Plus Plat / Flow 50
If remove bone - Notchblaster or curette Notchmaster
Step 2 - Graft Harvest
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
Step 3 - Femoral Tunnel
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)
Step 4 - Tibial Tunnel
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
Step 5 - Pass Graft
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
Step 6 - Fixation
Femur - EB / UB / Screw
Tib - Screw / UB
RCI = 1.5/2.0 cannuflex
Biosure = 1.2 guidewire
SoftSilk - 1.5 cannuflex
EndoButton Info
Size?
Loop material / sizes?
No holes?
Sutures
4x12mm Titanium
Polyester Loop 10-60mm
4 holes
Lead: White UB#5
Flip: Green UB #5
EndoButton Benefits (x4)
Highest Load to Failure
Simple, single Incision tech
Excellent tunnel placement
Easy to Revise
GOLD STANDARD
Screw fixation - BIOSURE PK
10+ years
Bio-inert
Strong, stiff and tough
Radiolucent
24 sizes
All grafts
Screw Fixation - BIOSURE RG
Open Architecture
Replaces bone in 24m
PLGA - 65% (24m)
B-TCP - 15% (18m)
CaSo - 20% (4-12w)
Screw Fixation - RCI
Deep, blunt thread = reduces ‘pushing’ graft into tunnel
Round Head = reduces stress on graft as graft exits
Screw Fixation - SOFTSILK
BTB only
Deep- rounded thread = reduces laceration
Corkscrew tip = self starting
Meniscal Function
Load Transmission
Lubrication
Shock Absorption
Stability
Proprioception
Fibrous Structure of Meniscus
- Circumferential Hoop Fibres
- Radial Tie Fibres
- Superficial Random Fibres
Classification of Meniscal Tears
RED-RED - Peripheral
RED-WHITE - Mid substance
WHITE-WHITE - Central
3 types of meniscal tear
Vertical (leads to Bucket Handle)
Radial (Parrot Beak)
Horizontal (Flap)
Paper on repair of White-White tears?
Gallagher 2010
Suceesfully repaired if:
1. Reducible
2. Appropriately held
Resection / Menisectomy
4 x Handles
4 x Shapes
4 x Families
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
What tears do we recommend repairing?
ANY acute repairable tear
(Older tears, with rounded edges = less success)
Meniscal Repair Options (x3)
All inside - Fastfix family
Outside-In - Meniscal Mender 2 (Anterior)
Inside-Out - Meniscal Stitcher (Post Incision)
Fast Fix 360 F&B x4
- Stiffer Needle Shaft - Better CONTROL
- Lower profile Needle - Less TRAUMA
- Active Deployment - More CONTROL
- 360 Trigger - Better DEPLOYMENT
FastFix 360 Product Features
- Laser marked needle
- Smaller Implants & UB2-0
- S / C / RC
- Enhance suture management
- Adjustable Depth Limiter
- Auditory Confirmation
- Ergo handle
Fastfix 360 & Flex Steps
- Unwrap not pull out
- Slide down slotted cannula
- Penetrate Meniscus and deploy T1, withdraw
- Keep needle in field of view
- Penetrate, deploy T2, withdraw from joint
- KP/SC
Flex Differentiators vs 360
- Implant alignment (in the same plane)
- Implant deployment - throw
- Needle exposure / shroud
- Enhanced accesibility to mid & ant
Curved: 24/35/80
Rev Curved: -12/-22/80
Advantages of Flex vs competition
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)
Acufex Advantages
Pinless Hinge (withstand force)
Acufex Edge - sharpening, no tearing cuts
