1. Incision and skin flaps
- previous incision may be L shaped
- may be good to use a vertical midline incision initially in HTO
- can usually incorporate incision
2. Removal of hardware
- may wish to consider staged procedure
- staples not usually a problem (can ignore)
Position
- GA, IV Abx
- supine on radiolucent table
Intact but lax ACL with symptomatic instability
Acute ACL rupture
Partial Tears
CT / quantify bone loss
X match 4 units
Cell saver
Anaesthetic review
Bone graft (cortical, cancellous)
Component removal gear
- extraction gear for femur / liners
- cement removers for cemented femur
- curved osteotomes for cemented cup
- X-plant for uncemented cup
Revision long stem femoral implants
Revision acetabular implants including cages
Aim
Reconstruct anterolateral bundle
Graft Options
A. 4 strand hamstring autograft
B. Achilles Allograft
- bony block for femur (9 x 20 mm)
- tubularise tendon to fit through 9 or 10 mm tunnel
- don't cut tendon short
Vumedi Dr Bruce Levy Cadaveric video
Graft Preparation
Defrost
- in 2 litres normal saline
- can add vancomycin powder
Choose which part of graft to use
- usually central third
- can take either side
- try to leave sufficient graft in case of disasters
- i.e. dropping or rupturing graft
Harvest graft
Advantage
- endobutton simple yet strong fixation
- endobutton eliminates problem if blow out back wall
Placing patient into a strong magnetic field
- 30 000 x stronger than the earth's magnetic field
Stronger magnets, better images, shorter times
- 1.5 Tesla
- 3 Telsa
The nuclei of elements with odd numbers of protons line up
- i.e. hydrogen atoms
- hydrogen is plentiful in fat and water
A radiofrequency is then applied, exciting the protons
Compare both shoulders
- ROM
- anterior and posterior draw
- load and shift
- sulcus sign