PHYSICA ZUK SURGICAL TECHNIQUE
Approach and Exposure
APPROACH AND EXPOSURE
The incision can be made with the leg in flexion or extension. A suggested medial parapatellar incision extending from the superior pole of the patella to about 2 cm - 4 cm below the joint line adjacent to the tibial tubercle is shown in Fig.2. (Fig. 2) Incise the joint capsule in line with the skin incision beginning just distal to the vastus medialis muscle and extending to a point distal to the tibial plateau. (Fig. 3) Excise a minimum amount of the fat pad, as necessary to facilitate visualization, being careful not to cut the anterior horn of the lateral meniscus. Reflect the soft tissue subperiosteally from the tibia along the joint line back towards, but not into, the collateral ligament. Excise the anterior third of the meniscus. The remaining meniscus will be removed after bone resection. A subperiostal dissection should be carried out towards the midline, ending at the patellar tendon insertion. This will facilitate positioning of the tibial cutting guide. TECHNIQUE TIP. It may be necessary to extend the incision intraoperatively to achieve appropriate exposure and visualization. Debride the joint and inspect it carefully. Remove intercondylar osteophytes to avoid impingement with the tibial spine or cruciate ligament. Also, remove peripheral osteophytes that interfere with the collateral ligaments and capsule. With medial compartment disease, osteophytes are commonly found on the lateral aspect of the medial tibial eminence and anterior to the origin of the ACL. Final debridement will be performed before component implantation. TECHNIQUE TIP. Careful osteophyte removal is important in achieving full extension. It is important for osteophytes to be removed before balancing your flexion and extension space.
Figure 2
Figure 3
PHYSICA ZUK Surgical Technique 7
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