141 / 460
C. Fink, C. Hoser, M. Veselko
140
Surgical technique
Positioning
Patient positioning has to allow free knee
motion between 0° and 120°.
The intraoperative access for the fluoroscope is
important to be kept in mind and ideally
checked prior to draping.
We prefer fixation of the operative leg in an
electric leg holder (fig. 3).
Surgical steps
In 90° of knee flexion a 2.5-3cm transverse
skin incision is placed over the superomedial
pole of the patella. The prepatellar bursa is
incised longitudinally and the quadriceps
tendon is then carefully exposed.
A long Langenbeck retractor is then introduced
and the quadriceps tendon subcutaneously
exposed proximal to the patella.
The double knife (Karl Storz) in 10 or 12mm
width is then introduced starting over the
middle of the superior patella boarder and
pushed up to a minimum of 8cm (mark on the
instrument) (fig. 4).
The thickness of the graft is then determined
with 2 or 3mm by a second special knife (Karl
Storz). The knife is pushed proximal to the
same mark (minimum 8cm) (fig. 5).
Finally the tendon strip is cut subcutaneously
by a special tendon cutter (Karl Storz) (fig. 6).
Fig. 3
Fig. 4
Fig. 5
Fig. 6