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Balancing the Flexion Gap: Relationship Between Tibial Slope and Posterior Cruciate Ligament Release and Correlation with Range of Motion by Adolph V.

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Presentation on theme: "Balancing the Flexion Gap: Relationship Between Tibial Slope and Posterior Cruciate Ligament Release and Correlation with Range of Motion by Adolph V."— Presentation transcript:

1 Balancing the Flexion Gap: Relationship Between Tibial Slope and Posterior Cruciate Ligament Release and Correlation with Range of Motion by Adolph V. Lombardi, Keith R. Berend, Jorge Aziz-Jacobo, and Mark B. Davis J Bone Joint Surg Am Volume 90(Supplement 4): November 1, 2008 ©2008 by The Journal of Bone and Joint Surgery, Inc.

2 Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

3 Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

4 Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

5 Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

6 The deep medial collateral ligament and the meniscal capsular ligament are released to assist with exposure. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

7 An intramedullary alignment guide is used to perform a measured resection equivalent to the amount replaced by the implant. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

8 An extramedullary guide is shown in position on the proximal part of the tibia, aligned perpendicular to the tibial shaft axis in the coronal plane. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

9 A posterior referencing femoral sizing guide is placed on the resected distal part of the femur to determine the anteroposterior implant size. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

10 Rotation of the femoral component is determined with use of a combination of landmarks, including the femoral anteroposterior (AP) axis, the transepicondylar axis, the posterior condylar axis, and a line 90° to the tibial shaft axis. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

11 Using a sliding cut block, the surgeon performs anterior, posterior condylar, and chamfer resections of the femur. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

12 Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

13 Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

14 Illustration demonstrating a resected knee in which the flexion gap is slightly tighter than the extension gap. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

15 If the surgeon determines that the tighter flexion gap is secondary to excessive tension in the collateral ligaments and the posterior cruciate ligament, tibial resection is adjusted to increase the posterior slope of the tibia, which will slightly increase... Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

16 The three common methods of balancing the posterior cruciate ligament. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

17 Screen image showing measurement of posterior tibial slope on a postoperative lateral radiograph with use of a calibrated picture archiving and communication system. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

18 The range of motion preoperatively, at six weeks postoperatively, and at the most recent evaluation in the 136 knees that underwent intraoperative release of the posterior cruciate ligament (PCL) compared with the 280 knees that did not undergo a release. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

19 The range of motion preoperatively, at six weeks postoperatively, and at the most recent evaluation in the 208 knees with 3° of tibial slope. Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

20 In the subgroup of 280 knees that did not undergo intraoperative release of the posterior cruciate ligament, the ranges of motion (ROM) preoperatively, at six weeks postoperatively, and at the most recent evaluation are compared between the 130 knees with <... Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

21 In the subgroup of 136 knees that underwent intraoperative release of the posterior cruciate ligament, the ranges of motion (ROM) preoperatively, at six weeks postoperatively, and at the most recent evaluation are compared between the seventy-eight knees wi... Adolph V. Lombardi, Jr. et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.


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