The surgical procedure to insert the OrthoGlide implant uses both arthroscopic and open techniques. A routine knee arthroscopy is performed addressing all intra-articular pathology. In preparation for the OrthoGlide a shaver is used to remove the articular cartilage on the tibial eminence in the medial compartment (Fig. 1). This aids in appropriate seating of the OrthoGlide and allows access to the posterior horn of the medial meniscus. Once the cartilage has been removed (avoid violating the subchondral bone) the posterior horn of the medial meniscus is removed to within 1-2 mm of the meniscocapsular junction (Fig. 2). The posterior rasp is then inserted and used to remove osteophytes on the posterior rim of the tibial plateau to facilitate seating of the posterior lip of the implant over the tibia (Fig. 3).
The medial portal is extended 5-7 cm and an arthrotomy is performed (Fig. 4) (click right arrow to advance). The infrapatellar fat pad and the remainder of the medial meniscus are excised. Osteophytes are then removed from the medial femoral condyle, medial tibial plateau, and medial aspect of the patella, preventing impingement of the implant as well as alleviating the tenting effect on the medial collateral ligament. The tibial shaper can then be used to smooth the remaining articular cartilage surface.
The anteroposterior length of the tibial plateau is measured with the trial selector and the appropriate trial device is selected. Insertion requires the knee to be in 20-30 degrees of flexion with external tibial rotation and valgus stress applied (Fig. 5) (click right arrow to advance). With the trial in place, the knee is assessed for stability, range of motion, and congruence of the implant during flexion-extension, and appropriate size. The OrthoGlide implant is inserted into the medial compartment as described (Fig. 6) (click right arrow to advance). Stability of the implant and range of motion are reevaluated. Intra-operative C-arm is used to confirm the proper length of the OrthoGlide and to verify the posterior lip is over the tibial plateau prior to closing the arthrotomy.
