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TKR: Patellar Eversion

- Discussion:
    - the patella should evert with minimal tension on the patella tendon;
    - methods to facilitate patellar eversion:
          - patellar resurfacing:
                - patellar resurfacing can be performed early in the exposure inorder to thin the patella and facilitate the eversion;
          - proximally ensure that there is an adequate quadriceps incision;
                - in revision TKR, a quadriceps snip may be required;
                - transect any adhesions in the in the suprapatella pouch;
          - distally ensure that the entire patellar tendon has been exposed;
                - it is permissible to sharply elevate a small amount (10-20%) of the patellar tendon off its insertion (rather than
                        have it partially avulse under tension);
          - incise the anterior attachements of the lateral mensicus of the tibia;
          - ensure that an adequate lateral capsular exposure has been performed;
          - excise patello-femoral ligaments:
                - attach a Kocher clamp to cuff of retinaculum attached to medial side of patella;
                - retract the Kocher to partially evert the patella so that the patellofemoral ligaments are placed under tension;
                - use curved Mayo's to spread under the patellofemoral ligament and then incise it;
          - lateral retinacular release

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