SURGICALLY ORIENTED MEASUREMENTS FOR THREE-DIMENSIONAL CHARACTERIZATION OF TUNNEL PLACEMENT IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
|
|
- Dale Carpenter
- 5 years ago
- Views:
Transcription
1 SURGICALLY ORIENTED MEASUREMENTS FOR THREE-DIMENSIONAL CHARACTERIZATION OF TUNNEL PLACEMENT IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION Introduction: The human knee is composed of three bones (femur, tibia, and patella), four major ligaments (anterior cruciate, posterior cruciate, lateral collateral, and medial collateral), articular cartilage, menisci (lateral and medial), and a variety of muscular attachments(1). The ligaments function to stabilize the knee during motion and load bearing. Specifically, the anterior cruciate ligament (ACL) acts as the primary restraint to anterior tibial translation and internal tibial rotation. Disruption of the ACL is a common injury of the knee, especially in athletes. It has been estimated that nearly 175,000 ACL reconstructions are performed each year with an estimated cost of up to $1 billion(2-4). The guiding principle in modern surgical ACL reconstruction is to replace the torn ACL with a graft. Ideally, the graft is placed in the exact location of the native ACL. Placing the graft in the native ACL location is technically challenging; the current single bundle methods require drilling two tunnels: one through the femur and one through the tibia. The graft is placed in the drill tunnels between the femur and tibia, and over time grows into the healing bone. ACL reconstruction has generated increased debate due to a number of unknowns including the best method of tunnel placement and the reasons for development of late sequela osteoarthritis after this procedure. One of several reasons for revision to ACL reconstruction is poor graft tunnel placement(4). Surgical ACL reconstructions typically fall into one of two categories: single bundle and double bundle procedures. Single bundle techniques (e.g. medial portal, transtibial, two-incision approaches) involve the placement of a single graft to replace the 1
2 torn ACL, while double bundle techniques use two independent grafts to replace the functional anteromedial and posterolateral bundles of the native ACL. Traditionally, the characterization of ACL tunnels has largely concentrated on twodimensional measurements from standard radiographic views. The European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA) Workshop on Reconstruction of the Anterior and Posterior Cruciate Ligaments has provided guidelines for describing tunnel locations on the distal femur and proximal tibia(5). Two-dimensional tunnel evaluation studies using plain films have been performed using these guidelines and variations of them(6-10). With the advent of CT technologies, several studies have extrapolated the two-dimensional measurements to CT slices(11-13). Virtual surface model generation from CT images has also been investigated as a method of tunnel placement evaluation(14-16). Three-dimensional surface-based techniques are desirable due to their ability to visualize not only the bone but also the tunnels through the bone. However, a standardized three-dimensional measurement system does not currently exist that allows for direct translation of measurements from the laboratory to the operating room. We hypothesize that simulating the placement of surgical drill bits within surface models of the femur and tibia will allow for localiztion of ACL graft drill tunnels. Herein, we describe a reliable and flexible three-dimensional measurement system capable of characterizing ACL tunnel position and orientation. 2
3 Materials and Methods: Three-Dimensional Measurement System We have developed a three-dimensional measurement system for characterizing femoral and tibial drill tunnels from ACL reconstructions. Our ability to characterize the drill tunnels relies on simulating the positioning of the drill bit originally used to create the tunnels within the bone. Based on positioning virtual drill bits, we are able to describe the drill tunnels both angularly and spatially with respect to previously described anatomic landmarks and radiographic views. An overview of this process is outlined in Figure 1. The following sections describe the methods used to develop a standardized three-dimensional orientation, align the bone surfaces to this orientation, generate and align virtual drill bits, match virtual drill bits to drill tunnel apertures, and automatically spatially and angularly measure the virtual drill bits. Standardized Orientation To ensure accurate and reproducible measurements, a standardized orientation is required for both the femur and the tibia. We have created separate orientations for the femur and tibia based on anatomic landmarks. For the femur, the orientation is illustrated in Figure 2A. The X- axis is defined by a line through the femoral condyles such that the posterior-most aspects of the medial and lateral condyles are aligned, which correlates with a perfect lateral 2D radiograph. The Z-axis is defined by the femoral diaphysis after compensating for the approximately 7 of anatomic valgus. The Y-axis is then defined by the cross-product of the X- and Z- axes. For the tibia, the orientation is illustrated in Figure 2B. The Y-Axis is defined by the AP medial tibial plateau, and the Z-axis is defined by a line through the posterior-most aspects of the medial and 3
4 lateral condyles of the tibial plateau. The X-axis is then defined by the cross-product of the Y- and Z-axes. Estimating ACL Tunnel Position As an estimate of the drill bit used for the surgical procedure, a cylinder was generated with a diameter equivalent to that of the drill bit. For this study, all procedures were performed using a 10mm diameter drill bit; thus, a virtual drill bit with a diameter of 10mm was created. The cylinder was assigned a length to adequately traverse the entire length of the drill tunnel; a 50mm long drill bit was satisfactory for all of the specimens used in this study. To compute the position of the tunnel within the bone, the cylinder was placed within the tunnel (Figures 3A and 4A) using custom tools. Modifying the opacity of the bone surfaces allowed for proper positioning of the virtual drill bits within the tunnels. Once the virtual drill bits were aligned with the tunnels, three angles were calculated: α (Eq. 1), β (Eq. 2), and γ (Eq. 3); the angles represent the deviation of the tunnel from the X-, Y-, and Z- axes, respectively (Figures 3 and 4). α = cos 1 p 1p 2 p 1 p x (1) p 1 p 2 p 1 p x β = cos 1 p 1p 2 p 1 p y (2) p 1 p 2 p 1 p y γ = cos 1 p 1p 2 p 1 p z (3) p 1 p 2 p 1 p z where p 1 is the centroid of the endcap of the virtual drill bit closest to the knee joint, p 2 is the centroid of the endcap at the opposite end of the drill bit, p x represents p unit in the X- 4
5 direction, p y represents p unit in the Y-direction, and p z represents p unit in the Z- direction. Spatial localization of the ACL drill tunnel apertures allows for correlation of surgical tunnel positioning with respect to the anatomic ACL footprint. To estimate the tunnel apertures from the virtual drill bits, the cylindrical surface was cropped at the tunnel aperture using custom software. After the virtual drill bits were cropped to match the tunnel apertures (Figures 4 & 5), two spatial measurements for each bone were calculated: m/m and a/a for the tibia and n/n and c/c for the femur. For the tibia, the position of the aperture centroid is measured as a proportion of the distance from the anterior aspect of the tibial plateau (a) with respect to the total tibial depth (A) as shown in Figure 4A, and also as a proportion of the distance from the medial aspect of the tibial plateau (m) with respect to the total width of the tibial plateau (M) as shown in Figure 4B. For the femur, the position of the aperture centroid is measured as a proportion of the distance from the distal-most aspect of the lateral condyle (c) with respect to the total diameter of the lateral condyle (C) as shown in Figure 6A and also as the proportion of the distance from the posterior-most aspect of the lateral condyle (n) with respect to the apex of the intercondylar notch (N) as demonstrated in Figure 6B. Evaluation Using Digital Phantoms To validate the angular and spatial measurements, two digital phantoms were created. The angular measurements were validated using 9 virtual drill bits in different known orientations as shown in Figure 7A. The spatial measurements were validated using 3 virtual drill bits encased in a cube as shown in Figure 7B. The resulting angular and spatial measurements were compared to the known values used to generate the digital phantoms. 5
6 Evaluation Using Cadaveric Specimens Ten cadaveric knee joints were collected (4 left and 6 right); each specimen included the full knee joint and a portion of the proximal tibia and distal femur. Prior to scanning, a single bundle ACL reconstruction was performed by a fellowship trained orthopaedic surgeon on each specimen using either the medial portal, transtibial, or two incision technique. The 10 specimens included four medial portal operations, four transtibial operations, and two two-incision operations from six fellowship trained orthopaedic surgeons. A Siemens Sensation 64 slice CT scanner was used to collect three-dimensional voxel datasets of the knee for each specimen (matrix = 1005x512, FOV = 261mm x 133mm, KVP = 120, Current = 128mA, Exposure = 160mAs) with a 0.26mm in-plane resolution and a 0.75mm slice thickness. Slices spanning the entire specimen were obtained for each dataset. The CT datasets were resampled to 1.0mm isotropic voxels, and all left knees were mirrored along the x-axis to produce 10 right knees for analysis. The BRAINS2 software was used to manually segment the distal femur and proximal tibia(17). 3DSlicer was used to generate and smooth surface representations from the manual tracings of the 10 femur surfaces and 10 tibia surfaces. An average sized femoral and tibial surface were aligned such that the surface orientations corresponded to the standardized orientation described above. The resulting orientations were verified to match the desired standardized orientation by an experienced orthopaedic surgeon. An Iterative Closest Point surface registration using 100 iterations and 5000 landmarks was used to rigidly align the remaining specimen surfaces to the standardized orientation(18). 6
7 Four users, two biomedical engineers and two orthopaedic residents, used the proposed measurement techniques to evaluate the femoral and tibial ACL tunnels on each of the 10 specimens. Each user was independently trained and performed placement and aperture matching of virtual drill bits into the tibia and femur for the 10 cadaveric datasets on a single occasion. The resulting virtual drill bits were processed using the 3D measurement techniques described above. The reliability of the raters was evaluated by computing the intraclass correlation coefficients for the described spatial and angular measures using SAS. As a test of the robustness of our measurement system, an additional two femur surfaces from a pre-existing dataset with misplaced tunnels (i.e. tunnels that missed the lateral femoral condyle) were also evaluated by a single user. Results: We have developed a novel three-dimensional measurement system to characterize ACL tunnel placement. The digital phantom evaluation verified the measurement methods by computing angular and spatial values that matched the known values in all cases. The ten cadaveric specimens showed average values of α = 60, β = 50, γ = 56, n/n = 0.54, and c/c = 0.68 for the femur and α = 77, β = 59, γ = 34, a/a = 0.49, and m/m = 0.46 for the tibia. The intraclass correlation coefficient was calculated for the four users and found to range from 0.95 to 0.99 for the femoral and tibial measurements. Tables describing these values were not included due to space constraints. The two misplaced femoral tunnels were successfully evaluated and can be seen in Figure 8. 7
8 Discussion: We have presented a surgically oriented tunnel localization system for ACL reconstructions based on estimating the positioning of surgically generated tunnels for the tibia and femur using surface models. Our methods are intentionally designed to be of practical use in the operating room and provide measurements based on the ESSKA recommendations(5) as well as the new measurements that we have proposed. By establishing a surgically relevant orientation, the aperture spatial measurements and the tunnel angular measurements provide a novel three-dimensional method to describe this inherently three-dimensional procedure. In addition, our methods allow for measurement of misplaced tunnels that could be difficult to describe using two-dimensional methods. Our methods are widely applicable. We have demonstrated their application on single bundle ACL reconstructions including the transtibial, medial portal, and two incision techniques. Simply incorporating a second drill bit would also allow this to be a method of evaluation for double bundle ACL reconstructions. In addition, this method could be used to evaluate posterior cruciate ligament (PCL) reconstruction and other procedures involving bone tunnels for graft placement. Our methods are reliable with intraclass correlation coefficients ranging from 0.95 to 0.99 between four users with both surgical and nonsurgical backgrounds. These high values can be attributed to a small degree of variability between raters in placing the virtual drill bits and a high degree of variability in the tunnel angles themselves. Blumensaat s line (a radiopaque region of overlapping bone in the roof of the intercondylar notch of the femur) has traditionally been a radiographic landmark important in describing the placement of ACL tunnels in two dimensions. Recently, Forsythe et al.(15) and Kopf et al.(16) have demonstrated the use of three-dimensional surfaces to characterize tunnel 8
9 locations using quadrants and spatial dimensions based on Blumensaat s line; however, we found this landmark difficult to reliably define across all anatomical variants on three-dimensional surfaces. We provide an alternative measurement tool based on the diameter of the lateral femoral condyle and the diaphysis of the femur. Currently, image segmentation may be seen as a limitation of this work; however, we recently developed semi-automated methods that require less than 60 seconds of manual intervention to perform the segmentation. While this study used surfaces generated from CT images, MRI could also be used for surface generation as it is more commonly obtained for an ACL revision surgery due to tunnel misplacement. Surfaces generated from MRI scans could also act as an input to our measurement process. Our surgically oriented coordinate system does deviate from orientations that have been proposed in the past. With respect to the femur, Grood et al.(19) proposed orienting the Z-axis corresponding to the femoral mechanical axis (partially defined with the femoral head). With respect to the tibia, Grood et al.(19) proposed aligning the Z-axis with the tibial mechanical axis (partially defined with the tibial malleoli). Forsythe et al.(15) and Kopf et al.(16) based their coordinate system on the recommendations from the International Society of Biomechanics and Grood et al(19). During ACL reconstructions, the femoral head is typically draped and is difficult to reference intraoperatively. In our measurement system, we have aligned the diaphysis of the femur with the Z-axis; this allows measurements to be taken with respect to a portion of the femur directly visible during the procedure. Our X- and Y- axes are defined similarly to that described by Grood et al(19). For the tibia, instead of orienting with respect to the tibial malleoli, we have oriented the tibia with regards to surface features of the tibial plateau. 9
10 Overall, our orientations were defined by aligning the femur and tibia with landmarks visible during the operative procedure. In the future, we hope to apply our methods to evaluate ACL reconstructions and provide a three-dimensional characterization to improve patient outcomes. We also hope to apply our techniques beyond ACL reconstructions to other surgical procedures. Future improvements to our methods will include fully automated segmentation of the tibia and femur, and automated placement of the virtual drill bits into the drill tunnels to foster an automated measurement system. To promote applicability, we plan to compile our tools into a user-friendly graphical user interface. In summary, we have presented a surgically oriented three-dimensional method of evaluating tunnel placement/orientation for ACL reconstructions. Our methods are applicable to both the femur and tibia and were based on the measurement recommendations made by the ESSKA(5). We have demonstrated our methods to be reliable and applicable to multiple techniques of ACL reconstruction. In the future, we will apply these methods to study the effects of multiple factors on the variability of tunnel placement to improve patient outcomes. 10
11 References: 1. F. Cimino, B. S. Volk, D. Setter, Am. Fam. Physician 82, 917 (2010). 2. D. Endele, C. Jung, U. Becker, G. Bauer, F. Mauch, Arthroscopy 25, 1067 (2009). 3. S. Lyman et al., J. Bone Joint Surg. Am. 91, 2321 (2009). 4. D. Kendoff, M. Citak, J. Voos, A. D. Pearle, Clin. Sports Med. 28, 41 (2009). 5. A. A. Amis et al., Knee Surg. Sports Traumatol. Arthrosc. 2, 124 (1994). 6. J. Dargel et al., Knee Surg. Sports Traumatol. Arthrosc. 17, 220 (2009). 7. S. M. Howell, M. E. Gittins, J. E. Gottlieb, S. M. Traina, T. M. Zoellner, Am. J. Sports Med. 29, 567 (2001). 8. L. A. Pinczewski et al., J. Bone Joint Surg. Br. 90, 172 (2008). 9. F. Giron, P. Cuomo, P. Aglietti, A. M. Bull, A. A. Amis, Knee Surg. Sports Traumatol. Arthrosc. 14, 250 (2006). 10. P. Aglietti, G. Zaccherotti, P. P. Menchetti, P. De Biase, Knee Surg. Sports Traumatol. Arthrosc. 3, 2 (1995). 11. C. Hoser, K. Tecklenburg, K. H. Kuenzel, C. Fink, Knee Surg. Sports Traumatol. Arthrosc. 13, 256 (2005). 12. A. Bedi, B. Raphael, A. Maderazo, H. Pavlov, R. J. Williams 3rd, Arthroscopy 26, 342 (2010). 13. Y. S. Chan et al., Arthroscopy 25, 54 (2009). 14. E. S. Abebe et al., Am. J. Sports Med. 37, 1904 (2009). 15. B. Forsythe et al., J. Bone Joint Surg. Am. 92, 1418 (2010). 16. S. Kopf et al., J. Bone Joint Surg. Am. 92, 1427 (2010). 17. V. A. Magnotta et al., Comput. Med. Imaging Graph. 26, 251 (2002). 18. G. C. Sharp, S. W. Lee, D. K. Wehe, In: Proc. IEEE Int. Conf. on Robotics and Autom. 1999, 932 (1999). 19. E. S. Grood, W. J. Suntay, J. Biomech. Eng. 105, 136 (1983). 11
12 Figure 1: A flow diagram describing the measurement process. Figure 2: A) The standardized orientation of the A) femur and B) tibia. Figure 3: Tibial tunnel angles (α, β, γ) were measured based on the tunnel centerline s deviation from the A) surgically oriented coordinate system as demonstrated B) looking down the y-axis and C) looking down the x-axis. Figure 4: Femoral tunnel angles (α, β, γ) were measured based on the tunnel centerline s deviation from the A) surgically oriented coordinate system as demonstrated B) looking down the y-axis and C) looking down the x-axis. 12
13 Figure 5: A) A measurement (a/a) of the tunnel aperture centroid based on the anterior-posterior distance of the tibial plateau. B) A measurement (n/n) of the tunnel aperture centroid based on the medial-lateral distance of the tibial plateau. Figure 6: A) A measurement (c/c) of the tunnel aperture centroid based on the diameter of the lateral femoral condyle. B) A measurement (n/n) of the tunnel aperture centroid based on the height of the intercondylar notch. Figure 7: A) Nine virtual drill bits used to test the angular measurements. B) Three virtual drill bits used to test the aperture localization measurements. 13 Figure 8: Two examples of misplaced ACL tunnels. A) A case where the femoral drill tunnel penetrated the cortex. B) A case where the femoral drill tunnel missed the lateral condyle.
Roof Impingement Revisited
Roof Impingement Revisited John A Tanksley MD, Evan J Conte MD, Brian C Werner MD, F Winston Gwathmey MD, Stephen F Brockmeier MD, Mark D Miller MD, University of Virginia, Charlottesville, VA Introduction
More informationDisclosures. Background. Background
Kinematic and Quantitative MR Imaging Evaluation of ACL Reconstructions Using the Mini-Two Incision Method Compared to the Anteromedial Portal Technique Drew A. Lansdown, MD Christina Allen, MD Samuel
More information5/31/15. The Problem. Every Decade We Change Our Minds The Journey Around the Notch. Life is full of Compromises. 50 years ago..
The Problem Surgical Treatment of ACL Tears Optimizing Femoral Tunnel Positioning Andrew D. Pearle, MD Associate Attending Orthopedic Surgeon Sports Medicine and Shoulder Service Hospital for Special Surgery
More informationTranstibial PCL Reconstruction. Surgical Technique. Transtibial PCL Reconstruction
Transtibial PCL Reconstruction Surgical Technique Transtibial PCL Reconstruction The Arthrex Transtibial PCL Reconstruction System includes unique safety features for protecting posterior neurovascular
More informationAvoiding ACL Graft Impingement: Principles for Tunnel Placement Using the Transtibial Tunnel Technique
96128_CH_14 6/28/07 7:51 AM Page 171 1 Evidence-based Orthopaedics 171 14 Avoiding ACL Graft Impingement: Principles for Tunnel Placement Using the Transtibial Tunnel Technique Keith W. Lawhorn and Stephen
More informationTorn ACL - Anatomic Footprint ACL Reconstruction
Torn ACL - Anatomic Footprint ACL Reconstruction The anterior cruciate ligament (ACL) is one of four ligaments that are crucial to the stability of your knee. It is a strong fibrous tissue that connects
More informationANATOMIC. Navigated Surgical Technique 4 in 1 TO.G.GB.016/1.0
ANATOMIC Navigated Surgical Technique 4 in 1 TO.G.GB.016/1.0 SCREEN LAYOUT Take screenshot Surgical step Dynamic navigation zone Information area and buttons 2 SCREEN LAYOUT Indicates action when yellow
More informationAn image analysis method to quantify the lateral pivot shift test
Knee Surg Sports Traumatol Arthrosc (2012) 20:703 707 DOI 10.1007/s00167-011-1845-x KNEE An image analysis method to quantify the lateral pivot shift test Yuichi Hoshino Paulo Araujo James J. Irrgang Freddie
More informationDouble Bundle ACL Reconstruction using the Smith & Nephew Outside-In Anatomic ACL Guide System
Knee Series Technique Guide Double Bundle ACL Reconstruction using the Smith & Nephew Outside-In Anatomic ACL Guide System Luigi Adriano Pederzini, MD Massimo Tosi, MD Mauro Prandini, MD Luigi Milandri,
More informationEffect of tibial tunnel diameter on femoral tunnel placement in transtibial single bundle ACL reconstruction
DOI 10.1007/s00167-014-3307-8 KNEE Effect of tibial tunnel diameter on femoral tunnel placement in transtibial single bundle ACL reconstruction Sanjeev Bhatia Kyle Korth Geoffrey S. Van Thiel Rachel M.
More informationTechnique for Creating the Anterior Cruciate Ligament Femoral Socket: Optimizing Femoral Footprint Anatomic Restoration Using Outside-in Drilling
Technique for Creating the Anterior Cruciate Ligament Femoral Socket: Optimizing Femoral Footprint Anatomic Restoration Using Outside-in Drilling James H. Lubowitz, M.D., Sam Akhavan, M.D., Brian R. Waterman,
More informationOPEN KNEE: CAPACITY TO REPRODUCE ANTERIOR CRUCIATE LIGAMENT DEFORMATIONS
OPEN KNEE: CAPACITY TO REPRODUCE ANTERIOR CRUCIATE LIGAMENT DEFORMATIONS A. Erdemir1,2 and S. Sibole3 1. ABSTRACT Simulation-based explorations of the knee have commonly relied on finite element analysis.
More informationACL AND PCL INJURIES OF THE KNEE JOINT
ACL AND PCL INJURIES OF THE KNEE JOINT Dr.KN Subramanian M.Ch Orth., FRCS (Tr & Orth), CCT Orth(UK) Consultant Orthopaedic Surgeon, Special interest: Orthopaedic Sports Injury, Shoulder and Knee Surgery,
More informationUse of transtibial aimer via the accessory anteromedial portal to identify the center of the ACL footprint
Knee Surg Sports Traumatol Arthrosc (2012) 20:69 74 DOI 10.1007/s00167-011-1574-1 KNEE Use of transtibial aimer via the accessory anteromedial portal to identify the center of the ACL footprint Umberto
More informationAnterior Cruciate Ligament Surgery
Anatomy Anterior Cruciate Ligament Surgery Roger Ostrander, MD Andrews Institute Anatomy Anatomy Function Primary restraint to anterior tibial translation Secondary restraint to internal tibial rotation
More informationDirect Measurement of Graft Tension in Anatomic Versus Non-anatomic ACL Reconstructions during a Dynamic Pivoting Maneuver
Direct Measurement of Graft Tension in Anatomic Versus Non-anatomic ACL Reconstructions during a Dynamic Pivoting Maneuver Scott A. Buhler 1, Newton Chan 2, Rikin Patel 2, Sabir K. Ismaily 2, Brian Vial
More informationTOTAL KNEE ARTHROPLASTY (TKA)
TOTAL KNEE ARTHROPLASTY (TKA) 1 Anatomy, Biomechanics, and Design 2 Femur Medial and lateral condyles Convex, asymmetric Medial larger than lateral 3 Tibia Tibial plateau Medial tibial condyle: concave
More informationARTICLE IN PRESS. Technical Note
Technical Note Hybrid Anterior Cruciate Ligament Reconstruction: Introduction of a New Technique for Anatomic Anterior Cruciate Ligament Reconstruction Darren A. Frank, M.D., Gregory T. Altman, M.D., and
More informationMako Partial Knee Patellofemoral
Mako Partial Knee Patellofemoral Mako Robotic-Arm Assisted Surgery Surgical reference guide Table of contents Implant compatibility.... 3 Pre-operative implant planning... 4 Intra-operative planning....
More informationRemnant Preservation in ACL Reconstruction: Is it Worth Doing?
Remnant Preservation in ACL Reconstruction: Is it Worth Doing? 1. Presentation (4 x approx. 5min.) i. Mitsuo Ochi ii. Freddie Fu, iii. Takeshi Muneta iv. Rainer Siebold, 2. Debate (approx. 10 min.) 1 ACL
More informationRIGIDFIX CURVE CROSS PIN SYSTEM
RIGIDFIX CURVE CROSS PIN SYSTEM This publication is not intended for distribution in the USA. FAQ SUMMARY RIGIDFIX CURVE CROSS PIN SYSTEM FREQUENTLY ASKED QUESTIONS (FAQ) SUMMARY 1 Why do the pins enter
More informationACL Forces and Knee Kinematics Produced by Axial Tibial Compression During a Passive Flexion Extension Cycle
ACL Forces and Knee Kinematics Produced by Axial Tibial Compression During a Passive Flexion Extension Cycle Keith L. Markolf, Steven R. Jackson, Brock Foster, David R. McAllister Biomechanics Research
More informationBIOMECHANICAL MECHANISMS FOR DAMAGE: RETRIEVAL ANALYSIS AND COMPUTATIONAL WEAR PREDICTIONS IN TOTAL KNEE REPLACEMENTS
Journal of Mechanics in Medicine and Biology Vol. 5, No. 3 (2005) 469 475 c World Scientific Publishing Company BIOMECHANICAL MECHANISMS FOR DAMAGE: RETRIEVAL ANALYSIS AND COMPUTATIONAL WEAR PREDICTIONS
More informationFaculty: Konsei Shino; Takeshi Muneta; Freddie Fu; Pascal Christel
ISAKOS ICL # 4 ACL Reconstruction - Single vs Double-Bundle Chair: Jon Karlsson Faculty: Konsei Shino; Takeshi Muneta; Freddie Fu; Pascal Christel Introduction: Jon Karlsson Rationale for Anatomic Double-Bundle
More informationProximal tibial bony and meniscal slopes are higher in ACL injured subjects than controls: a comparative MRI study
Proximal tibial bony and meniscal slopes are higher in ACL injured subjects than controls: a comparative MRI study Ashraf Elmansori, Timothy Lording, Raphaël Dumas, Khalifa Elmajri, Philippe Neyret, Sebastien
More informationBioRCI Screw System. Surgical Technique for Hamstring and Patellar Tendon Grafts
BioRCI Screw System Surgical Technique for Hamstring and Patellar Tendon Grafts Surgical Technique for Hamstring and Patellar Tendon Grafts Using the BioRCI Screw System The Smith & Nephew BioRCI cruciate
More informationWhy anteromedial portal is the best
Controversies in ACL Reconstruction Why anteromedial portal is the best Robert A. Gallo, MD Associate Professor Nothing to disclose Case presentation 20-year-old Division III track athlete sustained ACL
More information*smith&nephew ENDOBUTTON CL. Knee Series Technique Guide. Fixation System
Knee Series Technique Guide *smith&nephew ENDOBUTTON CL Fixation System Double Bundle ACL Reconstruction using the Smith & Nephew ACUFEX Director Set for Anatomic ACL Reconstruction French Anatomic ACL-R
More informationMedical Practice for Sports Injuries and Disorders of the Knee
Sports-Related Injuries and Disorders Medical Practice for Sports Injuries and Disorders of the Knee JMAJ 48(1): 20 24, 2005 Hirotsugu MURATSU*, Masahiro KUROSAKA**, Tetsuji YAMAMOTO***, and Shinichi YOSHIDA****
More informationAFX. Femoral Implant. System. The AperFix. AM Portal Surgical Technique Guide. with the. The AperFix System with the AFX Femoral Implant
The AperFix System AFX with the Femoral Implant AM Portal Surgical Technique Guide The Cayenne Medical AperFix system with the AFX Femoral Implant is the only anatomic system for soft tissue ACL reconstruction
More informationThe Effect of Lateral Meniscal Root Injuries on the Stability of the Anterior Cruciate Ligament Deficient Knee
The Effect of Lateral Meniscal Root Injuries on the Stability of the Anterior Cruciate Ligament Deficient Knee Charles Vega 1, Jebran Haddad 1, Jerry Alexander 2, Jonathan Gold 2, Theodore Shybut 1, Philip
More informationFigure 3 Figure 4 Figure 5
Figure 1 Figure 2 Begin the operation with examination under anesthesia to confirm whether there are any ligamentous instabilities in addition to the posterior cruciate ligament insufficiency. In particular
More informationDarren L. Johnson, M.D. Professor and Chairman Medical Director of Sports Medicine University of Kentucky School of Medicine
Revision ACL Surgery Stage it!!!!!!! Darren L. Johnson, M.D. Professor and Chairman Medical Director of Sports Medicine University of Kentucky School of Medicine Disclosure Consultant: Smith-Nephew Endoscopy
More informationTRUMATCH PERSONALIZED SOLUTIONS with the SIGMA High Performance Instruments
TRUMATCH PERSONALIZED SOLUTIONS with the SIGMA High Performance Instruments Resection Guide System SURGICAL TECHNIQUE RESECTION GUIDE SURGICAL TECHNIQUE The following steps are an addendum to the SIGMA
More informationRadiological Study of Anterior Cruciate Ligament of the Knee Joint in Adult Human and its Surgical Implication
Universal Journal of Clinical Medicine 3(1): 1-5, 2015 DOI: 10.13189/ujcm.2015.030101 http://www.hrpub.org Radiological Study of Anterior Cruciate Ligament of the Knee Joint in Adult Human and its Surgical
More informationMichael Elias Hantes Æ Vasilios C. Zachos Æ Athanasios Liantsis Æ Aaron Venouziou Æ Apostolos H. Karantanas Æ Konstantinos N.
Knee Surg Sports Traumatol Arthrosc (2009) 17:880 886 DOI 10.1007/s00167-009-0738-8 KNEE Differences in graft orientation using the transtibial and anteromedial portal technique in anterior cruciate ligament
More informationTechnique Guide. *smith&nephew N8TIVE ACL Anatomic ACL Reconstruction System
Technique Guide *smith&nephew N8TIVE ACL Anatomic ACL Reconstruction System N8TIVE ACL System The N8TIVE ACL Anatomic Reconstruction System provides a novel and simple approach to ACL repair. The N8TIVE
More informationOrthoMap Express Knee Product Guide. OrthoMap Express Knee Navigation Software 2.0
OrthoMap Express Knee Product Guide OrthoMap Express Knee Navigation Software 2.0 Product Guide 1 Introduction Introduction The Stryker OrthoMap Express Knee Navigation System is providing surgeons with
More informationACL Athletic Career. ACL Rupture - Warning Features Intensive pain Immediate swelling Locking Feel a Pop Dead leg Cannot continue to play
FIMS Ambassador Tour to Eastern Europe, 2004 Belgrade, Serbia Montenegro Acute Knee Injuries - Controversies and Challenges Professor KM Chan OBE, JP President of FIMS Belgrade ACL Athletic Career ACL
More informationSimulation of Ridge Formation in Cortical Bone near the Anterior Cruciate Ligament Insertion: Bone Remodeling due to Interstitial Fluid Flow
Simulation of Ridge Formation in Cortical Bone near the Anterior Cruciate Ligament Insertion: Bone Remodeling due to Interstitial Fluid Flow Yusuke TAKAHASHI, Shigehiro HASHIMOTO Biomedical Engineering
More informationEFFECT OF REAMER DESIGN ON POSTERIORIZATION OF THE TIBIAL TUNNEL DURING ARTHROSCOPIC TRANSTIBIAL ACL RECONSTRUCTION
EFFECT OF REAMER DESIGN ON POSTERIORIZATION OF THE TIBIAL TUNNEL DURING ARTHROSCOPIC TRANSTIBIAL ACL RECONSTRUCTION Sanjeev Bhatia, MD; Kyle Korth BS; Geoffrey S. Van Thiel MD, MBA*; Deepti Gupta BS; Brian
More informationSURGICAL TECHNIQUE VISUALIZE FEMORAL FIXATION 360 GRAFT TO BONE CONTACT INCREASED PULL-OUT STRENGTH
SURGICAL TECHNIQUE VISUALIZE FEMORAL FIXATION 360 GRAFT TO BONE CONTACT INCREASED PULL-OUT STRENGTH PINN-ACL CROSSPIN SYSTEM SURGICAL TECHNIQUE INTRODUCTION The ConMed Linvatec Pinn-ACL CrossPin System
More informationKnee Preservation System
Knee Preservation System Anatomic Patellar Tendon ACL Reconstruction using the Bullseye Cruciate System SURGICAL TECHNIQUE Anatomic Patellar Tendon ACL Reconstruction using the Bullseye Cruciate System
More informationCONTRIBUTING SURGEON. Barry Waldman, MD Director, Center for Joint Preservation and Replacement Sinai Hospital of Baltimore Baltimore, MD
CONTRIBUTING SURGEON Barry Waldman, MD Director, Center for Joint Preservation and Replacement Sinai Hospital of Baltimore Baltimore, MD System Overview The EPIK Uni is designed to ease the use of the
More informationComparative study of sensitivity and specificity of MRI versus GNRB to detect ACL complete and partial tears
Comparative study of sensitivity and specificity of MRI versus GNRB to detect ACL complete and partial tears Anterior cruciate ligament (ACL) tears are difficult to diagnose and treat (DeFranco). The preoperative
More informationArthroscopic Anterior Cruciate Ligament Reconstruction Using a Flexible Guide Pin With a Rigid Reamer AJO
Orthopedic Technologies & Techniques Arthroscopic Anterior Cruciate Ligament Reconstruction Using a Flexible Guide Pin With a Rigid Reamer Michael P. Elliott, DO, Colten C. Luedke, DO, and Brian G. Webb,
More informationACL Reconstruction Cross-Pin Technique
ACL Reconstruction Cross-Pin Technique Surgical Technique Lonnie E. Paulos, MD Salt Lake City, Utah 325 Corporate Drive Mahwah, NJ 07430 t: 201 831 5000 www.stryker.com A surgeon should always rely on
More informationKnee Surg Relat Res 2011;23(4): pissn eissn Knee Surgery & Related Research
Original Article Knee Surg Relat Res 2011;23(4):213-219 http://dx.doi.org/10.5792/ksrr.2011.23.4.213 pissn 2234-0726 eissn 2234-2451 Knee Surgery & Related Research Anatomic Single Bundle Anterior Cruciate
More informationTRK REVISION KNEE Surgical Technique
1 TRK REVISION KNEE Surgical Technique 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. INTERCONDYLAR RESECTION...... page FEMORAL STEM...... page NON CEMENTED FEMORAL STEM...... page TRIAL FEMORAL COMPONENTS...... page
More informationCurrent Concepts for ACL Reconstruction
Current Concepts for ACL Reconstruction David R. McAllister, MD Associate Team Physician UCLA Athletic Department Chief, Sports Medicine Service Professor Department of Orthopaedic Surgery David Geffen
More informationTensioning a Soft Tissue ACL Graft
Tensioning a Soft Tissue ACL Graft By Stephen M. Howell, MD Maury L. Hull, PhD. Sacramento, CA The method of tensioning a soft tissue ACL graft is controversial, because surgeons do not agree on how much
More informationThe AperFix II System
The AperFix II System A Complete Anatomic Solution Transtibial Surgical Technique 2 AperFix II System Transtibial Surgical Technique Figure 1 A Complete Anatomic Solution The Cayenne Medical AperFix and
More informationAnterior cruciate ligament reconstruction (ACLR)
Reliability of Early Postoperative Radiographic Assessment of Tunnel Placement After Anterior Cruciate Ligament Reconstruction Bryan A. Warme, M.D., Austin J. Ramme, B.S., Michael C. Willey, M.D., Carla
More informationPCL Reconstruction Utilizing the TightRope /GraftLink Technique Juxtaposed to posterior horn
Tibial & Femoral PCL Footprints PCL Reconstruction Utilizing the TightRope /GraftLink Juxtaposed to posterior horn Thomas M. DeBerardino, MD Associate Professor, UCONN Health Team Physician, Orthopaedic
More informationAnterolateral Ligament. Bradd G. Burkhart, MD Orlando Orthopaedic Center Sports Medicine
Anterolateral Ligament Bradd G. Burkhart, MD Orlando Orthopaedic Center Sports Medicine What in the world? TIME magazine in November 2013 stated: In an age filled with advanced medical techniques like
More informationPrecisely locate anatomic femoral ACL insertion sites 1. ACUFEX PINPOINT Anatomic ACL Guide System
Precisely locate anatomic femoral ACL insertion sites 1 ACUFEX PINPOINT Anatomic ACL Guide System This versatile and easy-to-use guide system enables visualization of the size and placement of femoral
More informationMasterclass. Tips and tricks for a successful outcome. E. Verhaven, M. Thaeter. September 15th, 2012, Brussels
Masterclass Tips and tricks for a successful outcome September 15th, 2012, Brussels E. Verhaven, M. Thaeter Belgium St. Nikolaus-Hospital Orthopaedics & Traumatology Ultimate Goal of TKR Normal alignment
More informationMRI grading of postero-lateral corner and anterior cruciate ligament injuries
MRI grading of postero-lateral corner and anterior cruciate ligament injuries Poster No.: C-2533 Congress: ECR 2012 Type: Educational Exhibit Authors: J. Lopes Dias, J. A. Sousa Pereira, L. Fernandes,
More informationDouble Bundle PCL Reconstruction. Surgical Technique
Double Bundle PCL Reconstruction Surgical Technique Double Bundle PCL Reconstruction With recent interest in double tunnel endoscopic PCL reconstruction, Arthrex has created a series of Femoral PCL Drill
More informationFIXED PERFORMANCE. Soft Tissue ACL Reconstruction
ADJUSTABLE CONVENIENCE, FIXED PERFORMANCE Soft Tissue ACL Reconstruction Surgical Technique The RIGIDLOOP Adjustable Cortical System The RIGIDLOOP Adjustable Cortical System is an innovative technology
More informationMedical Diagnosis for Michael s Knee
Medical Diagnosis for Michael s Knee Introduction The following report mainly concerns the diagnosis and treatment of the patient, Michael. Given that Michael s clinical problem surrounds an injury about
More informationInvestigating the loading behaviour of intact and meniscectomy knee joints and the impact on surgical decisions
Investigating the loading behaviour of intact and meniscectomy knee joints and the impact on surgical decisions M. S. Yeoman 1 1. Continuum Blue Limited, One Caspian Point, Caspian Way, CF10 4DQ, United
More informationADJUSTABLE CONVENIENCE, FIXED PERFORMANCE
ADJUSTABLE CONVENIENCE, FIXED PERFORMANCE Soft Tissue ACL Reconstruction This publication is not intended for distribution in the USA. SURGICAL TECHNIQUE THE RIGIDLOOP ADJUSTABLE CORTICAL SYSTEM The RIGIDLOOP
More informationBiomechanical Effects of Femoral Component Axial Rotation in Total Knee Arthroplasty (TKA)
Biomechanical Effects of Femoral Component Axial Rotation in Total Knee Arthroplasty (TKA) Mohammad Kia, PhD, Timothy Wright, PhD, Michael Cross, MD, David Mayman, MD, Andrew Pearle, MD, Peter Sculco,
More informationLateral Location of the Tibial Tunnel Increases Lateral Meniscal Extrusion After Anatomical Single Bundle Anterior Cruciate Ligament Reconstruction
Lateral Location of the Tibial Tunnel Increases Lateral Meniscal Extrusion After Anatomical Single Bundle Anterior Cruciate Ligament Reconstruction Takeshi Oshima Samuel Grasso David A. Parker Sydney Orthopaedic
More informationKnee Joint Anatomy 101
Knee Joint Anatomy 101 Bone Basics There are three bones at the knee joint femur, tibia and patella commonly referred to as the thighbone, shinbone and kneecap. The fibula is not typically associated with
More information2017 Resident Advanced Trauma Techniques Course COMPLICATIONS / CHALLENGES MALUNIONS/DEFORMITY
2017 Resident Advanced Trauma Techniques Course COMPLICATIONS / CHALLENGES MALUNIONS/DEFORMITY What is a Malunion? Definition: a fracture that has healed in a nonanatomic (i.e. deformed) position Must
More informationA NEW APPROACH TO ACL ANATOMY
SPORTS SURGERY A NEW APPROACH TO ACL ANATOMY THE RIBBON CONCEPT Written by Robert Smigielski and Urszula Zdanowicz, Poland Anterior cruciate ligament (ACL) injury is one of the most common knee injuries,
More informationEvolution of Technique: 90 s
Anterior Medial and Accessory Portal Techniques: ACL Reconstruction Charles A. Bush Joseph, MD Rush University Medical Center Chicago, IL Evolution of Technique: 80 s Open and 2 incision methods produced
More informationHISTORY AND INDICATIONS OF LATERAL TENODESIS IN ATHLETES
HISTORY AND INDICATIONS OF LATERAL TENODESIS IN ATHLETES Written by Philippe Landreau, Qatar The treatment of anterior cruciate ligament injuries remains challenging in young athletic populations. A residual
More informationMedial Meniscal Root Tears: When to rehab? When to repair? When to debride. Christopher Betz, DO Orthopedics Sports Medicine Bristol, CT
Medial Meniscal Root Tears: When to rehab? When to repair? When to debride Christopher Betz, DO Orthopedics Sports Medicine Bristol, CT Disclosure Consultant Mitek Smith and Nephew-biologic patch Good
More informationFrom Wall Graft to Roof Graft: Reassessment of Femoral Posterior Cruciate Ligament Positioning
( aspects of sports medicine an original study) From Wall Graft to Roof Graft: Reassessment of Femoral Posterior Cruciate Ligament Positioning Bradley S. Raphael, MD, Travis Maak, MD, Michael B. Cross,
More informationMako Partial Knee Medial bicompartmental
Mako Partial Knee Medial bicompartmental Surgical reference guide Mako Robotic-Arm Assisted Surgery Table of contents Implant compatibility.... 3 Pre-operative planning.... 4 Intra-operative planning....
More informationClinical Results Comparing Transtibial Technique and Outside in Technique in Single Bundle Anterior Cruciate Ligament Reconstruction
Original Article Knee Surg Relat Res 2013;25(3):133-140 http://dx.doi.org/10.5792/ksrr.2013.25.3.133 pissn 2234-0726 eissn 2234-2451 Knee Surgery & Related Research Clinical Results Comparing Transtibial
More informationAlignment of the femoral component in a mobile-bearing unicompartmental knee arthroplasty Kort, N. P.; van Raay, J. J. A. M.; Thomassen, B. J. W.
University of Groningen Alignment of the femoral component in a mobile-bearing unicompartmental knee arthroplasty Kort, N. P.; van Raay, J. J. A. M.; Thomassen, B. J. W. Published in: Knee DOI: 10.1016/j.knee.2007.04.007
More informationDisclosures. Outline. The Posterior Cruciate Ligament 5/3/2016
The Posterior Cruciate Ligament Christopher J. Utz, MD Assistant Professor of Orthopaedic Surgery University of Cincinnati Disclosures I have no disclosures relevant to this topic. Outline 1. PCL Basic
More informationImpact of Intramedullary Reaming Depth on Establishing Femoral Canal Axis in the Sagittal Plane
Impact of Intramedullary Reaming Depth on Establishing Femoral Canal Axis in the Sagittal Plane Yifei Dai, Ph.D., Dwight Todd. Zimmer Inc, Warsaw, IN, USA. Disclosures: Y. Dai: 3A; zimmer inc. 4; zimmer
More informationDimensions of the intercondylar notch and the distal femur throughout life
Dimensions of the intercondylar notch and the distal femur throughout life Poster No.: P-0089 Congress: ESSR 2013 Type: Scientific Exhibit Authors: L. Hirtler, S. Röhrich, F. Kainberger; Vienna/AT Keywords:
More informationInvestigation performed at the University of California at Davis, Davis, California
1018 COPYRIGHT 2003 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Effect of the Angle of the Femoral and Tibial Tunnels in the Coronal Plane and Incremental Excision of the Posterior Cruciate
More informationComputer-Assisted, Anatomic, Double-Bundle Anterior Cruciate Ligament Reconstruction
Technical Note Computer-Assisted, Anatomic, Double-Bundle Anterior Cruciate Ligament Reconstruction Philippe D. Colombet, M.D., and James R. Robinson, M.S., F.R.C.S.(Orth) Abstract: Accurate placement
More informationRESECTION GUIDE SYSTEM. TRUMATCH Personalized Solutions Surgical Technique with ATTUNE Knee INTUITION Instruments
RESECTION GUIDE SYSTEM TRUMATCH Personalized Solutions Surgical Technique with ATTUNE Knee INTUITION Instruments RESECTION GUIDE SURGICAL TECHNIQUE The following steps are an addendum to the ATTUNE Knee
More informationJOINT RULER. Surgical Technique For Knee Joint JRReplacement
JR JOINT RULER Surgical Technique For Knee Joint JRReplacement INTRODUCTION The Joint Ruler * is designed to help reduce the incidence of flexion, extension, and patellofemoral joint problems by allowing
More informationCROSS PIN TECHNOLOGY FOR AN ANATOMIC ACL
CROSS PIN TECHNOLOGY FOR AN ANATOMIC ACL INTRODUCTION The RIGIDFIX Curve Cross Pin System is designed specifically for use with the anteromedial (AM) portal approach to achieve a more anatomic soft tissue
More informationANTERIOR REFERENCE NEXGEN COMPLETE KNEE SOLUTION. Multi-Reference 4-in-1 Femoral Instrumentation Anterior Reference Surgical Technique
ANTERIOR REFERENCE NEXGEN COMPLETE KNEE SOLUTION Multi-Reference 4-in-1 Femoral Instrumentation Anterior Reference Surgical Technique For NexGen Cruciate Retaining & Legacy Posterior Stabilized Knees INTRODUCTION
More informationMinimally Invasive ACL Surgery
Minimally Invasive ACL Surgery KOCO EATON, M.D. T A M P A B A Y R A Y S ( 1 9 9 5 P R E S E N T ) T A M P A B A Y B U C C A N E E R S ( 2 0 1 5 2 0 1 6 ) T A M P A B A Y R O W D I E S ( 2 0 1 4 2 0 1 7
More informationAnterior Cruciate Ligament Reconstruction
Anterior Cruciate Ligament Reconstruction Can Anatomic Placement Be Achieved With a Transtibial Technique? Dana P. Piasecki,* y MD, Bernard R. Bach Jr, z MD, Alejandro A. Espinoza Orias, z PhD, and Nikhil
More informationSTATE OF THE ART OF ACL SURGERY (Advancements that have had an impact)
STATE OF THE ART OF ACL SURGERY (Advancements that have had an impact) David Drez, Jr., M.D. Clinical Professor of Orthopaedics LSU School of Medicine Financial Disclosure Dr. David Drez has no relevant
More informationACL RECONSTRUCTION HAMSTRING METHOD. Presents ACL RECONSTRUCTION HAMSTRING METHOD. Multimedia Health Education
HAMSTRING METHOD Presents HAMSTRING METHOD Multimedia Health Education Disclaimer Stephen J. Incavo MD This movie is an educational resource only and should not be used to make a decision on Anterior Cruciate
More informationAnterior Cruciate Ligament (ACL) Injuries
Anterior Cruciate Ligament (ACL) Injuries Mark L. Wood, MD The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. The incidence of ACL injuries is currently estimated
More informationAn Articulated Statistical Shape Model of the Human Knee
An Articulated Statistical Shape Model of the Human Knee Matthias Bindernagel, Dagmar Kainmueller, Heiko Seim, Hans Lamecker, Stefan Zachow, Hans-Christian Hege Zuse Institute Berlin bindernagel@zib.de
More informationPOSTERIOR REFERENCE NEXGEN COMPLETE KNEE SOLUTION. Multi-Reference 4-in-1 Femoral Instrumentation Posterior Reference Surgical Technique
POSTERIOR REFERENCE NEXGEN COMPLETE KNEE SOLUTION Multi-Reference 4-in-1 Femoral Instrumentation Posterior Reference Surgical Technique For NexGen Cruciate Retaining & Legacy Posterior Stabilized Knees
More informationOpening Wedge Osteotomy System using PEEKPower HTO Plate. 2 nd Generation Surgical Technique
Opening Wedge Osteotomy System using PEEKPower HTO Plate 2 nd Generation Surgical Technique Preoperative Planning HTO Body weight < 100 kg, Non smoker. For preoperative planning be aware of potential femoral
More informationKnee Surgical Technique
Knee Surgical Technique COMPASS Universal Hinge by Jimmy Tucker, M.D. Orthopaedic Surgeon Director, Arkansas Sports Medicine, P.A. Little Rock, Arkansas Table of contents Design features 3 Indications
More informationPRE & POST OPERATIVE RADIOLOGICAL ASSESSMENT IN TOTAL KNEE REPLACEMENT. Dr. Divya Rani K 2 nd Year Resident Dept. of Radiology
PRE & POST OPERATIVE RADIOLOGICAL ASSESSMENT IN TOTAL KNEE REPLACEMENT Dr. Divya Rani K 2 nd Year Resident Dept. of Radiology PRE OPERATIVE ASSESSMENT RADIOGRAPHS Radiographs are used for assessment and
More informationACL Reconstruction for BTB Grafts
Transtibial ACL Reconstruction System for BTB Grafts Surgical Technique Designed in conjunction with John C. Garrett, M.D., Atlanta, GA ACL Reconstruction for BTB Grafts Reference Anatomical Constants
More informationKnee Android Model Reproducing Internal-External Rotation with Screw-Home Movement of the Human Knee
Journal of Robotics, Networking and Artificial Life, Vol. 3, No. 2 (September 2016), 69-73 Knee Android Model Reproducing Internal-External Rotation with Screw-Home Movement of the Human Knee Daichi Yamauchi,
More informationHuman ACL reconstruction
Human ACL reconstruction current state of the art Rudolph Geesink MD PhD Maastricht The Netherlands Human or canine ACL repair...!? ACL anatomy... right knees! ACL double bundles... ACL double or triple
More informationPosterior cruciate ligament (PCL) reconstructions
All-Inside Posterior Cruciate Ligament Reconstruction With a GraftLink Gerard G. Adler, M.D. Abstract: Posterior cruciate ligament (PCL) reconstructions are challenging surgeries. Recent advances have
More informationTKA Gap Planning. Supporting healthcare professionals
TKA Gap Planning The NAVIO TKA Gap Planning stage helps you adjust the plan based on gap information between the femur and tibia implants. Supporting healthcare professionals Interactive Views Four interactive
More information