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Quads cut - why and when do they cut the quads tendon/muscle

Discussion in 'The surgical procedure (knees)' started by Josephine, Aug 30, 2017.

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    This can be confusing as there are two definitions here - one is the standard method of accessing the knee joint, the other is old-fashioned. Even then there are a variety of different incisions but they vary only slightly.

    All start with the incision in skin which can vary greatly - but the only factor governing this is surgeon's preference!

    They can be straight down the middle

    1-year-jpg.19024.jpg

    curved

    braindoc.jpg


    "S" shaped

    002-jpg.19155.jpg


    And even with bilateral knees done at the same time, the incisions can vary in length and style!

    shmi-jpg.25682.jpg



    Once inside, through the fat and superficial tissues, the surgeon gets to the major muscular structures on top of the joint

    quads structure 2.JPG


    Here there are well described pathways to make this part of the incisions the median parapatellar (first image) being the most popular. The mid or subvastus incisions are commonly used for partial knees where the opening into the knee needs to be more to the side.

    various.JPG

    So you can see here there are a number of ways of taking the top end of the incision to avoid the dreaded 'quads snip'.

    The "Quads Snip"
    Years ago, surgeons actually used to extend this intrusion into the muscle of the quads (see the red line in the image in the next post) as it was believed it provided better access to the joint but time and experience showed this to be untrue and more than that, to retard the patient's recovery so over the years it was gradually dropped from use. However, the tale still lives on!
     
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  2. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    Location:
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    I'm sure some are told this by their surgeons but nevertheless, it's incorrect! There is no 'minimally invasive' approach in TKR. It's impossible because the wound has to be big enough the get the implants in and the femoral part is as least the size of your palm! This was the smallest incision I've ever seen - it was about 4 inches long!

    Cutter++.jpg

    The 'quads sparing' is also a misnomer. It was routine back in the 80s and early 90s simply in order to give better access to the joint. But it was quickly realised that it made the patients recovery longer and more troublesome and unable to function well. Around the early 90s it then became a no-no so far as surgical technique was concerned though there were still a number of ill-informed surgeons who were using it, mostly in the US.

    The "Quads Snip" as it was often called, was when the surgeon followed the line of the patella and then the patellar tendon, thus dividing the quads muscle from the it - see the red line

    The "Quads Sparing" was just to follow the natural line of divide from the patella up to the right and along the lower aspect of the body of the muscle - see the yellow line


    quads sparing MIS.JPG
     
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