Reconstructive Knee Surgery by Douglas W. Jackson MD

By Douglas W. Jackson MD

Featuring fifteen brand-new chapters and twenty completely up to date chapters, the 3rd variation of this hugely acclaimed quantity describes the most recent ideas for reconstructive knee surgical procedure. The world's top-rated specialists percentage their techniques to extensor mechanism and patellofemoral reconstruction, meniscal fix and fixation, meniscal transplantation, cruciate ligament tunnel placement and fixation, graft harvesting, use of allografts, ACL, PCL, MCL and posterolateral nook reconstruction, opening-wedge osteotomy, laptop assisted surgical procedure, arthroscopic chondroplasty, microfracture, osteochondral plugs, chondrocyte transplantation, and pigmented villonodular synovitis resection.

The individuals describe their hottest innovations in step by step aspect and provide pearls and guidance for bettering effects. The ebook is punctiliously illustrated with full-color, sequential, surgeon's-eye view intraoperative images, in addition to drawings by way of famous clinical illustrators.

A better half site deals the absolutely searchable textual content and a picture bank.

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A standard axial (10) view (knee flexed 45 degrees and x-ray beam 30 degrees from the horizontal plane) provides a good idea of patella orientation in the trochlea and is our view of choice. If a specific malalignment pattern is identifiable on the axial radiograph, no further radiographic evaluation is necessary. igninelt of the extensor mechanism will demonstrate a normal axial radiograph yet have significant lateral subluxation and/or tilt on computed tomography (C'n of the patellofemoral joint A true lateral radiograph of the knee (posterior condyles superimposed) at 0 and 30 degrees knee flexion will help greatly in understanding trochlea morphology from top to bottom.

Reducing the fluid inflow pressure gives an idea of the extent of patellar subluxation and/or tilt with flexion and extension of the knee. The femoral nerve may be stimulated (to brief tetany) with the knee in progressive flexion to help determine the dynamic alignmentlmalalignment The arthroscopy is completed through an infrapatellarportal to evaluate the rest of the knee and to confirm the patellar findings noted if a proximal approach was used. The surgeon must first characterize and document (by print or video) the natme and location of any articular lesion.

A suction drain may be used but is not usually necessary. If one anteriorizes more than 2 em, one may wish to consult preoperatively with a plastic surgeon. Using careful smgical technique, a precise flat osteotomy, secme fixation of the transferred pedicle with two screws, appropriate anteriorization, meticulous hemostasis, appropriate patient selection, early range of motion, and good postoperative rehabilitation, anteromedial tibial tubercle transfer will give uniformly good results. POSTOPERATIVE MANAGEMENT Assuming secure two-screw fixation of the transferred bone pedicle (as described), patients are started on immediate, once-daily active and passive range-of-motion exercises of the knee but are maintained in a knee immobilizer for 4 weeks on crutches.

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