Femoral Preparation

Intramedullary Femoral Alignment

1. Flex the knee to 70-90°.
2. Place a thin bent Hohmann retractor laterally around the tibia and retract the patella laterally (not everted).
3. Divide and excise the ACL and the anterior horn of the lateral meniscus.
4. Identify the rotational reference landmarks
   
   • A-P axis (as described by Whiteside)
   • Medial/lateral posterior femoral condyles
   • Epicondylar axis
5. Open the femoral canal (generally just anterior to the PCL insertion) with the 9.5 mm drill.
6. Select the valgus angle bushing/rod based on preoperative measurements. Assemble the selected bushing to the valgus alignment guide (left or right). Make sure the bushing is positioned so that "left" is facing anteriorly when operating on a left knee and "right" is facing anteriorly when operating on a right knee. Attach a quick connect handle to the valgus alignment guide. (Figure 3)
7. Insert the intramedullary rod into the canal. Position the valgus guide through the skin window until it contacts the distal femur. (Figure 4)