AANA/SOMOS Course Materials (August 2021)-Saturday Afternoon Lectures

Video Transcription

Video Summary

The session began with Judd Robbins discussing tibial tubercle osteotomy (TTO) for anterior knee surgery, emphasizing the importance of patellofemoral joint anatomy, contact pressures, and indications for various TTO techniques. He reviewed historical techniques including medialization, anteriorization, and anterior-medialization (Fulkerson), discussing their effects on contact pressures, outcomes, and complications such as skin necrosis, fractures, and compartment syndrome. Appropriate patient selection based on anatomy and pathology was stressed, with conservative treatment favored for anterior knee pain, and surgery considered mainly for maltracking or overload.<br /><br />Jen Smith then demonstrated a medial patellofemoral ligament (MPFL) reconstruction technique involving precise incision, graft fixation with small all-suture anchors on the patella, fluoroscopic guidance for femoral tunnel placement, soft tissue graft preparation, and tensioning to avoid overtightening.<br /><br />Next, detailed surgical approaches to the posterolateral corner, specifically LaPrade and other techniques, were described, highlighting identification and protection of the peroneal nerve, creation of tunnels for ligament reconstruction, graft passage, fixation, and tensioning at specific degrees of knee flexion.<br /><br />Finally, a presentation on osteotomies in complex knee reconstruction by an expert covered the rationale, indications, and techniques of realignment procedures including high tibial osteotomy (HTO) for varus knees, distal femoral osteotomy (DFO) for valgus, and slope-altering osteotomies for sagittal plane stability. Emphasis was placed on preoperative planning, patient selection, mechanical axis correction goals, surgical technique nuances, and the interplay between bony alignment and ligament integrity.<br /><br />The session concluded with reminders about upcoming lab work focusing on intra-articular procedures and osteotomy practice, followed by a guest speaker presentation and a panel discussion.

Keywords

tibial tubercle osteotomy

anterior knee surgery

patellofemoral joint anatomy

medial patellofemoral ligament reconstruction

posterolateral corner surgery

peroneal nerve protection

high tibial osteotomy

distal femoral osteotomy

knee realignment procedures

intra-articular knee procedures