ACTIVMOTION

1

• ACTIVMOTION

2
ACTIVMOTION

• GENERAL THEORY

• Lower limb can present as an inward (varus) or
  outward (valgus) angulation.

• If mechanical axis is deviated, can get
  overloading and wearing of the cartilage on one
  side.

3
ACTIVMOTION

• GENERAL THEORY

• Closing wedge osteotomy External bone wedge
  removal (with an osteotomy from the fibula).

4
ACTIVMOTION

• GENERAL THEORY

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

5
ACTIVMOTION

• Stress distribution in a healthy knee

• The medial tibial plateau supports most of the
  weight bearing.
• During walking the stress is predominantly
  anterior.
• ? 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 healthy knee

• 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 corrected knee

• 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

• NEWCLIPS Technology as problem solver

• Problem
• Post-op care too long (6 weeks) before putting
  patients on load.
• Material may fail when putting on earlier load.

NCT solution Design an antero-medial plate
for an optimal answer to the biomechanics of the
knee.
12
ACTIVMOTION

• ACTIVMOTION CONCEPT

Stress distribution on the plateau
Lateral
21 system

• 2 screws under the external plateau. (Minimum 60
  of the load).

• 1 screw under the internal plateau. (Maximum
  40of the load)

• Antero-medial positioning to be as close as
  possible to the lateral stress.

Medial
13
ACTIVMOTION

• STRESS ABSORPTION

Dynamic stress inside the knee during walking

• Antero-medial positioning of the implant, to face
  the main anterior forces during walking.

• Antero-medial positioning limits the tibial
  internal-rotation of the distal fragment and
  preserves the lateral hinge.

• Antero-posterior orientation of the screws
  answering the roll-back of the knee.

14
ACTIVMOTION

• STRESS ABSORPTION SUMmary

Lateral

• Problem
• Post-op care too long (6 weeks) before a full
  weight bearing.
• Early weight bearing has to be possible.

• NCT solution
• 21 system antero-medial positioning.
• Hold up to 2.5 T when static.
• Early weight bearing possible if no pain.

Medial
15
ACTIVMOTION

• NEWCLIPS Technology as problem solver

Why should an implant supports that much of a
load ?

• Leverage effect
• 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

• NEWCLIPS concept solving the problem

• Problem
• The lateral cortex has to remain intact, as bone
  growth will start from it.
• To respect it, Pes Anserinus and MCL have to be
  progressively released distally.

• NCT solution
• Antero-medial positioning with anatomical implant
  based on bone-mapping technology.
• Compact and thin implant allowing the recommended
  HTO surgical approach.

17
ACTIVMOTION

• HTO ACL Recon

• Problem
• Classic treatment ACL recon followed by HTO.
• Post-op care too long.
• Sport-medicine approach both at the same time.
• No specific HTO implant on the market.

• NCT/Orthofix solution Specific implant
• Two variable angle screws.
• Specific positioning.

18
ACTIVMOTION

• Surgical Approach

An 8-cm slightly oblique vertical incision is made along the antero-medial surface, running over the joint space down to under the tibial tuberosity.

19
ACTIVMOTION

• Surgical Approach

• 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

• Surgical Approach

• Elevator used over the posterior surface of the
  tibial and 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 tricalcic phosphate.
• Proposed in several sizes corresponding to the
  osteotomy correction (6 to 16mm).

27
ACTIVMOTION

• Surgical technique

• Cage as bone substitute holder.
• Avoid bone substitute migration.
• Optionnal.

28
ACTIVMOTION

• SUM Up

NCT innovation

• 2 1 system.?2 screws under external plateau, 1
  screw under internal plateau for better weight
  bearing load care.

• Antero-internal positioning of the plate.?
  orientation of the screws in the direction of the
  postero-anterior roll-back induced stress.

• Low profile implant? Doesnt interfere with the
  hamstring ligaments, patient dont feel it
  under-skin.

• Combination of ACL reconstruction and
  HTO.?Specific implant that leave room for the
  tunnel.

29

• THANK YOU

Xavier PeiffertInternational Product
Manager 33672689718xpeiffert_at_newcliptechnics.com