activmotion
Download
Skip this Video
Download Presentation
ACTIVMOTION

Loading in 2 Seconds...

play fullscreen
1 / 29

ACTIVMOTION - PowerPoint PPT Presentation


  • 47 Views
  • Uploaded on

ACTIVMOTION. ACTIVMOTION. Lower limb can present as an inward (varus) or outward (valgus) angulation. GENERAL THEORY. If mechanical axis is deviated , can get overloading and wearing of the cartilage on one side. ACTIVMOTION.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' ACTIVMOTION' - holden


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
activmotion1
ACTIVMOTION
  • Lowerlimbcanpresent as an inward (varus) or outward (valgus) angulation.

GENERAL THEORY

  • If mechanical axis isdeviated, cangetoverloading and wearing of the cartilage on one side.
activmotion2
ACTIVMOTION
  • Closingwedgeosteotomy: Externalbonewedgeremoval (with an osteotomyfrom the fibula).

GENERAL THEORY

activmotion3
ACTIVMOTION
  • Opening wedge osteotomy: Medial osteotomy of the tibia with the addition of illiac crest or bone substitute to fill the bone gap.

GENERAL THEORY

activmotion4
ACTIVMOTION

Stress distribution in a healthyknee

  • The medial tibial plateau supports most of the weightbearing.
  • Duringwalking the stress ispredominantlyanterior.
  •  Mechanical stress antero-medial.
  • The ratio is about 70% of the load on the medial plateau and 30% on the lateral one.
activmotion5
ACTIVMOTION

Stress distribution in a healthyknee

  • During the roll back process of the knee (standing up, kneeling down…), the body weight stress oscillates between the posterior side of the tibial plateau and the anterior side of the plateau.
  • Creates a postero-anterior stress inside the knee.
  • While standing up, the load goes from 80% on the back and 20% on the front to 20% on the back and 80% on the front.
activmotion6
ACTIVMOTION

Stress distribution in a knee in Varus

  • In Varus :
  • Mechanical axis passes outside from the articulation.
  • Medial compartment supports 100% of the stress.
activmotion7
ACTIVMOTION

Stress distribution in a knee in varus

  • Same impact as in a healthy knee.
  • While standing up, the load goes from 80% on the back and 20% on the front to 20% on the back and 80% on the front.
activmotion8
ACTIVMOTION

Stress distribution in a correctedknee

  • After osteotomy, +3° valgus.
  • The ratio is about 60% of the load on the lateral plateau and 40% left on the medial one.
  • During walking, the stress is still predominantly anterior.
activmotion9
ACTIVMOTION

Stress distribution in a Corrected Knee

  • Same impact as in a healthy knee.
  • While standing up, the load goes from 80% on the back and 20% on the front to 20% on the back and 80% on the front.
activmotion10
ACTIVMOTION
  • Problem :
  • Post-op care too long (6 weeks) before putting patients on load.
  • Materialmayfailwhen putting on earlierload.

NEWCLIP’S Technology as problemsolver

NCT solution :

Design an antero-medial plate for an optimal answer to the biomechanics of the knee.

activmotion11
ACTIVMOTION

Stress distribution on the plateau :

Lateral

ACTIVMOTION CONCEPT

2+1 system :

  • 2 screwsunder the external plateau. (Minimum 60% of the load).
  • 1screwunder the internal plateau. (Maximum 40%of the load)
  • Antero-medialpositioningto be as close as possible to the lateral stress.

Medial

activmotion12
ACTIVMOTION

STRESS ABSORPTION

Dynamic stress inside the kneeduringwalking :

  • Antero-medialpositioning of the implant, to face the main anterior forces duringwalking.
  • Antero-medialpositioninglimits the tibial internal-rotation of the distal fragment and preserves the lateralhinge.
  • Antero-posterior orientation of the screwsanswering the roll-back of the knee.
activmotion13
ACTIVMOTION

Lateral

  • Problem :
  • Post-op care too long (6 weeks) before a full weightbearing.
  • Earlyweightbearing has to be possible.

STRESS ABSORPTION : SUMmary

  • NCT solution :
  • 2+1 system & antero-medialpositioning.
  • Hold up to 2.5 T whenstatic.
  • Earlyweightbearing possibleif no pain.

Medial

activmotion14
ACTIVMOTION

Whyshould an implant supports thatmuch of a load ?

NEWCLIP’S Technology as problemsolver

  • Leverageeffect :
  • knee supports more than the weight of the body (while standing up, kneeling down…)
  • Up to 8 times the weight of the body.
activmotion15
ACTIVMOTION
  • Problem :
  • The lateral cortex has to remain intact, as bonegrowthwillstartfromit.
  • To respect it, PesAnserinus and MCL have to beprogressivelyreleaseddistally.

NEWCLIP’S concept : solving the problem

  • NCT solution :
  • Antero-medialpositioningwithanatomical implant based on bone-mappingtechnology.
  • Compact and thin implant allowing the recommended HTO surgicalapproach.
activmotion16
ACTIVMOTION
  • Problem:
  • Classictreatment: ACL reconfollowed by HTO.
  • Post-op care too long.
  • Sport-medicineapproach: bothat the same time.
  • No specific HTO implant on the market.

HTO & ACL Recon

  • NCT/Orthofix solution : Specific implant
  • Two variable angle screws.
  • Specificpositioning.
activmotion17
ACTIVMOTION

SurgicalApproach

activmotion18
ACTIVMOTION

SurgicalApproach

  • A single-plane incision is made through the periosteum.
  • The hamstring and the medial collateral ligament (MCL) are retracted posteriorly.
  • The larger the angular correction must be, the more the hamstring and MCL should be released distally.
activmotion19
ACTIVMOTION

SurgicalApproach

  • Elevator used over the posterior surface of the tibialand remain as protection.
  • Clear the deepest part of the patellar tendon down to its attachment onto the tibial tuberosity, and protect it using a retractor during the osteotomy.
activmotion20
ACTIVMOTION

Surgical Technique

  • Incise upward toward the head of the fibula and stop incision 5-10mm before the lateral cortical area.
activmotion21
ACTIVMOTION

Surgical Technique

  • Insert wedges of gradually larger size until finding the appropriate one (6-16mm).
  • The angular correction is maintained during osteosynthesis.
activmotion22
ACTIVMOTION

Surgical Technique

  • Position the plate onto the antero-internal side.
  • Proximal part of the plate runs parallel to the osteotomy cut.
activmotion23
ACTIVMOTION

Surgical Technique

  • Fit the first Ø3.5mm guide under the osteotomy cut, then start drilling using a Ø3.5mm drill.
  • Fit a second Ø3.5mm guide into the polyaxial slot of the plate. Adjust the drilling to the lateral tibial plateau.
activmotion24
ACTIVMOTION

Surgical Technique

  • The synthesis is complete when each screw has been perfectly tightened.
activmotion25
ACTIVMOTION

Surgical technique

  • The MBCP bone substitute : 60% of hydroxyapatite and 40% of tricalcicphosphate.
  • Proposed in several sizes corresponding to the osteotomy correction (6 to 16mm).
activmotion26
ACTIVMOTION

Surgical technique

  • Cage as bone substitute holder.
  • Avoidbone substitute migration.
  • Optionnal.
activmotion27
ACTIVMOTION

NCT innovation :

SUM Up

  • 2 + 1 system.2 screwsunderexternal plateau, 1 screwunderinternal plateau for betterweightbearingload care.
  • Antero-internalpositioning of the plate. orientation of the screws in the direction of the postero-anterior roll-back induced stress.
  • Low profile implant Doesn’tinterferewith the hamstring ligaments, patient don’tfeelitunder-skin.
  • Combination of ACL reconstruction and HTO.Specific implant thatleave room for the tunnel.
thank you
THANK YOU

Xavier PeiffertInternational Product Manager

[email protected]

ad