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Medial Collateral Ligament Release Facilitates Exposure in Revision Total Knee Arthroplasty
| Content Provider | Semantic Scholar |
|---|---|
| Author | Monsef, Jad Bou Boettner, Friedrich |
| Copyright Year | 2015 |
| Abstract | Exposure in revision knee replacement can be challenging. Following the medial parapatellar incision,1 the first step in every revision surgery is a sufficient medial capsule release on the tibia and external rotation of the tibia to relieve tension on the extensor mechanism. Additional surgical options have been described to improve exposure. The quadriceps snip or rectus snip is usually the first step as it entails minimal risk to the extensor mechanism, and allows nearly identical postoperative rehabilitation and outcome.2 The oblique extension of the arthrotomy at 45 degrees superiorly and laterally is parallel to the fibers of the vastus lateralis and preserves its musculotendinous junction. This facilitates eversion and displacement of the patella and extensor mechanism.3 In fact, a quadriceps snip combined with a subperiosteal medial collateral ligament (MCL) release provides adequate exposure for most revision total knee arthroplasty (TKA).4 In extensively scarred or ankylosed knees, a full quadriceps release might be necessary. This quadriceps turndown, an incision connecting the medial arthrotomy with a lateral retinaculum release, provides wide exposure at the expense of a weakened extensor mechanism as well as restricted postoperative rehabilitation.5 Alternatively, a tibial tubercle osteotomy can be utilized to facilitate exposure and tibial component removal. Although it spares the quadriceps and provides excellent exposure,6 risks include nonunion, drainage from the area leading to sinus tract formation, the potential for deep space infection,5 and the potential of tibial fracture.7 Wide exposure is crucial to allow component removal, bone reconstruction, and reimplantation while reducing operative time and risks. We describe a novel technique used with two patients to gain exposure for revision and implantation of rotating hinge knee prosthesis. At 2-year follow-up, the patient walked painlessly, without the use of assisting devices and had a postoperative range ofmotion of 0 to 110–110 degrees. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0035-1551546.pdf |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Belief revision Bone structure of tibia Condyle of femur Cubic Millimeter Displacement mapping Eversion Hinge Device Component Ion implantation Knee Replacement Arthroplasty (procedure) Knee joint prosthesis (device) Lateral thinking Macintosh Common Lisp Medial graph Nasal sinus Oblique projection Patella (Invertebrate) Patients Prosthesis Implantation Psychologic Displacement Repeat Surgery Revision procedure Snipping Tool Structure of collateral ligament Structure of condyle Structure of medial collateral ligament of knee joint Structure of quadriceps femoris muscle Structure of vastus lateralis muscle Surgical Replantation Surgical revision Tension Tissue fiber Tract (literature) revision of total knee arthroplasty soft tissue |
| Content Type | Text |
| Resource Type | Article |
