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ACTIVMOTION

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.

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ACTIVMOTION

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  1. ACTIVMOTION

  2. 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.

  3. ACTIVMOTION • Closingwedgeosteotomy: Externalbonewedgeremoval (with an osteotomyfrom the fibula). GENERAL THEORY

  4. 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

  5. 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.

  6. 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.

  7. ACTIVMOTION Stress distribution in a knee in Varus • In Varus : • Mechanical axis passes outside from the articulation. • Medial compartment supports 100% of the stress.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. ACTIVMOTION SurgicalApproach

  19. 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.

  20. 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.

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

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

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

  24. 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.

  25. ACTIVMOTION Surgical Technique • The synthesis is complete when each screw has been perfectly tightened.

  26. 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).

  27. ACTIVMOTION Surgical technique • Cage as bone substitute holder. • Avoidbone substitute migration. • Optionnal.

  28. 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.

  29. THANK YOU Xavier PeiffertInternational Product Manager +33672689718xpeiffert@newcliptechnics.com

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