Briard Jl. How To Correct Extra Articular Deformity. Slide 15 26

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Briard Jl. How To Correct Extra Articular Deformity. Slide 15 26

  1. 1. <ul><li>in flexion: </li></ul><ul><li>released, elongated LCL may be weak </li></ul><ul><li>(danger of instability) </li></ul><ul><li>Rotate the femoral implant in exagerated ER to be stable </li></ul>NB: due to the release: tibial cut & Trans Epicondylar Axis are not even // !
  2. 2. <ul><li>think of lateral condyle osteotomy to have strong lateral structures at the right length </li></ul>Lateral collateral ligament release (saving popliteus tendon) P
  3. 3. 2nd MESSAGE <ul><li>MEDIAL RELEASE is a safe & easy technique with a good sleeve </li></ul><ul><li>LATERAL RELEASE is difficult and carry a high risk of secondary FT instability and may require more constrained designs (or PCR) </li></ul>
  4. 4. The effect of Extraarticular Varus & Valgus Deformity on TKA A.Wolff, D.Hungerford, C.Pepe Clin.Orthop. 271: 35-51, 1991 MALUNIONS
  5. 5. the closer to the knee (like HTO) the more is the consequent malorientation of the knee 25° HKA: 176° HKA: 159°
  6. 6. <ul><li>If you want to create coronal laxity in extension , you must e longate, release : </li></ul><ul><li>Iry & I I ry stabilizers in extension </li></ul><ul><li>Medially: </li></ul><ul><li>MCL </li></ul><ul><li>ACL + PCL </li></ul><ul><li>Posterior capsule </li></ul><ul><li>(severe destabilization) </li></ul>INTRAARTICULAR CORRECTION of EA DEFORMITY 3rd MESSAGE
  7. 7. FEMUR VARUM <ul><li>consider: </li></ul><ul><li>medial release, magnitude </li></ul><ul><li>distal resection of lateral condyle </li></ul><ul><li>OK in extension but…. </li></ul>+
  8. 8. <ul><li>Rotate the femoral implant in IR </li></ul><ul><li>subluxation of the Patella </li></ul>but in flexion in order to be stable: + IR + IR
  9. 9. <ul><li>if significant femur varum : </li></ul><ul><li>think of a tibial cut in slight valgus </li></ul><ul><li>a metaphyseal femoral osteotomy </li></ul><ul><li>or a medial condylar osteotomy with flexion gap first and then bring the osteotomized MC distally </li></ul>
  10. 10. Femur Varum HKA 162°
  11. 12. TIBIA VALGUM <ul><li>consider : </li></ul><ul><li>Tibia (no consequence in F for the rotation of the femoral implant) </li></ul><ul><li>collateral lgts frame hinge perpendicular </li></ul><ul><li>Valgum= lateral release necessary to create laxity in full extension </li></ul>

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