Special thanks to the following surgeons for development of ODYSSEY Anterior Rough Cut Instrumentation:

MICHAEL J ANDERSON, MD Attending Orthopaedic Surgeon Blount Orthopaedic Clinic Milwaukee, Wisconsin BRAD PENENBERG, MD Attending Orthopaedic Surgeon, Cedars Sinai Medical Center, Midway Hospital Medical Center Los Angeles, California JOHN BALL, MD Attending Orthopaedic Surgeon St. Bernard's Regional Hospital Jonesboro, Arkansas

The ADVANCE Knee System was developed in conjunction with:

J. DAVID BLAHA, MD Clinical Professor Department of Orthopedic Surgery, University of Michigan Ann Arbor Michigan DAN DALUGA, MD Orthopaedic Surgeon Arnett Clinic, Lafayette Home Hospital, St. Elizabeth Medical Center Lafayette, Indiana M.A.R. FREEMAN, MD, FRCS Honorary Consultant Orthopaedic Surgeon Royal London Hospital London, U.K. WILLIAM MALONEY, MD, Elsbach-Richards Professor and Chairman Department of Orthopaedic Surgery Stanford University School of Medicine Stanford, California KENT SAMUELSON, MD Attending Orthopaedic Surgeon, LDS Hospital Salt Lake City, Utah ROBERT SCHMIDT, MD The Texas Hip and Knee Center, Fort Worth, Texas STEVEN STUCHIN, MD Associate Professor, Clinical Orthopaedics, Director of Orthopaedic Surgery Hospital for Joint Diseases Orthopaedic Institute, New York University Medical Center New York, New York The Hospital for Special Surgery New York, New York.

ODYSSEY

TM

Tissue Preserving Initiative MIS Anterior Rough Cut Surgical Technique Instrumentation for the ADVANCE Knee Systems

ODYSSEYTM M I S A N T E R I O R R O U G H C U T I N S T R U M E N TAT I O N

ODYSSEY
TISSUE PRESERVING INITIATIVE

TM

MIS ANTERIOR ROUGH CUT Instrumentation for the ADVANCE Knee Systems

general PRECAUTIONS

Proper surgical techniques are necessarily the responsibility of the medical professional. The following guidelines are furnished only as recommended techniques. Each surgeon must evaluate the appropriateness of the techniques based on his or her own medical training and experience.

surgical APPROACH

ODYSSEYTM instrumentation is designed to be applicable to both minimally invasive and standard total knee procedures. Therefore, surgeons should employ the technique they are most comfortable with; be it standard midline, mid-vastus, or subvastus.

patella PREPARATION

NOTE | Recessed patellar instrumentation is available but may not be applicable to a minimally invasive procedure. To use this instrumentation, see Appendix A

With the leg extended, the patella is tilted to almost a 90 angle. The onlay patellar resection guide can be used with or without the 8mm resection depth gauge. When used without the gauge, the resection guide is positioned at the desired level of resection. For a calibrated resection, the 8mm resection depth gauge should be attached to the top of the resection guide with the lock screw.
| FIGURE 1A Position the resection guide jaws parallel to the articular margin

and securely clamp the guide to the bone; ensuring the gauge is contacting the apex of the articular surface. Remove the gauge and locking screw and make the patellar resection along the top face of the jaws. | FIGURE 1B Attach the appropriate drill guide to the patellar clamp and clamp the patella.
| FIGURE 2 The drill guides have grooves on their surfaces indicating FIGURE 1A |

the patellar diameter options. The appropriate tri-peg or central peg reamer is used to prepare the peg hole(s).
NOTE | The patellar peg holes may be prepared after the tibial and femoral resections. NOTE | Instead of utilizing a clamp for patellar resection some surgeons prefer a non-instrumented technique. NOTE | The tri-peg patellae have the same peg patterns between sizes and can be easily changed during trial reduction.

FIGURE 1B |

FIGURE 2 |

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PREPARATION OF THE DISTAL FEMUR

NOTE | Prior to femoral preparation, draw a line down the deepest part of the trochlear groove to represent the A/P axis (see below). This line will be utilized later in the technique as a reference for femoral guide rotation. 3

FIGURE 3 |

Tibial and femoral resections are made independently; therefore, the order in which they are made is left to the discretion of the orthopaedic surgeon. STARTER HOLE PREPARATION Initiate an opening in the femoral canal with the 3/8" (9.5 mm) diameter drill bit. The hole is placed medial and anterior to the anteromedial corner of the intercondylar notch (PCL origin), or in the center of the trochlear groove.
| FIGURE 3

NOTE | Osteophytes may need to be removed from the intercondylar notch to identify landmarks.

ALIGNMENT ROD INSERTION Insert the fluted intramedullary (IM) reamer/rod into the femoral canal, being sure to irrigate and aspirate several times to reduce the chance of a fat embolus.
FIGURE 4 |

Turn the reamer during insertion with the t-handle. | FIGURE 4 Remove the thandle and IM reamer rod.

DISTAL FEMORAL ALIGNMENT/ EXTERNAL ROTATION

Utilizing the driver cap and pin, insert the appropriate 10 mm diameter valgus angled IM rod (3, 5, 7) into the femoral canal without sinking the anti-rotation fins. Each valgus rod can be used for a left or right knee and is marked
LT 7 5

accordingly. For a left knee, the LT marking on the shaft of the rod should be facing up. For a right knee, the RT marking should be facing up | FIGURE 5 To set external rotation of the rod, utilize the alignment crosshair, the external rotation clamp, or the driver pin.
NOTE | When impacting the fins of the valgus rod make sure not to completely immerse them in cancellous bone. NOTE | It is recommended that the cap and pin always be utilized to impact the valgus rod. Impaction directly on the end of the valgus rod may deform it and make removal of the alignment instruments difficult.

FIGURE 5 |

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ALIGNMENT CROSSHAIR Slide the crosshair down the shaft of the valgus rod and tighten it to the flats of the rod. Align the vertical arm of the crosshair with the trochlear groove (A/P axis).
| FIGURE 6

Once the vertical arm is aligned with the trochlear groove, impact the

rod until the fins are no longer visible. The horizontal arm of the crosshair may be utilized to reference the medial epicondyle as a secondary landmark. EXTERNAL ROTATION CLAMP Slide the external rotation clamp over the rod. | FIGURE 7 The central rod capture should be steadied with a thumb to prevent it from swiveling as it is loaded onto the shaft of the rod. | FIGURE 7A Ensure the anterior clamp stylus rests on the most proximal region of the articular cartilage between the raised anterior
FIGURE 6 |

condyles, and the posterior stylus straddles the intercondylar ridge.

| FIGURE 8

When clamped, the valgus rod will be rotated in line with the

trochlear groove. The adjustable clamp crosshair may be aligned with the medial epicondyle by loosening the tightening outrigger and raising or lowering A the crosshair. | FIGURE 7B Once rotation is determined, impact the rod until the fins are no longer visible. Care should be taken to ensure the alignment is not altered during impaction. DRIVER PIN After preliminarily impacting the valgus rod, remove the driver cap, but return the B pin to the hole in the shaft of the rod. Align the pin vertically with the deepest part of the trochlear groove. | FIGURE 9 Once aligned with the trochlear groove, impact the rod until the fins are no longer visible.
FIGURE 7 |

FIGURE 8 |

FIGURE 9 |

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ANTERIOR ROUGH CUT

NOTE | All ODYSSEY femoral resection slots are designed for use with a .050" (1.3mm) thick saw blade.

Slide the IM alignment body down the shaft of the valgus rod until it contacts B A the distal femur. Lock the IM alignment body to the flats of the valgus rod by tightening the locking screw | FIGURE 10A with a 3.5mm hex head screwdriver. Slide the support bars of the anterior rough cut guide into the IM alignment body. | FIGURE 10B Introduce the tip of the anterior stylus through the hole in the stylus body. | FIGURE 11A The stylus should be pushed cephalad until it "clicks". Each click represents one femoral size. The stylus should be pushed until the number of clicks equals the estimated femoral size. ( femoral size is estimated based on pre-operative templating) The femoral size markings are
FIGURE 10 |

indicated posteriorly on the stylus where it meets the stylus body. | FIGURE 11B
NOTE | For additional stability, headed pins may be placed in the holes on the distal face of the IM alignment body. | FIGURE 11C However, these pins should be removed prior

A B

to a distal resection and before removal of the alignment body is attempted.

Once the anterior stylus has determined the depth of anterior resection, fix the anterior rough cut guide position by tightening the two screws on the distal face of the IM alignment body. | FIGURE 11D This is performed with a 3.5mm hex

head screwdriver. Resect the anterior condyles and remove the anterior rough cut guide, leaving the IM alignment body in place.

DISTAL FEMORAL RESECTION

Insert the distal resection guide with attached crosshead into the IM alignment body. | FIGURE 12A Lower the crosshead as close as possible to the anterior

FIGURE 11 | The dual reference gauge may

be placed through the resection slot to confirm resection depth

rough cut. In some cases, the crosshead will not touch the anterior rough cut. With the crosshead in the standard position, 9mm of the distal femur will be resected from the prominent distal condyle. If 13mm of resection is necessary, the
STD +2mm

crosshead may be repositioned by pushing the locking button down and sliding the crosshead
+4

LEFT
+4

proximally until the "+4mm" mark is seen. | FIGURE 13A The crosshead is then locked into

position by pushing the locking button up. | FIGURE 13B

FIGURE 12 |

FIGURE 13 |

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After the resection amount is set, the crosshead is pinned to the anterior cortex with two headless pins. Push down the locking button to separate the alignment body from the crosshead. With the IM alignment body affixed to the valgus rod, utilize the slap hammer and hook to carefully remove the valgus rod and assembled IM alignment body. | FIGURE 14 At this point, if headless pins are used, the crosshead can be readjusted 2 mm proximally by sliding it down the pins through the "+2mm" holes. A divergent pin hole is available and recommended for additional stability. FEMORAL SIZING Place the A-P femoral sizer flush against the resected distal femur and adjust the sizer so the feet contact the posterior condyles and the stylus rests on the
FIGURE 14 |

anterior rough cut. | FIGURE 15 The femoral size is indicated on the distal face of the A-P femoral sizer. If the femur measures between sizes, the femoral resection block correlating to the smaller of the two sizes should be utilized.
NOTE | Resecting the proximal tibia before femoral sizing may facilitate placing the
1 2 3 4 5 6

posterior feet of the sizer under the posterior femoral condyles.

ANTERIOR AND POSTERIOR RESECTIONS Place the femoral resection block flush against the distal and anterior femoral surfaces. | FIGURE 16 The distance between the pin outriggers on the sides of the block is the same M/L width as the corresponding femoral component. Affix the block to the bone with headed pins on the medial and lateral sides of the block. Secondary fixation pins may be placed through the distal face of the block, but must be removed prior to the chamfer resections. The recommended order of the resections is: posterior, posterior chamfer, anterior, anterior chamfer. A narrow sawblade (12.5mm) is recommended for the chamfer resections.
NOTE | Use of threaded pins in the side outriggers of the femoral resection blocks may lead to a higher incidence of pin cross-threading and shearing. Use of standard, nonthreaded pins is recommended.

FIGURE 15 |

FIGURE 16 |

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SULCUS RESECTION Place the sulcus resection guide on the femur that corresponds to the previous femoral resection block. Ensure the top of the guide rests on the resected anterior cortex. Generally, the guide is lateralized on the femur to reacquire the Q-angle. Pin the guide through the holes overlying the anterior chamfers. The edges of the guide represent the M/L dimensions of the femoral implant.
| FIGURE 17

Drill for the femoral implant fixation pegs through the distal holes in

the sulcus resection guide using the 3/16 4.8mm drill bit. The trochlear groove should be resected by using a 12.5mm saw blade on the either the anterior or posterior angled surface and along the sides of the central portion of the guide.

FIGURE 17 |

tibial PREPARATION

EXTRAMEDULLARY TIBIAL RESECTION

NOTE | The ODYSSEY tibial resection guides are designed for use with a .050" (1.3 mm) thick saw blade.

Position the ankle clamp of the extramedullary (EM) tibial resection guide against the lower leg just proximal to the malleoli and collapse the arms around the ankle. | FIGURE 18 Attach the appropriate left or right tibial crosshead onto the guide and adjust the guide until the resection slot is located a few millimeters below the lowest articular surface. Use the adjustment knobs at the ankle to align the resection guide in the coronal and sagittal planes. When the vertical axis of the guide is parallel to the tibial axis, it is positioned for a 3 posterior sloped resection. Attach the external alignment guide and slide the alignment rod through the appropriate TR or TL (Tibia Left or Tibia Right) hole. If the rod is parallel to the tibia, 3 slope is confirmed. | FIGURE 19
FIGURE 18 |

FIGURE 19 |

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For an anatomically sloped resection, place the dual reference gauge or a saw blade in the cutting slot and adjust the long axis of the EM guide by loosening the ankle screw | FIGURE 20A and pulling the distal end of the guide away from B the ankle. Adjust the guide until the cutting slot angle matches the anatomic slope of the tibia. | FIGURE 20B Slide the 2mm/10mm stylus into the slot of the crosshead and turn the crosshead adjustment knob until the proper resection is found. | FIGURE 21A Pin the crosshead to the proximal tibia through the +0mm holes. | FIGURE 21B The alignment guide and rod can be used to check alignment to the ankle. If the crosshead is detached from the guide, the crosshead can be moved distally 2mm if headless pins are used. Divergent pin holes are available for additional stability and are highly recommended.
NOTE | The top surface of the crosshead can be used to resect the tibia and is 4 mm proximal to the distal surface of the captured slot.

A
FIGURE 20 |

INTRAMEDULLARY TIBIAL RESECTION The 3/8" (9.5 mm) drill bit is used to penetrate the proximal tibia just posterior to the tibial ACL attachment. Insert the fluted IM reamer/rod into the tibial canal A constantly turning the t-handle. | FIGURE 22 Irrigate and aspirate several times to reduce the chance of a fat embolus. The reamer/rod should be inserted to at least the mid isthmus. Slide the tibial resection guide onto the IM reamer/rod. B
| FIGURE 23 Turn the locking screw to lock the guide to the IM reamer/rod. | FIGURE 23A

FIGURE 21 |

FIGURE 22 |

FIGURE 23 |

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Slide the 2mm/10mm stylus into the slot of the crosshead to set the desired level of tibial resection. | FIGURE 24A Pin the crosshead to the proximal tibia through the 0mm holes. When the crosshead is detached from the guide, the block can be moved proximally or distally 2 mm if headless pins are used. Varus/valgus angulation can be checked to the ankle using the external alignment guide and rod. | FIGURE 25

TIBIAL SIZING, KEEL PREPARATION, AND TRIAL REDUCTION

NOTE | In all ADVANCE Total Knees, with the exception of the ADVANCE Double-High Knee, the trial insert size must match the femoral trial size (see chart 1 and 2 on

A
FIGURE 24 |

next page ). There are two tibial base trial sizes that can be used with any one size femoral trial. For example, a size 3 femoral trial can be used with either a size 3 or 3+ tibial trial base. When using the ADVANCE Double-High insert trial, a femoral trial one size greater than the tibial insert trial may be utilized. For example, a size 3 ADVANCE Double-High insert trial may be used with a size 3 or 4 femoral trial and a size 3 or 3+ tibial base trial. (Implant dimensions are listed at end of technique.)

Assemble the trial tibial base equal in size to the femoral implant with the trial base handle and place against the proximal tibial surface. | FIGURE 26 If using the ADVANCE Double-High insert, a trial base one size smaller than the femur may be utilized. The alignment rod can be inserted through the handle to check alignment to the ankle. | FIGURE 26A Align the base and pin it to the tibia using short headed tibial fixation pins. | FIGURE 26B

B
FIGURE 25 |

FIGURE 26 |

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If the tibial size is too small, a "plus size" will provide additional tibial coverage. Attach the keel punch guide to the keel punch handle and secure it to the trial base by turning the knurled handle. | FIGURE 27 Prepare the entry hole for the tibial stem using the 15mm drill guide and reamer (press-fit or oversize).
| FIGURE 28 Ream to the first line on the reamer for a size 1, 1+, or 2 base; to the

second line for a 2+, 3, 3+, or 4 base; and to the third line for a 4+, 5, 5+, or 6 base. Using the threaded punch handle and appropriate keel punch, plunge through the guide until the punch is fully seated and the punch collar is level with the edge of the guide. | FIGURE 29A Remove the punch and punch guide, leaving the trial base in place for a trial reduction. TRIAL REDUCTION/IMPLANT INSERTION
FIGURE 27 |

NOTE | In all ADVANCE total knees, with the exception of the ADVANCE Double-High Knee, the tibial insert size must match the femoral implant size (see Chart 1). There are two tibial base sizes that can be used with any one size femoral component. For example a size 3 femoral implant can be used with either a size 3 or 3+ tibial base.
| FIGURE 30 When using the ADVANCE Double-High insert, a femoral component

one size greater than the tibial insert may be utilized. For example, a size 3 ADVANCE Double-High insert may be used with a size 3 or 4 femur and a size 3 or 3+ tibial base trial (see Chart 2)

FIGURE 28 | FIGURE 30 |

* Implant dimensions are listed at the end of this technique.

MEDIAL-PIVOT
FEMUR 1 2 A 3 4 5 6
FIGURE 29 | CHART 1

DOUBLE-HIGH
FEMUR 1 or 2 2 or 3 3 or 4 4 or 5 5 or 6
CHART 2

INSERT 1 2 3 4 5 6

TIBIA 1 or 1+ 2 or 2+ 3 or 3+ 4 or 4+ 5 or 5+ 6

INSERT 1 2 3 4 5

TIBIA 1 or 1+ 2 or 2+ 3 or 3+ 4 or 4+ 5 or 5+

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Place the appropriate size femoral trial on the distal femur using the femoral impactor. | FIGURE 31 Insert the trial insert of appropriate size and thickness onto the trial base and complete the trial reduction. If necessary, drill for the femoral implant fixation peg through the femoral trial implant using the 3/16 (4.8mm) drill bit. After the trial reduction is complete, remove the femoral trial with the slaphammer by sliding the disc extractor tip between the femoral condyles. | FIGURE 32 During removal, keep one hand on the trial to control its extraction. Remove the short headed tibial fixation pins with the pin puller or slap hammer pin extractor. The recommended order for implantation is left to the discretion of the orthopaedic surgeon. Insert the femoral implant with the femoral impactor.| FIGURE 31 The tibial base implant is inserted with the tibial
FIGURE 31 |

base impactor. | FIGURE 33 After the base has been inserted, the appropriate trial tibial insert can be used to recheck ligament and soft tissue balancing.
| FIGURE 34 An additional trial insert pin may be placed through the trial insert

and tibial base implant to provide a more secure construct during final assessment of joint stability.
NOTE | The trial insert only engages the central locking detail and a gap will be present along the anterior periphery of the insert. | FIGURE 34A

FIGURE 32 |

FIGURE 33 |

FIGURE 34 |

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The patellar implant can be held in place while the cement cures using the parallel patellar recessing clamp and plastic seater. | FIGURE 35 TIBIAL INSERT SEATING Once the cement surrounding the tibial base has cured, the appropriate tibial insert may be locked into place. Initial seating is accomplished by pushing the insert as far posterior as possible with hand pressure, paying special attention to engage the central dovetail and posterior captures of the tibial base. For final seating of the insert, two options are available. In the first option, the 45 insert impactor may be utilized by placing the impactor tip in the anterior slot of the tibial insert. | FIGURE 36 The impactor handle should be at an angle slightly greater than 45. Keeping the impactor tip in the slot, decrease the angle of the
FIGURE 35 |

impactor handle until the tip is felt to impinge within the slot. This should be approximately 45. While maintaining this 45 angle relative to the tibial base, apply several strong mallet blows directing the insert posteriorly. After the anterior edge of the insert has been pushed past the anterior capture of the tibial base, it will automatically drop behind the anterior capture and the insert face will be flush against the surface of the tibial base. | FIGURE 37 In the second option, an insert assembly gun may be utilized by placing the lower jaw in the anterior slot of the tibial base. | FIGURE 38 With the bottom jaw inserted, slide the locking shim completely forward to ensure proper gun position. | FIGURE 39A To seat the insert, squeeze the handle until the top jaw pushes the insert fully posterior and flush against the surface of the tibial base.
| FIGURE 37 Withdraw the locking shim to loosen the assembly gun.

FIGURE 36 |

FIGURE 37 |

FIGURE 38 |

FIGURE 39 |

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APPENDIX A | RECESSED PATELLAR PREPARATION

Attach the patellar reamer guide to the parallel patellar clamp. Center the guide over the apex of the patellar articular surface, and clamp the patella. | FIGURE 1 Slightly loosen the two thumbscrews on the depth regulator until it sits at the bottom of the patellar reamer guide. Insert the appropriate patellar reamer into the guide until it rests on the apex of the patellar articular surface. Note the reamer depth by referencing the bottom of the reamer collar | FIGURE 2A to the scale on the side of the reamer guide. Set the top edge of the depth regulator to 14mm below the patellar reamer collar for a high dome patellar implant, and 12mm below the reamer collar for a low dome. Ream until the depth regulator stops the patellar reamer.
NOTE | The reamer is a "one step" instrument that resects bone for the patellar body and
FIGURE 1 |

peg simultaneously.

FIGURE 2 |

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APPENDIX B | FLEXION/EXTENSION GAP MEASUREMENT

The flexion/extension gaps are measured following the tibial resection and femoral resections. With the knee flexed at 90, insert the 10mm spacer block assembly into the space between the posterior femoral condyle and tibial bone surfaces. | FIGURE 1 If the 10mm spacer block does not fit in flexion, additional tibial resection or a smaller femoral size may be needed. Use progressively thicker spacer blocks until the appropriate tension is obtained in flexion. Slide the external alignment rod through the holes in the tibial trial base handle to check accuracy of the tibial cut to the center of the ankle. After the flexion gap has been determined, place the leg in extension | FIGURE 2 If the 10mm spacer block does not fit, use the minus 2mm spacer block to determine the amount of additional distal femoral bone resection required to achieve full extension.
FIGURE 1 |

NOTE | The spacer blocks indicate the thickness of the appropriate tibial insert. The thicknesses of the femoral condyles, tibial base, and tibial insert are built into the spacer block thickness.

FIGURE 2 |

APPENDIX C | 2MM RESECTION GUIDE

The 2mm resection guide is generally employed for use on the anterior femoral rough cut, distal femoral resection, and resected proximal tibia. To position the guide, place the anterior wings on the resected surface with the resection slot abutting the edge of the surface. Two divergent pin holes are available for fixation.

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FEMORAL
SIZE
A B C

A 60 65 70 75 80 85

B 52 57 62 66 71 76

C 8 8 8 8 8 9

1 2 3 4

5 6*

* Not available for ADVANCE Stemmed Medial-Pivot

Porous and Non-Porous CoCr femoral components accommodate patient anatomy, restore natural patellofemoral function, maximize fixation and enhance stress distribution.

PATELLAR
SIZE
DIAMETER

SINGLE PEG
M

TRIPEG N/A
M

THICKNESS (MM)

DIAMETER

25 26 28 29 32 35 38 41

RECESSED

N/A
RECESSED
M

N/A
M M M M M

N/A
M M M M

7 OR 9 8 7 OR 9 8 8 8 10 11

All-Poly Patellar Components are offered in both single and tri-peg configurations. Patellar components are completely interchangeable with any size femoral component, improving the flexibility required to match patient anatomy and available bone with implant size. Both designs incorporate cement interlock features. The tri-peg design maintains a constant peg pattern easing intraoperative size changes.

TIBIAL
A B

TRAY SIZE

A 60 65 65 70 70 75 75 80 80 85 85

B 41 44 44 48 48 51 51 54 54 58 58

C 35 35 35 43 43 43 43 50 50 50 50 1 1 2 2 3 3 4 4 5 5 6

1 1+
C

2 2+ 3 3+ 4 4+ 5 5+ 6

The CoCr Tibial Trays are available in 11 sizes (6 regular sizes, 5 plus sizes). The 3 posteriorly inclined keel is proportional by size and offers improved rotational control and fixation with less compromise of proximal tibial bone stock. Instrumentation allows control of cement mantle thickness around the stem.

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DOUBLE HIGH INSERT | PCL RETAINING

10MM RAISED ANTERIOR MEDIAL LIP

ANTERIOR MEDIAL BALL-IN-SOCKET

12 17
MEDIAL POSTERIOR LIP REDUCED TO ALLOW PCL DICTATED FLEXION ROTATION AROUND ANY POINT ON MEDIAL SIDE

10 14

DOUBLE-HIGH INSERT THICKNESS

(MM)

MEDIAL PIVOT INSERT | PCL SACRIFICING

PCL SACRIFICING FULL MEDIAL BALL IN-SOCKET

12
11MM RAISED ANTERIOR MEDIAL LIP MEDIAL POSTERIOR LIP PROVIDES STABILITY

10 14

17 20 25
ROTATION AROUND MEDIAL CONDYLE
MEDIAL PIVOT INSERT THICKNESS
(MM)

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