SynACART® Joint Resurfacing
The Surgical Technique for Treating Osteochondral Defects
The dog is placed in dorsal recumbency with the stifle undergoing surgery isolated in a standard four point drape fashion. Strict adherence to aseptic technique for patient preparation and surgery is critical to success. An assistant is required to position the limb during surgery.
For lesions affecting the lateral femoral condyle, the proposed skin incision is outlined by first identifying the patella and lateral trochlear ridge. A curved parapatellar incision is made from the tibial tuberosity to the level of the patella and continued proximally for an equal distance. The approach is continued with an incision through the fascia lata, along the cranial border of the biceps femoris muscle and extending distally through the lateral retinacular fascia, making sure to allow adequate remaining fascia to allow closure of the approach. The joint capsule is incised, the patella may need to be luxated medially from the trochlear groove, and the assistant positions the stifle in hyperflexion, optimizing exposure of the articular surface of the lateral femoral condyle. Strategically-placed small Gelpi Retractors can help improve visibility.
For lesions affecting the medial femoral condyle, an incision is made from the tibial tuberosity to the patella and then continued proximally for an equivalent distance. A stab incision is made into the joint at the level of the patella and the incision is extended distally through the medial fascia, the vastus medialis and the joint capsule, parallel to the straight patellar tendon.
Use caution as to not cause iatrogenic damage to the articular cartilage of the medial condyle. The incision extends to the distal portion of the sartorius muscle. The patella is luxated laterally and the joint is hyperflexed by the assistant to allow adequate visibility of the articular surface of the medial femoral condyle. The use of the strategically-placed small Gelpi Retractorscan help improve visibility.
The articular surface is inspected and the damaged surface is debrided with a scalpel or curette. It is important that the lesion is clearly defined by a circumferential marginal collar of viable hyaline cartilage. If the lesion is caudally disposed, this may require extreme hyperflexion.
The diameter of the lesion is measured using the concave end of the SynACART Guide to determine the most appropriate implant size. Once selected, the guide should be placed perpendicular to the defect and the 2.4 mm guide pin advanced through the cannulation of the guide anddrilled at least 2 cm into the bone.
The guide is removed and the appropriate sized SynACART Cannulated Drill is placed over the guide pin. The drill is advanced until the recipient bed is prepared to a stoplimited depth of 8 mm. The recipient bed is vigorously flushed to remove all debris which may prevent correct implant seating.
The implant is introduced into the recipient bed either by hand or by utilizing the SynACART Implant Holder. Using the concave end of the SynACART Guide, tamp the implant so that it is firmly seated to ensure accurate restoration of the articular topography.
The joint is flushed prior to routine closure.
Recommended Postoperative Management:
• Analgesia is provided in the form of nonsteroidal anti-inflammatory medication for 10-14 days post-surgery
• Restrict to kennel rest for the first 14 days post-surgery when unobserved
• Toileting and muscle-building walks are allowed 3-4x daily, lasting a maximum of 5-10 minutes
• Further confinement of the patient is recommended between weeks 3-6. Exercise breaks can be increased by 5 minutes per week, resulting in lead-controlled walks of 30 minutes, 3-4x daily by 6 weeks post-surgery
• Recheck examination at 6 weeks. Radiographic imaging or CT scan of joint is recommended.
• If the patient is progressing as expected, lead-controlled exercise can be gradually increased week by week until 12 weeks post-surgery where the patient can resume off-lead activity
• The success of this intervention relies upon a controlled return to a normal exercise pattern. The patient must remain under lead control, while not confined, and must be prevented from running, jumping or slipping on the operated limb until the appropriate recovery period has elapsed.
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