Technique of Bone Cuts with Conventional Instruments

Abstract

A long, straight incision, four fingerbreadths above the superior pole of the patella, is made and extended to two fingerbreadths below the tibial tubercle. This operative technique assumes that there is no fixed deformity of valgus, varus, or flexion contracture in the knee. When these deformities are present, soft tissue balance is performed first. If there has been a previous incision, it is best to utilize it and extend the incision both superiorly and inferiorly to expose the knee. It is important to avoid a parallel incision placed closely and at narrow angles, even if of long duration, to avoid skin necrosis. Skin necrosis often leads to sepsis. It is tempting to undermine the lateral flap for lateral release. However, no undermining of the skin flap should be done on either side. Lateral release, as described in the literature, where the lateral skin flap is undermined to expose the iliotibial band, lateral collateral ligament, and posterior corner of the knee is to be avoided [1]. The risk of such a wide lateral undermining is serious and necrosis may occur, although the incidence of such a complication is uncommon.