A 71-year-old Former Marathon Runner with 15 Degree Valgus: A - - PowerPoint PPT Presentation

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Feb 15, 2023 345 likes •537 views

A 71-year-old Former Marathon Runner with 15 Degree Valgus: A Winning Checklist William A. Jiranek MD, FACS Professor and Vice Chair Duke University Orthopaedic Summit 2017 Las Vegas, Nev. Dec. 6-9, 2017 Adult Reconstruction Disclosure

SLIDE 1

Adult Reconstruction

A 71-year-old Former Marathon Runner with 15 Degree Valgus: A Winning Checklist

William A. Jiranek MD, FACS Professor and Vice Chair Duke University Orthopaedic Summit 2017 Las Vegas, Nev.

Dec. 6-9, 2017

SLIDE 2

Disclosure

Personal

– Royalties

Depuy

– Consultant

Depuy

– BOD and Committee

AAHK

S, Hip Society

Institution

– Research and clinical support:

Depuy
Stryker

SLIDE 3

Game Plan Preop – What do I assess?

Preop

– Clinical Issues

Patellar tracking Prior incisions Lumbar Spine issues

– Shared Decision Making

Risk of peroneal palsy (.7-4%) Risk of patella maltrack

Musculoskeletal Key Chap 14

SLIDE 4

Game plan Preop - What’s the coronal femoral < ?

SLIDE 5

Game Plan - Preop

Consider position of

patella

– Is there already subluxation? – If markedly subluxed consider a lateral arthrotomy – Often the patella is markedly thinned on the lateral facet

SLIDE 6

Game Plan - Intraop

Approach

– Chance of devascularizing patella is significant if extensive lat release !

SLIDE 7

Get tibial resection right

Reference thickness
f cut off good

(medial) side

Protect but do not

release MCL, be careful with saw on medial side

SLIDE 8

How do you get the femur right?

SLIDE 9

Game Plan - Intraop

Make sure your femoral

component is adequately externally rotated – account for posterolateral wear

Tendency in measure

resection is to internally rotate the jig (and component) due to the posterolateral wear of the femur

SLIDE 10

How do I get the gaps right?

Balancer
Lamina spreaders
Poor man’s balancer

SLIDE 11

How do I get tibial rotation right?

SLIDE 12

Trial Reduction

SLIDE 13

What releases do you perform?

John Insall approach:

– Release what is tight

Most released

– Lateral retinaculum – IT band (off Gerdy’s) – LCL (off femoral side,

r by pie crust)

SLIDE 14

How do I get the lateral release right?

SLIDE 15

Close in flexion

Leave the knee in

flexion overnight

Don’t wrap the Ace

too tight

Always assess

peroneal nerve

SLIDE 16

Conclusion

Respect old lateral incisions
Preserve patellar vascularity
Careful femoral rotation – keep flexion gap equal

– External rotation helps patella tracking

Make proper bony cuts and delay releases till trial

reduction

Resurface patella if there is maltracking, and

lateral release

SLIDE 17

Moving forward. Climbing higher. Moving forward. Climbing higher.

SLIDE 18

Moving forward. Climbing higher.