KneeTec Deep Dish SURGICAL TECHNIQUE

Transcription

1 KneeTec Deep Dish KneeTec Deep Dish SURGICAL TECHNIQUE

2 SURGICAL TECHNIQUE This surgical technique describes the use of the instrumentation dedicated to the KneeTec DEEP DISH implant: cemented version. The reference of this instrumentation is YKAG131 (A: extramedullary reference or B: intramedullary reference), YKAG 132, YKAG 133 & YKAG134A. For the long-term benefit of the patient the surgeon should know and be able to perform the correct surgical technique and be competent in inserting knee replacements. KneeTec Deep Dish Temporary Surgical Technique UGIT142 2

3 INSTRUMENTATION NOTES Extensor system has to be checked and if necessary fixed during surgery. Ø 3,5 mm Flat Ended Drill The Flat Ended Drill is designed for drilling holes for the Cutting Pins or Headed Pins. It has a rapid attachment mechanism to fit either the Stryker-Zimmer-Hall tip, or to connect to a Jacob mandrel through the trepan part at the end of the drill bit. Before use, check that the Flat Ended Drill is not bent since that may apply excessive stress to the Flat Ended Drill, motor or drill guide. On first insertion care should be taken to follow the central axis of the hole before drilling, to avoid any twisting of the Flat Ended Drill, which could cause bending or even breakage of the instrument. Saw blades The saw blades included have various types of attachment which correspond to different types of drills on the market. It is important that the correct attachment type be used for proper functioning of the saw blade. Before use, be sure to check that the saw blade is not bent since this may create excessive stress on the saw blade, motor or slot. During insertion care should be taken to follow the central axis of the slots before cutting, to avoid any twisting of the saw blade, which could cause bending or even breakage of the saw blade. Cutting pin Ø 3,5 mm L 50/80/100 mm Cutting Pins support the cutting blocks and guide cutting. Before use, ensure that the Cutting Pins are not bent, since this can interfere with their insertion and cause significant stress on the groove blocks. On initial placement, care should be taken to follow the central axis of the hole before drilling, to avoid any twisting of the Cutting Pin, which could cause bending or even breakage of the instrument. The pegs are sharp and can damage soft tissue. It is therefore important when impacting them not to go beyond the second bony cortex. Quick Connect Pin driver and Autodrilling pins: Auto drilling pins are designed to lock the Femoral and Tibial Guides. These Pins have a rapid attachment for connection through the trepan part at the end of the Quick Connect Pin Driver. Before use, ensure that the Cutting Pins are not bent, since this can interfere with their insertion and cause significant stress on the groove blocks. On first insertion, ensure it is placed along the central axis of the hole to avoid any twisting of the headed pegs which could cause bending or even breakage of the instrument. KneeTec Deep Dish Temporary Surgical Technique UGIT142 3

4 Headed INSTRUMENTATION Pin Ø 3,5 mm L 25/50 mm NOTES Headed Pin Ø 3,5 mm L 25/50 mm Headed Pins support the cutting blocks and orientation tools. Before use, ensure that the headed pegs are not bent, since this can interfere with their insertion and cause significant stress on the blocks. On first insertion, ensure it is placed along the central axis of the hole to avoid any twisting of the headed pegs which could cause bending or even breakage of the instrument. All pins can be removed with the Pin Puller. Stem Reamer + Fin Impactor The Stem Reamer has a rapid attachment for connection to the Stryker Zimmer-Hall tip or to a Jacob mandrel through the trepan part at the end of the reamer. During its first insertion into the punch guide, ensure the reamer is along the central axis of the guide to avoid any twisting of the reamer or Fin Impactor which could cause bending or even breakage of the instruments. The reamer has a limit stop that allows it to reach the correct keel depth for its size. Do not apply force on the reamer that might cause the breakage or bending of the instruments. IM Drill The IM Drill has a rapid attachment of the Stryker Zimmer-Hall type to connect to the Stryker Zimmer-Hall tip or to a Jacob mandrel through the trepan part at the end of the drill bit. Ensure you follow all the instructions of the Surgical Technique when preparing the femoral canal and tibial canal to avoid any risk of damaging bony or soft tissues. Assembly & Disassembly of Instruments Some of the instruments can be disassembled for deep cleaning. Please see the assembly & disassembly instructions. KneeTec Deep Dish Temporary Surgical Technique UGIT142 4

5 Approach KneeTec Deep Dish Step1: TIBIA Standard antero-medial approach. Exposure of tibial aspect: cut the anterior & posterior cruciate ligaments, excise the meniscus, remove osteophytes. 1. Tibial preparation 1.1 Entry point of Intramedullary stem Use IM drill This drill bit can be attached on a rapid Stryker Zimmer Hall attachment tip or on a Jacob mandrel. Determine the entry point for the intramedullary (IM) canal and open the tibial canal. Do not drill the entry point too deep, to avoid any instability of the IM Rod. 1.2 Intramedullary reference Assemble the Tibial cutting guide (make sure the accurate side indication can be seen on the top of the guide) onto the support and lock it by tightening the screw. Insert the IM rod into the tibial medullary canal Inert the entire assembly mounted on the IM rod. KneeTec Deep Dish Temporary Surgical Technique UGIT142 5

6 Step1: TIBIA Introduce the tibial stylus into the cutting guide slot. The stylus has to sit on the least worn away part of the tibial plateau. Tighten the spanner : block the height A 1mm height set up can be used for severe wear. Alignment in the frontal plane Screw on the nose of the cutting guide support allows automatic adjustment of the tibial cut of 90. In case of bone deformity, it might be necessary to confirm the alignment with an extramedullary stem. Free Adjustment 90 Adjustment Insert the second rod into the hole in front of the support nose Loosen the 90 adjustment screw Confirm the alignment with the extramedullary rod, Tighten the left screw on the support nose. Drill the fixation holes in the cutting block with the auto drilling pins (80mm). Pins are oriented with a 15 angle to the inside. Orientation is noted on the top of cutting guide. KneeTec Deep Dish Temporary Surgical Technique UGIT142 6

7 Step1: TIBIA Nota: If unsure of the tibial cut height, it is possible to position the Cutting Guide with the lower holes. This option allows raising or lowering the cutting block by 2 mm after pinning. Option : Final check available using the additional IM rod inside the tibial cutting guide check palette. Remove the assembly instrumentation: o remove the stylus o unscrew the tibial cutting guide, o Remove the assembly using an extraction handle. Bring closer the tibial cutting guide until it contacts the t Tibial cortex. If necessary, you can lock the assembly with a autodrilling pin. The distal cut can be performed. The tibial cut is correct when the Cutting Pins are visible. If necessary remove the Tibial Cutting Guide and cut flush the pins with a saw blade. KneeTec Deep Dish Temporary Surgical Technique UGIT142 7

8 Step1: TIBIA Option: 1.3 Gap in flexion/extension Assemble hemi spacers on the spacer holder. Insert the assembly into the gap created by the cut. The Hemi-spacers allow verification of the space created by the tibial cut. It is possible to use Hemispacers of different widths both medially and laterally in order to assess the femoral rotation. A 9mm (at least) hemi-spacer should fit the space created by the performed cut. KneeTec Deep Dish Temporary Surgical Technique UGIT142 8

9 Step 2: FEMUR 2. Femoral preparation 2.1 Preparation of the IM canal The IM entry point is found as an extension of the diaphysis in frontal and Sagittal planes, usually above the posterior cruciate ligament's femoral insertion.. Determine the entry point for the intramedullary (IM) canal and open the tibial canal with the IM Drill. 2.2 Adjustment of femoral valgus Femoral valgus can be adjusted degree by degree (3 to 9 ). The correction is determined by preoperative goniometry. In practice we suggest 7 valgus for cases of medial femoral tibial degenerative joint disease and 5 valgus for cases of lateral femoral tibial degenerative joint disease. Transfer the chosen angle to the Femoral Valgus Alignment Guide after unscrewing the screw. Once the setting is obtained lock the assembly by screwing the screw. Once assembled, Long Grooved Stem + Valgus Alignement 2.3 Distal cut Insert the dagger in the canal and then place the femoral valgus alignment guide on it. Control of the insertion dimension is available : first mark on the dagger points out 10cm, then next ones point out each additional 5cm. KneeTec Deep Dish Temporary Surgical Technique UGIT142 9

10 Step 2: FEMUR Position the distal cutting guide support onto the distal cut support. Use headed pins in order to fix the support guide in position against the bone (2 distal holes). Drill 4 autodrilling pins through the guide to fix it onto the bone Nota: If unsure of the tibial cut height, it is possible to position the Cutting Guide with the lower holes. This option allows raising or lowering the cutting block by 2 mm after pinning. Unscrew the screw on the top of the support guide and remove it. Bring the cutting guide onto the cortex. Perform the cut. KneeTec Deep Dish Temporary Surgical Technique UGIT142 10

11 Step 2: FEMUR 2.4 Joint space control Insert full spacers into the joint in the gap in flexion. These spacers correspond to a PE height of 9, 11 or 13mm. This allows verification of the gap created. They must hold with some play, evenly but without a loose fit. 2.5 Adjustment of the femoral rotation Choose the femoral rotation: - with posterior augments, o Insert the chosen height under the lateral condyle: 1mm =1 rotation. - with the whiteside line, - based on a chosen value, o Unscrew the rotation screw, o Choose the value and tighten the screw. Place the orientator guide onto the tibial cut and in contact with the distal cut and the posterior condyles Secure the position of the orientator guide on the distal cut with 2 threaded pins. KneeTec Deep Dish Temporary Surgical Technique UGIT142 11

12 Step 2: FEMUR 2.6 Femoral sizing and choice of the 4in1 cutting guide Positioning of the sizing guide. Adjustment of the femoral external rotation. Measurement of the femoral antero-posterior (AP) size Anterior reference Remove the gap gauge, Insert the Anterior Reference Drill Guide on the module, Drill the two holes corresponding to the size previously measured with two autodrilling pins (Ø 3,5 mm Length 80mm). Take care to drill until pins are out of the guide. Remove the all assembly Posterior reference Remove the gap gauge and the femoral stylus, Insert the Posterior reference Drill guide on the module, Drill the two holes with the autodrilling pins (Ø 3,5 mm Length 50mm), Remove the all assembly. KneeTec Deep Dish Temporary Surgical Technique UGIT142 12

13 Step 2: FEMUR in 1 cutting guide postioning Position the 4in1 cutting guide (proper size) onto the pins. Check the accuracy of the anterior femoral cut by drilling with the flat ended drill 3,5mm through one of the holes on the top of the guide. You can also control the accuracy with the resection check tool. Lock the cutting guide postition with threaded pins (it is imperative that you stop the engine before the stop collar and finish slowly to ensure a better hold). Then remove the pins. Perform the cuts and chamfers cuts using the dedicated cutting slots: 1 : Anterior cut 2 : Posterior cut 3 : Chamfers KneeTec Deep Dish Temporary Surgical Technique UGIT142 13

14 Step 3: TRIALS 3. Trials 3.1 Tibial sizing The Choice of tibial base can be done by matching the resected tibial bone and the preparation plate. Assemble the plate holder with the plate of the chosen size. 3.2 Tibial trials Place the plate according to your usual bone landmarks and fix the plate with 2 pins (25mm). Use a trial insert according to the thickness previously chosen. In flexion, place the trial mobile insert (KneeTec Deep dish) onto the preparation plate, then position the trial insert onto the Assembly. KneeTec Deep Dish Temporary Surgical Technique UGIT142 14

15 Step 4: FEMUR PREPARATION Switching from a 9mm insert thickness to a 13mm thickness, you only have to use the 4mm augment (thickness adaptator). Using the same 4mm augment, you can change the 11mm into a 15mm thickness insert. 3.3 Femoral preparation Position the proper sized femoral trial, Adjust the Medio lateral position, Impact the femoral trial until it reaches contact with the distal cut, Drill the two holes on the femoral trial, With a flat ended drill, mark off the two holes on the top of the trochlea. They will be used as positioning landmarks during the next surgical step. KneeTec Deep Dish Temporary Surgical Technique UGIT142 15

16 Step 4: FEMUR PREPARATION 3.4 Trials Once every component is positioned, test the joint in flexion and extension : No oversizing of the prosthesis, Absence of femorotibial laxity or subluxation in flexion, Thickness of insert compatible with the ligament balancing. In case of important laxity, you can test a thicker trial insert. Absence of flessum, recurvatum & frontal laxity. 3.5 Central chamfer preparation Place the guide against the distal & anterior chamfer cuts. Adjust the ML positioning in order to be aligned with the holes performed previously Use the sticks to fix the chamfers cutting guide into the holes prepared for the femoral pegs. Use the small uni sawblade or the osteotome to prepare the central chamfer. Femoral trial can also be used to prepare the central chamfer by using the cutting slot under the trochlea. In this case please fix the femoral trial with two threaded pins. KneeTec Deep Dish Temporary Surgical Technique UGIT142 16

17 Step 5: TIBIA PREPARATION 4. Tibial preparation Remove the femoral trial, Remove the trial insert, Remove the trial mobile insert. Mount the fin impactor guide (chosen size) onto the preparation plate. KneeTec Deep Dish Temporary Surgical Technique UGIT142 17

18 Step 5: TIBIA PREPARATION Prepare the tibial keel with the keeled reamer mounted on the drill. Drill until you reach the stop Prepare the fins with a fin punch mounted on a universal handle (choose the proper fin punch size). Impact until the fin punch reaches the stop. KneeTec Deep Dish Temporary Surgical Technique UGIT142 18

19 Step 6: PATELLA 5. Patella preparation Exposure of the patella, Measure the thickness of the patella, Determine resection level: - Restoration of the initial thickness of the patella minus 1 or 2 mm. Patellar components are 7 mm for XS and S, and 8,5 mm for M and L. - Resection that leaves at least a remaining of 12 mm thickness. Resection plane: Resection should be performed parallel to the anterior cortex and should provide an equal residual thickness (to achieve this, more bone is generally removed medially than laterally). 5.1 Patellar resection The resection is performed with a patellar resection clamp. Encircle tightly the patella, adjusting direction and thickness of the resection, with the screw. Lock the assembly. Perform the resection with the saw blade. 5.2 Pegs preparation The impaction clamp or the patella drill guide can be used to perform the slots associated with the patellar drill bit. The various sizes of patellar rings could help to center the slots. Assemble the ring on the clamp or guide. Perform the 3 holes, one laterally, and 2 medially Trials Insert the trial patella on the resection Validate the patellar tracking KneeTec Deep Dish Temporary Surgical Technique UGIT142 19

20 IMPLANTS 6. Cemented KneeTec DEEP DISH Bone surfaces have to be washed and dried previously 6.1 Tibia During cementing ensure a homogeneous cement layer is obtained on the entire surface of the base and all along the keel. Impact the tibial base-plate with the tibial impactor. OPTION extended Keel: Use the tightening key to unscrew the initial stem. Screw the extended stem on the base with the tightening key. Nota: Trial inserts are designed to permit trials with final femoral and final tibial implants. Cement and impact the final femoral component and final tibial component. Insert trial insert into the joint and test the laxity in flexion and extension. KneeTec Deep Dish Temporary Surgical Technique UGIT142 20

21 IMPLANTS 6.2 Femur The femoral phase may be performed at the same time as the tibial Phase, when cementing is carried out in one step, or may be performed later when cementing, in 2 steps. The deepest face of the implant is coated by a thin layer of cement, take care to apply a very thin layer of cement on the posterior part to avoid expulsion of cement. Pegs and positioning holes must be not cemented in order to facilitate a revision surgery. The gripper enables positioning of the femoral implant in constrained flexion. The impactor allows the prosthesis to abut against the bone. Cement is forced out and carefully removed. 6.3 Patella The patellar phase may be performed at the same time as the 2 previous phases. Apply a layer of cement to the patella. Position the patellar pins into the previously drilled holes. Tighten and maintain the patella in position with the Patellar impaction System. KneeTec Deep Dish Temporary Surgical Technique UGIT142 21

22 IMPLANTS OPTION Extra medullary Tibial cut Assemble cutting tibial guide onto the extramedullary support : sliding it from bottom to top. Tighten slightly the screw. Insert stylus into the cutting guide slot. Assemble the malleolar clamp on the Extramedullary Guide, Secure the assembly : fix the pike with a pin, Adjust the varus-valgus by moving the extramedullary assembly either medially to increase varus or laterally to increase valgus. Tighten the thumb wheel when the desired alignment is obtained. It is also possible to change the tibial inclination by moving the extramedullary assembly forwards to increase the posterior slope or backwards to diminish the posterior slope. Lock the assembly with an autodrilling pin Ø 3,5 mm, L 80 mm. Insert the autodrilling pins. Note: If unsure of the tibial cut height, it is possible to position the Tibial Cutting Guide with the lower holes. This option allows raising or lowering the Guide by 2 mm after pinning. The on pins cut can be performed. KneeTec Deep Dish Temporary Surgical Technique UGIT142 22

23 SIZE COMBINATION Size combination KneeTec CR/ Deep Dish Femur(cemented) HLS KneeTec mobile tray (cemented) KneeTec Deep Dish mobile insert 1 X X X 2 X X X X 3 X X X X 4 X X X X 5 X X X X 6 X X X X 7/8 X X X X Patella Extra Small X X X X X X X Small X X X X X X X X Compatibility Medium X X X X X X X Large X X X X X X X Incompatibility KneeTec Deep Dish Temporary Surgical Technique UGIT142 23

24 Implants list KneeTec Deep Dish IMPLANTS Femur KneeTecCR/Deep Dish Size Side Size Left Right 1 GDJ011 GDJ001 2 GDJ012 GDJ002 3 GDJ013 GDJ003 3N GDJ113 GDJ103 4 GDJ014 GDJ004 4N GDJ114 GDJ104 5 GDJ015 GDJ005 5N GDJ115 GDJ105 6 GDJ016 GDJ006 7 GDJ017 GDJ007 KneeTec DEEP DISH Insert & Tray Tray ref inserts 9mm 11mm 13mm 15mm 1 GDI031 GDJ141 GDJ151 GDJ161 GDJ171 2 GDI032 GDJ142 GDJ152 GDJ162 GDJ172 3 GDI033 GDJ143 GDJ153 GDJ163 GDJ173 4 GDI034 GDJ144 GDJ154 GDJ164 GDJ174 5 GDI035 GDJ145 GDJ155 GDJ165 GDJ175 6 GDI036 GDJ146 GDJ156 GDJ166 GDJ176 7 GDI037 8 GDI038 Patella GDJ147 GDJ157 GDJ167 GDJ177 Size Extra Small Small Medium Large Reference GDI120 GDI121 GDI122 GDI123 Extended stem Diameter Length Reference 10mm 30mm GDF531 14mm 30mm GDF533 KneeTec Deep Dish Temporary Surgical Technique UGIT142 24

25 INSTRUMENTATION YKAG131 Tibial preparation Ref. Description Qty N MDI446 Fin impactor S MDI445 Fin impactor S MDI444 Fin impactor S MDI448 Stem reamer 1 4 MDI129 IM drill 1 5 MDI139 Full spacer H. 9mm 1 6 MDI141 Full spacer H. 11mm 1 7 MDI143 Full spacer H. 13mm 1 8 MDI515 Fin impactor guide S MDI516 Fin impactor guide S MDI517 Fin impactor guide S MDI513 Superior part EM alignment guide YKAG131A 1 12 MDI512 Inferior part EM alignment guide YKAG131A 1 13 MDI322 Malleolar clamp YKAG131A 1 14 MDS401 Tibial IM Rod 2 15 MDI511 EM stylus 1 16 MDI290 Trial mobile insert 1 16 MDI291 Trial fixed insert 1 16 MDJ035 Cemented stem for punch 1 16 MDI505 Cement adaptator S MDI504 Cement adaptator S MDI506 Cement adaptator S MDI518 EM check palette 1 16 MDI220 Spacer holder Th. 6mm 1 16 MDI231 Hemi spacer Th.9mm 2 16 MDI233 Hemi spacer Th. 11mm 2 16 MDI235 Hemi spacer Th. 13mm 2 16 KneeTec Deep Dish Temporary Surgical Technique UGIT142 25

26 INSTRUMENTATION Ref. Description Qty N Upper tray 1 MDI520 3 IM alignment guide YKAG131B 1 1 MDI510 Tibial cutting guide Right/Left 1 2 MLN113 Hexagonal screwdriver 3,5mm 1 3 MDI509 IM Rod extraction handle YKAG131B 1 4 MDI519 IM alignment guide YKAG131B 1 5 Grey Box 1 MDI151 Tibial preparation plate S MDI152 Tibial preparation plate S MDI153 Tibial preparation plate S MDI154 Tibial preparation plate S MDI155 Tibial preparation plate S MDI156 Tibial preparation plate S MDI157 Tibial preparation plate S MDI158 Tibial preparation plate S MDI160 Preparation plate holder 1 6 KneeTec Deep Dish Temporary Surgical Technique UGIT142 26

27 INSTRUMENTATION YKAG132 Femoral preparation Ref. Description Qty N MDI530 Femoral valgus alignment guide 1 1 MDI532 Distal cutting guide support 1 2 MDI163 Femoral stylus 1 3 MDI164 Anterior ref. drill guide 1 4 MDI165 Posterior ref. drill guide 1 5 MDI162 Orientor guide 1 6 MDI166 Post augment trial Th.3mm 1 7 MDI167 Post augment trial Th.5mm 1 8 MDI168 Post augment trial Th.7mm 1 9 MDI551 Chamfer cutting guide 1 10 MDI541 4in1 cutting guide S MDI542 4in1 cutting guide S MDI543 4in1 cutting guide S MDI544 4in1 cutting guide S MDI545 4in1 cutting guide S MDI546 4in1 cutting guide S MDI547 4in1 cutting guide S MDI533 Distal cutting guide on pins 1 12 MDI161 Dagger 1 13 KneeTec Deep Dish Temporary Surgical Technique UGIT142 27

28 INSTRUMENTATION 10 YKAG133 Patella preparation & general instrumentation Ref. Description Qty N MGG021 Autodrilling pins Ø3,5mm L. 80 mm 6 1 MGG019 Autodrilling pins Ø3,5mm Lg 110 mm 4 1 MDF698 Flat ended drill Ø 3,5 mm 2 1 MDU557 Oscillating saw blade 1,2mm Aesculap 1 1 MDU558 Oscillating saw blade 1,2mm Hall Linvatec 1 1 MDU559 Oscillating saw blade 1,2mm AO 1 1 MDU560 Oscillating saw blade 1,2mm Stryker B 1 1 MVV672 Aesculap stamp saw blade 1 1 MDI514 Oscillating saw blade 1,2mm Hall Linvatec 1 1 MVV673 AO Müller stamp saw blade 1 1 MVV671 StrykerB stamp saw blade 1 1 MVV670 Zimmer stamp saw blade 1 1 MDF020 Headed pin Ø 3,5mm - L25mm 2 1 MDI441 Threaded pin Ø 3,5mm - L50mm 3 1 MDF951 Quick connect pin driver 1 1 MDI300 Resection check 1 1 MLP311 Allen Key 1 1 MDI362 Impactor handle 1 2 MDI553 Femoral impactor 1 3 MDI336 Tibial tray impactor 1 4 MDF372 Tightening key for stem 1 5 MDI327 Femoral clamp 1 6 MDI376 Pin extractor 1 7 MDI363 Osteotome 1 8 MDJ222 Rasp 1 9 MDI128 Dia 7mm patellar drill bit 1 10 MDI381 to 384 Patella ring XS, S, M et L 1 11 MDI120 to 123 Trial patellar XS, S, M et L 1 11 MDI133 Patellar impaction clamp 1 12 MDI132 Patellar resection clamp 1 13 KneeTec Deep Dish Temporary Surgical Technique UGIT142 28

29 KneeTec DEEP DISH INSTRUMENTATION YKAG134A trial insert and trial femur Ref. Description Qty N MDJ201 Trial femoral comp S.1 Right 1 1 MDJ202F Trial femoral comp S.2 Right 1 1 MDJ203F Trial femoral comp S.3 Right 1 1 MDJ204F Trial femoral comp S.4 Right 1 1 MDJ205F Trial femoral comp S.5 Right 1 1 MDJ206F Trial femoral comp S.6 Right 1 1 MDJ207F Trial femoral comp S.7 Right 1 1 MDJ211 Trial femoral comp S.1 Left 1 2 MDJ212F Trial femoral comp S.2 Left 1 2 MDJ213F Trial femoral comp S.3 Left 1 2 MDJ214F Trial femoral comp S.4 Left 1 2 MDJ215F Trial femoral comp S.5 Left 1 2 MDJ216F Trial femoral comp S.6 Left 1 2 MDJ217F Trial femoral comp S.7 Left 1 2 MDJ141 Trial insert size 1 Th. 9mm 1 3 MDJ142 Trial insert size 2 Th. 9mm 1 3 MDJ143 Trial insert size 3 Th. 9mm 1 3 MDJ144 Trial insert size 4 Th. 9mm 1 3 MDJ145 Trial insert size 5 Th. 9mm 1 3 MDJ146 Trial insert size 6 Th. 9mm 1 3 MDJ147 Trial insert size 7/8 Th. 9mm 1 3 MDJ151 Trial insert size 1 Th. 11mm 1 4 MDJ152 Trial insert size 2 Th. 11mm 1 4 MDJ153 Trial insert size 3 Th. 11mm 1 4 MDJ154 Trial insert size 4 Th. 11mm 1 4 MDJ155 Trial insert size 5 Th. 11mm 1 4 MDJ156 Trial insert size 6 Th. 11mm 1 4 MDJ157 Trial insert size 7/8 Th. 11mm 1 4 MDJ220 CS thickness adaptator 1 5 MDI550 Drill bit for pegs d7,3 mm 1 6 KneeTec Deep Dish Temporary Surgical Technique UGIT142 29

30 US HEADQUARTERS INTERNATIONAL HEADQUARTERS FABRICANT Tornier, Inc. Tornier SAS Nesbitt Avenue South 161 rue Lavoisier Bloomington, MN Montbonnot Saint Martin USA France (0) w w.tornier.com KneeTec Deep Dish Temporary Surgical Technique UGIT142 30