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6Opening the medullary canal

On the lateral view, the entry point must be at the anterior tip of the Blumensaat’s intercondylar roof line. There is no “safe zone” posterior to this line. Take care not to start the entry point posterior to the Blumensaat’s line, in order to avoid damage to the cruciate ligaments when reaming.

The x-ray shows the desired 30° flexion of the knee joint. With less flexion the tibial plateau hinders the guide wire insertion. With more flexion the articular surface is in danger and the patella is in the way.