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Presentation transcript:

Ligament Balancing in Total Knee Arthroplasty Section 1 | Anatomy of the knee ligaments

Disclaimer/Terms of use slide ©Smith & Nephew 2013. These images may be downloaded for personal, educational and non-commercial use only. Reference: Smith & Nephew (2013) SurgeryGuides – Ligament balancing in total knee arthroplasty (Version 1.5). Author: Schroeder-Boersch H. [Mobile application software] Retrieved from http://www.smith- nephew.com/education/resources/literature/medical-guides/surgery-guides/ No other contents of this site may be copied without the express permission of Smith & Nephew.

Colour coding of illustrations - reference

1.0 – Overview The surgeon’s anatomical perspective [Fig 1.0.1a] Bony landmarks and ligament/muscle attachments on the anterior aspect of the knee.

1.0 – Overview The surgeon’s anatomical perspective [Fig 1.0.1a] Bony landmarks and ligament/muscle attachments on the anterior aspect of the knee.

1.0 – Overview The surgeon’s anatomical perspective [Fig 1.0.1a] Bony landmarks and ligament/muscle attachments on the anterior aspect of the knee.

1.0 – Overview The surgeon’s anatomical perspective [Fig 1.0.1a] Bony landmarks and ligament/muscle attachments on the anterior aspect of the knee.

1.1 – Medial aspect of the knee The deep medial layer [Fig 1.1.1] Anatomic specimen after removal of medial capsule with distal part of the vastus medialis muscle, superficial MCL, and pes anserinus. Now displaying the deep MCL.

1.1 – Medial aspect of the knee The deep medial layer [Fig 1.1.1] Anatomic specimen after removal of medial capsule with distal part of the vastus medialis muscle, superficial MCL, and pes anserinus. Now displaying the deep MCL.

1.1 – Medial aspect of the knee The middle medial layer [Fig 1.1.2a] Anatomic specimen after removal of the medial capsule and the distal part of the vastus medialis muscle.

1.1 – Medial aspect of the knee The middle medial layer [Fig 1.1.2a] Anatomic specimen after removal of the medial capsule and the distal part of the vastus medialis muscle.

1.1 – Medial aspect of the knee The middle medial layer [Fig 1.1.2b] Dorsal aspect of the knee joint with the five different capsular and tendinous attachments of the semimembranosus muscle.

1.1 – Medial aspect of the knee The middle medial layer [Fig 1.1.2c] The semimembranosus muscle has a direct attachment to the posteromedial corner of the tibia. The attachment can be located posteriorly to the oblique fibers of the superficial MCL and by retracting the pes anserinus.

1.1 – Medial aspect of the knee The middle medial layer [Fig 1.1.2c] The semimembranosus muscle has a direct attachment to the posteromedial corner of the tibia. The attachment can be located posteriorly to the oblique fibers of the superficial MCL and by retracting the pes anserinus.

1.1 – Medial aspect of the knee The superficial medial layer [Fig 1.1.3] Tibial attachment of the pes anserinus.

1.1 – Medial aspect of the knee The superficial medial layer [Fig 1.1.3] Tibial attachment of the pes anserinus.

1.2 – Lateral aspect of the knee The deep and middle lateral layer [Fig 1.2.1a] Anatomic specimen of the extended knee after the lateral capsule and the complete iliotibial band has been removed.

1.2 – Lateral aspect of the knee The deep and middle lateral layer [Fig 1.2.1a] Anatomic specimen of the extended knee after the lateral capsule and the complete iliotibial band has been removed.

1.2 – Lateral aspect of the knee The deep and middle lateral layer [Fig 1.2.1b] Anatomic specimen of the flexed knee after the lateral capsule and the complete iliotibial band have been removed.

1.2 – Lateral aspect of the knee The deep and middle lateral layer [Fig 1.2.1b] Anatomic specimen of the flexed knee after the lateral capsule and the complete iliotibial band have been removed.

1.2 – Lateral aspect of the knee The superficial lateral layer [Fig 1.2.2] Anatomic specimen of the lateral aspect. The ventral fibers of the iliotibial band attaching to the patella are lifted by a retractor.

1.2 – Lateral aspect of the knee The superficial lateral layer [Fig 1.2.2] Anatomic specimen of the lateral aspect. The ventral fibers of the iliotibial band attaching to the patella are lifted by a retractor.

1.3 – Posterior aspect of the knee The posterior cruciate ligament [Fig 1.3.1a] Anatomic specimen: anterior view after resection of the anterior cruciate ligament. The origin of the PCL is on the lateral surface of the medial femoral condyle.

1.3 – Posterior aspect of the knee The posterior cruciate ligament [Fig 1.3.1a] Anatomic specimen: anterior view after resection of the anterior cruciate ligament. The origin of the PCL is on the lateral surface of the medial femoral condyle.

1.3 – Posterior aspect of the knee The posterior cruciate ligament [Fig 1.3.1b] Posterior cruciate ligament. The anterior fibers are loose in extension and tight in flexion. The posterior fibers are tight in (hyper-) extension and become loose in flexion.

1.3 – Posterior aspect of the knee The posterior cruciate ligament [Fig 1.3.1b] Posterior cruciate ligament. The anterior fibers are loose in extension and tight in flexion. The posterior fibers are tight in (hyper-) extension and become loose in flexion.

1.3 – Posterior aspect of the knee The posterior cruciate ligament [Fig 1.3.1b] Posterior cruciate ligament. The anterior fibers are loose in extension and tight in flexion. The posterior fibers are tight in (hyper-) extension and become loose in flexion.