It goes by many names: MagicKnee, Jiffy Knee, “comb-over”, subvastus, undervastus, midvastus, lateral knee, quad sparing. Originally described by Erkes in 1929, and popularized slowly over the last 3 decades, this approach allows for access to the joint without cutting the quad tendon. There are plenty studies including meta analysis that support better early recovery compared to cutting the quad tendon, with those benefits dissipating out by 6 months or one year. The pushback I see these days towards this approach is what happened with direct anterior (DA) approach to the hip. And now industry sponsored labs are thriving with surgeons wanting to learn DA. I believe similar teaching opportunities will be available for muscle sparing knee replacement. Glad to see more and more surgeons coming on board… American Association of Hip and Knee Surgeons (AAHKS) #musclesparing #tka
Florian Dibra, MD I completely agree with you as well. I have been performing this technique for 18 years now. The results I’ve seen are remarkable. So far with my Jiffy knee program by end of next month, I will have 19 surgeons that I’ve completed and they are seeing amazing results as well. If we’re able to do everything exactly the same, keeping everything agnostic but preserve the soft tissues like the quads and the VMO I don’t see any downsides. Tim Kavanaugh MD Chris Nanson, MD, MPH, FAAOS Sarkis Bedikian, DO James Loging, MD, MBA, FAAOS Logan Hanson D.O. Matthew Romer Paul Codjoe Moby Parsons, MD American Association of Hip and Knee Surgeons (AAHKS) Cory Calendine, MD
I've been doing a few more recently. It SEEMS to make early recovery easier for some. In the deconditioned 40 BMI patient with 10-85°ROM and prolific osteophytes, I'm hard pressed to see that it would be a huge difference maker and may carry some additional risks from a technical standpoint in terms of iatrogenic injury due to difficulty of exposure. Always interesting to see how these things run in cycles 🔄
Craig Loucks, MD
3mo
I’ve done a bunch of these over the last few weeks. Thanks to Ryan “Saw-Bones” Molli, D.O., F.A.A.H.K.S., F.A.A.O.S. For posting the full video on the technique. Initial thoughts: 1. Excellent exposure. 2. Key is getting under VMO above capsule and marking/tagging layers for anatomical closure of capsule. 3. No question patellar resurfacing a bit more challenging with tilt rather than everting but still easy. 4. Patellar tracking is amazing. 5. Early ROM and less pain impressive. 6. Works well in large knees too….simply blunt dissect more proximal off septum and comb it over I’m hooked!
Dr Kunal Aneja
3mo
Big proponent for subvastus - for sure it’s helping my patients in early recovery
I embraced the subvastus this year and I’m not coming back. I don’t see any drawbacks, the pain control and recovery is better
Lucas Anissian
3mo
How (when) did it get the name Jiffy?
Hip & Knee Joint Replacement Surgeon / Podcast Host x 2 / Proud Private Practice Owner-“Operator” / Healthcare Hospitality Specialist (HHS)
3moI agree! The interest is certainly growing. I get multiple messages each week of people interested in learning what I have named the “Comb-Over” technique. It makes sense and has many theoretical AND proven benefits! No going back for me! I’m embracing the “Comb-Over”!!!! Full speed ahead!!!