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The Insall Legacy
in Total Knee Arthroplasty
Giles R. Scuderi, MD; W. Norman
Scott, MD ; Gregory H. Tchejeyan, MD
From the The Insall Scott Kelly Institute
for Orthopaedics and Sports Medicine, New York, NY.
AND RELATED RESEARCH 2001;2001:3-14
N. Insall was a pioneer in the field of knee surgery.
He was a rare individual who accomplished unparalleled
levels of success as a surgeon, designer, and teacher.
During the past 4 decades, he was instrumental in evolving
total knee arthroplasty to its current state of excellence.
Insall´s impact on orthopaedics is felt by all
who have come in contact with him.
Four decades ago, total knee arthroplasty was in its
infancy and surgeons were seeking alternatives for arthrodesis
and fascial arthroplasties in the treatment of the arthritic
knee. Innovative designers were developing various implants
such as the Polycentric, the ICLH, and the Freeman Swanson
It was then that John N. Insall ( Fig 1 ) became involved
in the design of modern total knee arthroplasty.
Fig 1. John N. Insall, MD (Reprinted
with permission from Brad Hess).
In 1970, at the Hospital for Special Surgery, the Duocondylar
Prosthesis was designed as a modification of the Polycentric
Knee prosthesis. 63 Although
Insall contributed to the design of the Duocondylar
prosthesis, which first was implanted in 1971 and the
subsequent Duopatellar prosthesis ( Fig 2 ), Peter Walker
was the primary bioengineer on this project. Insall
and Walker worked together on total knee implant designs
until the era of the Insall-Burstein Stabilized Knee
Fig 2A-B. (A) The Duopatellar Prosthesis
and (B) the Duocondylar Prosthesis are shown.
These designs were followed by a rapid evolution in
total knee arthroplasty design. 32,44,52
Although others were focused on nonconforming posterior
cruciate-retaining implants or hinged implants, Insall
directed his implant design toward a nonlinked surface
replacement with conforming surfaces. Dissatisfied with
the Duocondylar and Duopatellar prostheses, Insall was
the major clinical investigator in designing the Total
Condylar prosthesis 45,51
( Fig 3 ). This posterior cruciate-sacrificing design
with a conforming articular surface, an anterior femoral
flange, and a dome-shaped patella component became the
first implant of modern design. 2,64
Critical to the success of the arthroplasty was the
surgical technique. He recognized the limitations of
posterior cruciate retention and was convinced that
removal of the cruciate ligaments provided superior
and more reproducible clinical results. Insall recognized
that surgical technique was crucial for the success
of any implant design and simultaneously described the
surgical technique that included ligament releases for
restoring axial alignment and balancing the flexion
and extension spaces.
Fig 3. The Total Condylar prosthesis
was a popular posterior cruciate-sacrificing prosthesis.
In February 1974, Insall implanted the first Total Condylar
prosthesis. By 1976, he implanted more than 300 prostheses.
As his clinical experience in total knee arthroplasty
matured, Insall realized that the successful Total Condylar
prosthesis required improvement and modification. 40,42,47,50,86,87
There were reported cases of flexion instability, which
were most likely errors in surgical technique rather
than implant design. Insall determined that to stabilize
the knee in flexion, the posterior cruciate ligament,
which was resected, would require some type of substitution.
The first design modification was the Total Condylar
Prosthesis II (TCP II) ( Fig 4 ), with its high tibial
post that was designed to be a passive stop against
posterior displacement in flexion. 49
The TCP II was implanted between 1976 and 1977. Its
life was short lived because of early loosening. Not
discouraged by his failure with the TCP II and his desire
to find a posterior cruciate-substituting knee design,
Insall began to work with bioengineer, Albert Burstein.
Together they designed the implant that bears their
names, The Insall-Burstein posterior-stabilized knee
prosthesis (IB I) ( Fig 5 ). The implant was introduced
in 1978 and has been the design against which all future
posterior cruciate-substituting designs will be compared.
43 The IB I was designed
with a dished articular surface and a tibial spinefemoral
cam mechanism that substituted for the resected posterior
cruciate ligament and controlled femoral rollback and
improved the range of motion (ROM). The original IB
I had an all-polyethylene tibial component; however,
laboratory studies revealed that metal-backed tibial
components transmitted the load better to the underlying
bone and potentially reduced the incidence of tibial
component loosening. 4
By November 1980, Insall was exclusively implanting
the IB I prosthesis with a metal-backed tibial component.
The IB I prosthesis had an exemplary history with both
tibial components as shown with its excellent clinical
performance and survivorship data. 9,65,67,72,79
In 1988, the Insall-Burstein Posterior-Stabilized II
prosthesis ( Fig 6 ) was introduced with a modular tibial
tray and the ability to add augments and stem extensions
to the core prosthesis.
Fig 4. The Total Condylar II prosthesis
was designed to have a passive stop against posterior
Fig 5. The Insall Burstein Posterior
Stabilized I Knee prosthesis was designed to substitute
for the posterior cruciate ligament. (Reprinted with
permission from Zimmer, Warsaw, IN).
Fig 6. The Insall Burstein Posterior
Stabilized II Knee prosthesis introduced a modular tibial
tray that would accommodate augments and stem extensions.
(Reprinted with permission from Zimmer, Warsaw, IN).
By this time the concept of posterior cruciate ligament
substitution was well entrenched in prosthetic knee
design. This concept was gaining in popularity and always
generated great debate and controversy at meetings.
Recognized as one of the premier designing knee surgeons,
Insall became the international spokesman for posterior
cruciate substitution. Although others touted the merits
of posterior cruciate retention, Insall responded with
sound scientific information and excellent clinical
reports. The fears of loosening and early failure in
this semiconstrained implant, as announced by the contrarians,
never materialized. Although cruciate-retaining knee
designs changed their articular geometry from a flat-on-flat
design to a more dished design, Insall never significantly
modified the original conformity of his posterior-stabilized
implant. Although surgeons who implanted cruciate-retaining
protheses began to use alternative methods of implant
fixation, Insall always advocated cement fixation. He
was unwavering in these ideas and it now is apparent
that he was correct because many surgeons are embracing
However, Insall was not finished with implant design.
In the mid1990s, Insall improved on the IB II prosthesis
with the introduction of the NexGen Legacy Posterior-Stabilized
Knee Prosthesis (LPS) ( Fig 7 ). This prosthesis is
the direct descendent of the IB II prosthesis and was
designed to improve patellar femoral tracking. The prosthesis,
with more size options, offered an anatomic design with
right and left femoral components, a raised lateral
femoral flange, and a deeper trochlear recess to achieve
optimal knee kinematics. In designing a longer trochlear
groove, the femoral cam was moved more posteriorly on
the femoral condyles, which had a beneficial effect
on the spine cam mechanism. Similar to the IB II prosthesis,
the cam would engage the tibial spine at 70°. However,
instead of riding up the tibial spine, as happens with
the IB II, the LPS cam rides down the tibial spine as
the knee flexes. This increases the jump distance and
provides an inherent safety feature against flexion
instability. Intrigued by the desire to bring total
knee arthroplasty to regions of the world, such as Asia
and the Middle East, where patients require higher degrees
of flexion for their social and religious activities,
Insall designed the LPS-Flex Knee Prosthesis
( Fig 8 ). Coupled with the predictable kinematics of
a posterior-stabilized and augmented posterior femoral
condyles, the LPS-Flex Knee Prosthesis potentially can
revolutionize total knee arthroplasty.
Fig 7. The Legacy Posterior Stabilized
Knee prosthesis is a direct descendent of the IB II
prosthesis. (Reprinted with permission from Zimmer,
Fig 8. The LPS-Flex fixed-bearing prosthesis
was designed to accommodate high degrees of flexion
safely. (Reprinted with permission from Zimmer, Warsaw,
Although fixed-bearing knee designs always had been
Insall´s primary interest, he was open to newer
design concepts that may improve implant durability
and performance. While working on the LPS project, he
also was working on a parallel project with mobile-bearing
knee replacements. 8,33
It was becoming apparent, with reports in the literature
of wear and osteolysis with other implant designs, 92,93
that prosthetic designs may need to increase their surface
area to reduce contact stresses. This could be achieved
by increasing the conformity of the tibiofemoral articulation,
which also meant that a mobile-bearing tray would need
to be designed to diminish any kinematic conflicts.
The outcome of this project was the Mobile Bearing Knee
(MBK) prosthesis, now popular in Europe and Asia ( Fig
9 ). A spin-off of the MBK design is the LPS-Flex Mobile
prosthesis ( Fig 10 ), which is a rotating platform
that is receiving a great deal of attention and excellent
Fig 9. The Mobile Bearing Knee prosthesis
has greater articular conformity with a modular mobile
bearing tray. (Reprinted with permission from Zimmer,
Fig 10. The LPS-Flex mobile bearing
prosthesis is a posterior-stabilized implant with a
rotating tibial platform. (Reprinted with permission
from Zimmer, Warsaw, IN).
During this rapid evolution of knee prosthetic design,
instrumentation often lagged behind implant technology.
The thought that better implant design would lead to
a lower incidence of component loosening and an improvement
in the ROM resulted in greater focus on prosthetic design.
Although it initially was thought that ligamentous laxity
and angular deformity in the arthritic knee could be
compensated for by bone resection, it soon became apparent
that this created the risk of instability and compromised
the clinical outcome. However, Insall realized that
meticulous surgical technique, in particular component
positioning, knee alignment, and soft tissue balancing,
was essential in obtaining a long-lasting total knee
arthroplasty. He described soft tissue releases to correct
fixed angular deformities and to create balanced flexion
and extension gaps ( Fig 11 ). The specific soft tissue
technique for the correction of a varus deformity first
was described in 1976. 45
This publication includes the original description of
the medial release for a fixed varus deformity. Insall
stressed the importance of a subperiosteal release of
the medial collateral ligament, posteromedial capsule,
and the pes anserinus tendon. This soft tissue release
continues to be used today and essentially is unchanged
from Insall´s first description. With almost subliminal
coincidence, Insall´s friend, Michael Freeman,
independently developed a similar philosophy and technique
concerning soft tissue balance in total knee arthroplasty.
However, the valgus knee was a more perplexing problem
and Insall continued to refine and improve his surgical
technique. Between 1976 and 1979, he was doing an outside-in
lateral ligamentous technique, with dissection and isolation
of the peroneal nerve, to correct fixed valgus deformity
( Fig 12 ). However, he was not satisfied with the potential
risk of a peroneal nerve palsy, even though they were
transient, and he began looking for alternative techniques.
82 This led him away
from peroneal nerve dissection and to an allinside technique
in which the lateral supporting structures were stripped
from the lateral femoral condyle. Although this technique
restored proper axial alignment, he occasionally observed
flexion instability. Seeking a more perfect solution
for the fixed valgus deformity Insall used an all-inside
soft tissue release that pie crusted the lateral supporting
structures and preserved the popliteus tendon ( Fig
13 ). Insall thought this was the ideal solution to
a difficult problem. His most recent comments on soft
tissue balancing and the quest for perfection can be
found in the report of Griffin et al. 20
Fig 11. The varus release is shown.
(Reprinted with permission from Insall JN: Total Knee
Replacement. In Insall JN (ed). Surgery of the knee.
New York, Churchill Livingstone 587-696, 1984.)
Fig 12. The complete valgus release
is shown. (Reprinted with permission from Insall JN:
Total Knee Replacement. In Insall JN (ed). Surgery of
the Knee. New York Churchill Livingstone 587-696, 1984.)
Fig 13. The pie crust technique for
correcting a valgus knee is shown.
These soft tissue releases always have been coupled
with the philosophy of equal flexion and extension gaps
( Fig 14 ). Adopting the tensor instrumentation of Freeman
in 1974, Insall embraced the concept of balanced gaps.
In 1976, Insall first coined the terms flexion gap and
extension gap. 45 To
achieve balance between these two gaps, Insall described
the classic method of bone resection and aforementioned
soft tissue releases. He described the use of an alignment
rod and spacer block to achieve the properly balanced
gaps between the femur and tibia. This method of bone
resection introduced the concept of rotational alignment
of the femoral component. To create a symmetric flexion
gap, the femoral component needed to be rotated externally.
In 1988, Insall elaborated on his surgical techniques
and offered solutions to flexion and extension mismatches.
30 Being receptive to
new ideas that had sound scientific support, he developed
instrument systems for improvement in the surgical technique.
Realizing that the tensor was accurate, but not easy
to apply, he began to use intramedullary instruments
in 1986. These instruments resected a fixed amount of
bone from the femur and tibia and relied on soft tissue
balance and femoral component rotation to balance the
gaps. Realizing that the shortfall of this instrument
system was the accuracy of positioning the femoral component
in the proper degree of external rotation, he sought
an improved technique. Enamored by the concept of the
epicondylar axis as the axis of knee flexion, Insall
designed the epicondylar instruments 19,21,62,70
( Fig 15 ).
Fig 14A-B. Spacer blocks are used for
balancing the (A) flexion and (B) extension gaps.
Fig 15. The epicondylar axis is shown.
With the rapid evolution of total knee arthroplasty
design in the 1970s and 1980s, the need for revision
arthroplasty became apparent. 36,58
Insall was instrumental in the design of revision components,
and in the diagnosis and treatment of failed arthroplasty.
In the arena of implant design, he was integral in the
design of the Total Condylar III prosthesis ( Fig 16
). Introduced in 1977, the TCP III was the successor
to the Stabilocondylar prosthesis and was designed as
an alternative to fixed hinges ( Fig 17 ). Historically,
hinged implants, such as the Walldius, Shiers, and GUEPAR
were easy to use because at the time of the arthroplasty
all the ligaments were resected and the stems dictated
the alignment. Unfortunately, reports of long - term
results with these prostheses revealed high rates of
loosening, significant patellar pain and instability,
and high infection rates. 26,53,54
Also, severe bone loss made salvage by arthrodesis difficult.
The Total Condylar Constrained Knee prosthesis (TCP
III) was designed by Insall and colleagues to provide
greater stability and constraint with a nonlinked implant.
The indications for a constrained implant include medial
collateral insufficiency, lateral collateral insufficiency,
inability to balance the flexion and extension gaps,
and severe valgus. The early results with the TCP III
were very encouraging. Donaldson et al 12
reported on the use of the TCP III in complex primary
and revision total knee arthroplasty. The majority of
patients had excellent or good results with this nonlinked
constrained prosthesis. In 1988, the TCP III eventually
became the Insall-Burstein II Constrained Condylar Knee
prosthesis (CCK) ( Fig 18 ) with a full complement of
stem extensions, augments, and wedges. This modular
knee system improved surgical versatility and enabled
surgeons to deal with most intraoperative situations.
This design also would accommodate a posterior-stabilized
or constrained condylar tibial insert. This was the
first complete revision knee system. When Insall designed
the LPS, he also introduced the Legacy CCK (LCCK) system
( Fig 19 ). This revision system included all the modular
features of the IB CCK, but increased the modular options
and stem extensions, including the introduction of offset
Fig 16. The Total Condylar III prosthesis
was introduced as a nonlinked constrained implant.
Fig 17. The Stabilocondylar prosthesis
was one of the first constrained implants.
Fig 18. The IB Constrained Condylar
Knee prosthesis is a modular implant that permits the
addition of femoral and tibial augments and stem extensions.
(Reprinted with permission from Zimmer, Warsaw, IN).
Fig 19. The Legacy CCK prosthesis has
a large assortment of modular options. (Reprinted with
permission from Zimmer, Warsaw, IN).
Implant design is not the only variable that influences
a successful outcome. Paramount to success is the identification
of the cause of failure and then appropriate treatment.
Numerous articles and chapters on the mechanisms of
failure in total knee arthroplasty have been published.
Insall always stated that before considering a revision
total knee arthroplasty, the etiology of failure should
be defined. Revision surgery without a clear reason
may fail to correct the underlying problem. Revision
for infection also is a complex situation, which requires
skill and meticulous technique to restore a functional
Insall et al 49 wrote
the landmark article on the treatment of infected total
knee arthroplasty with a two-stage procedure. The principles
of revision total knee arthroplasty are similar to the
principles of primary surgery. This is evident in a
monograph, coauthored by Insall, which describes a nine-point
grid for achieving appropriate balance in revision total
knee arthroplasty. 84
These complex cases also present with difficulties in
exposure and Insall has been credited with describing
the quadriceps snip, which bears his name 17
( Fig 20 ).
Fig 20. The Insall quadriceps snip
is shown. RF = rectus ferrous; QT = quadriceps tendon;
VM = vastus medians; VL = vastus lateralis.
During more than 30 years of orthopaedic practice, Insall
shared his clinical experiences with the medical community.
Insall and coworkers wrote exhaustive articles on various
conditions that affect the outcome of total knee arthroplasty
such as osteonecrosis, 80
posttraumatic arthritis, 55,94
rheumatoid arthritis, 66
hemophilia, 56 psoriasis,
81 Charcot arthropathy,
77 poliomyelitis, 61
Parkinson´s disease, 85
diabetes mellitus, 14
extraarticular deformities, bone defects, 65
ipsilateral hip fusion, 16
knee ankylosis, 59 chronic
patella dislocation, 7
valgus deformity, 13,82
prior high tibial osteotomy, 89
and obesity. 22 He also
cowrote articles on young active patients 11,78
and patients with bilateral disease who had total knee
replacement. 76 He also
had an interest in deep vein thrombosis and its impact
on the results of total knee arthroplasty. 24,25,73
Recognized by his colleagues as a leader in the field
of total knee arthroplasty, he was elected president
of the Knee Society in 1987. 31
With time, his innovations have been embraced and, most
importantly, his results have been reproducible.
John N. Insall´s contributions
to knee arthroplasty are legendary. He was a rare individual
who accomplished unparalleled levels of success as a
surgeon, designer, and educator. His academic influence
was most powerful on an individual basis for those fortunate
enough to have worked with him. For the entire orthopaedic
community he laboriously worked on his book now in its
third edition. 29,31,33
Although the current authors focus on Insall´s
contributions to the field of total knee arthroplasty,
it is essential to remember that he also was a major
contributor to the areas of osteotomy, 5,6,48,74
anterior cruciate ligament reconstruction, 41
posterior cruciate ligament reconstruction, 39
and patellofemoral disorders. 1,10,28,34,35,38,46
Similar to his life, John N. Insall´s contributions
in perpetuity will manifest his unparalleled influence
on surgery of the knee.
1. Aglietti P, Insall JN, Cerulli G:
Patellar pain and incongruence: I. Measurement of incongruence.
Clin Orthop 176: 217- 224, 1983.
2. Aglietti P, Insall JN, Walker PS,
et al: A new patellar prostheis: Design and application.
Clin Orthop 107: 175- 187, 1975.
3. Bargen JH, Freeman MAR, Swanson
SAV, et al: ICLH (Freeman/Swanson) arthroplasty in the
treatment of arthritic knee: A 2 to 4-year review. Clin
Orthop 120: 65- 75, 1976
4. Bartel DL, Burstein AH, Santavicca
EA, et al: Performance of the tibial component in total
knee arthroplasty. J Bone Joint Surg 64A: 1026- 1033,
5. Bauer GCH, Insall J, Koshino T:
The effect of angular deformity and pain in osteoarthritis.
Arthritis Rheum 12: 279- 284, 1969.
6. Bauer GCH, Insall J, Koshino T:
Tibial osteotomy in gonarthrosis. J Bone Joint Surg
51A: 1545- 1563, 1969.
7. Bullock DD, Scuderi GR, Insall JN:
Management of the chronic irreducible patellar dislocation
in total knee arthroplasty. J Arthroplasty 11: 339-
8. Callaghan JJ, Insall JN, Greenwald
AS, et al: AAOS instructional course lecture: Mobile
bearing knee replacement: Concepts and results. J Bone
Joint Surg 82A: 1020- 1041, 2000.
9. Collizza W, Insall JN, Scuderi GR:
The posterior stabilized total knee prosthesis: Assessment
of polyethylene damage and osteolysis. Ten year minimum
followup. J Bone Joint Surg 77A: 1713- 1720, 1995.
10. Crosby EB, Insall JN: Recurent
dislocation of the patella: Relation of treatment to
osteoarthritis. J Bone Joint Surg 58A: 9- 13, 1976.
11. Diduch DR, Insall JN, Scott WN,
et al: Total knee replacement in young active patients:
Long term followup and functional outcome. J Bone Joint
Surg 79A: 575- 582, 1997.
12. Donaldson III WF, Sculco TP, Insall
JN, et al: Total condylar III knee prosthesis: Long
term followup study. Clin Orthop 226: 21- 28, 1988.
13. Easley ME, Insall JN, Scuderi GR,
et al: Primary constrained condylar knee arthroplasty
for arthritic valgus knee. Clin Orthop 380: 58- 64,
14. England SP, Stern SH, Insall JN,
et al: Total knee arthroplasty in diabetes mellitus.
Clin Orthop 260: 130- 134, 1990.
15. Freeman MAR, Swanson SAVS, Todd
RC: Total replacement of the knee using the Freeman/Swanson
knee prosthesis. Clin Orthop 94: 153- 170, 1973.
16. Garvin KL, Pellicci PM, Windsor
RE, et al: Contralateral total hip arthroplasty or ipsilateral
total knee arthroplasty in patients who have a long
standing fusion of the hip. J Bone Joint Surg 71A: 1355-
17. Garvin K, Scuderi GR, Insall JN:
The evolution of the quadriceps snip. Clin Orthop 321:
131- 137, 1995.
18. Goldman RT, Scuderi GR, Insall
JN: Two stage reimplantation for infected total knee
arthroplasty: Long term results and survivorship analysis.
Clin Orthop 331: 118- 124, 1996.
19. Griffin FM, Insall JN, Scuderi
GR: The posterior condylar angle in osteoarthritic knees.
J Arthroplasty 13: 812- 817, 1998.
20. Griffin FM, Insall JN, Scuderi
GR: Accuracy of soft tissue balancing in total knee
arthroplasty. J Arthroplasty 15: 970- 973, 2000.
21. Griffin FM, Math K, Scuderi GR,
et al: Anatomy of the epicondyles of the distal femur:
MRI analysis of normal knees. J Arthroplasty 15: 354-
22. Griffin FM, Scuderi GR, Insall
JN, et al: Total knee arthroplasty in patients who are
obese with 10 year followup. Clin Orthop 356: 28- 33,
23. Gunston FH: Polycentric knee arthroplasty:
Prosthetic simulation of normal knee movement. J Bone
Joint Surg 53B: 272- 277, 1971.
24. Haas SB, Scuderi G, Insall JN,
et al: Pneumatic sequential compression boots versus
aspirin for prophylaxis of deep vein thrombosis following
total knee arthroplasty. J Bone Joint Surg 72A: 27-
25. Haas SB, Tribus CB, Insall JN:
The significance of calf thrombi after total knee arthroplasty.
J Bone Joint Surg 74B: 799- 802, 1992.
26. Hui FC, Fitzgerald Jr RH: Hinged
knee arthroplasty. J Bone Joint Surg 62A: 513- 519,
27. Insall J: A midline approach to
the knee. J Bone Joint Surg 53A: 1584- 1586, 1971.
28. Insall JN: Current concepts review:
Patellar pain. J Bone Joint Surg 64A: 147- 151, 1982.
29. Insall JN: Total Knee Replacement.
In Insall JN (ed). Surgery of the Knee. Ed 1. New York,
Churchill Livingstone 587- 696, 1984.
30. Insall JN: Presidential address
to the Knee Society: Choices and compromises in total
knee arthroplasty. Clin Orthop 226: 43- 48, 1988.
31. Insall JN: Historical Development,
Classification and Characteristics of Knee Prostheses.
In Insall JN, Windsor RE, Scott WN, Kelly MA, Aglietti
P (eds). Surgery of the Knee. Ed 2. New York, Churchill
Livingstone 677- 718, 1993.
32. Insall JN, Aglietti P: A five to
seven year followup of unicondylar arthroplasty. J Bone
Joint Surg 62A: 1329- 1337, 1980
33. Insall JN, Aglietti P, Baldini
A, et al: Meniscal Bearing Knee Replacement. In Insall
JN, Scott WN (eds). Surgery of the Knee. Ed 3. New York,
Churchill Livingstone 1717- 1738, 2001.
34. Insall JN, Aglietti P, Tria AJ:
Patellar pain and incongruence: II Clinical application.
Clin Orthop 176: 225- 232, 1983
35. Insall JN, Bullough PG, Burstein
AH: Proximal tube realignment of the patella for chondromalacia
patellae. Clin Orthop 144: 63- 69, 1979.
36. Insall JN, Dethmers DA: Revision
of total knee arthroplasty. Clin Orthop 170: 123- 130,
37. Insall JN, Dorr LD, Scott RD, et
al: Rationale of the Knee Society clinical rating system.
Clin Orthop 248: 13- 14, 1989.
38. Insall JN, Falvo KA, Wise DW: Chondromalacia
patellae: A prospective study. J Bone Joint Surg 58A:
1- 8, 1976.
39. Insall JN, Hood RW: Bone block
transfer of the medial head of the gastrocnemius for
posterior cruciate insufficiency. J Bone Joint Surg
64A: 691- 699, 1982.
40. Insall JN, Hood RW, Flawn LB, et
al: The total condylar knee prosthesis in gonarthrosis:
A five to nine year followup of the first one hundred
consecutive cases. J Bone Joint Surg 65A: 619- 628,
41. Insall JN, Joseph DM, Aglietti
P, et al: Bone block iliotibial band transfer for anterior
cruciate insufficiency. J Bone Joint Surg 63A: 560-
42. Insall JN, Kelly MA: The total
condylar prosthesis. Clin Orthop 205: 43- 48, 1985.
43. Insall, JN, Lachiewicz PF, Burstein
AH: The posterior stabilized condylar prosthesis: A
modification of the total condylar design. J Bone Joint
Surg 64A: 1317- 1323, 1982.
44. Insall JN, Ranawat CS, Aglietti
P: A comparison of four models of total knee replacement
prostheses. J Bone Joint Surg 58A: 754- 765, 1976.
45. Insall JN, Ranawat CS, Scott WN,
et al: Total condylar knee replacement: Preliminary
report. Clin Orthop 120: 149- 154, 1976.
46. Insall JN, Salvati E: Patellar
position in the normal knee joint. Radiology 101: 101-
47. Insall JN, Scott WN, Ranawat CS:
The total condylar prosthesis: A report of two hundred
and twenty cases. J Bone Joint Surg 61A: 173- 180, 1979.
48. Insall JN, Shoji H, Mayer V: High
tibial osteotomy: A five year evaluation. J Bone Joint
Surg 56A: 1397- 1405, 1974.
49. Insall JN, Thompson FM, Brause
BD: Two stage reimplantation for the salvage of infected
total knee arthroplasty. J Bone Joint Surg 65A: 1087-
50. Insall JN, Tria AJ: The total condylar
prosthesis type II. Orthop Trans 3: 300- 301, 1979.
51. Insall JN, Tria AJ, Scott WN: The
total condylar knee prosthesis: The first five years.
Clin Orthop 145: 68- 77, 1979.
52. Insall JN, Walker PS: Unicondylar
knee replacement. Clin Orthop 120: 83- 85, 1976.
53. Jones E, Insall JN, Inglis AE,
et al: GUEPAR knee arthroplasty: Results and late complications.
Clin Orthop 140: 145- 152, 1979.
54. Jones GB: Arthroplasty of the knee
by the Walldius prosthesis. J Bone Joint Surg 50B: 505-
55. Kress K, Scuderi GR, Windsor RE,
et al: Treatment of nonunions about the knee utilizing
custom knee replacement with press fit intramedullary
stems. J Arthroplasty 8: 49- 55, 1993.
56. Lachiewicz PF, Inglis AE, Insall
JN, et al: Total knee arthroplasty in hemophilia. J
Bone Joint Surg 67A: 1361- 1366, 1985.
57. Lucey SD, Scuderi GR, Kelly MA,
et al: A practical approach to dealing with bone loss
in revision total knee arthroplasty. Orthopedics 23:
1036- 1041, 2000.
58. Merkow, RL, Soudry M, Insall JN:
Patellar dislocation following total knee replacement.
J Bone Joint Surg 67A: 1321- 1327, 1985.
59. Montgomery WH, Insall JN, Haas
SB, et al: Primary total knee arthroplasty in stiff
and ankylosed knees. Am J Knee Surg 11: 20- 23, 1998.
60. Pagnano, MW, Scuderi GR, Insall
JN: Patellar component resection in revision and reimplantation
total knee arthroplasty. Clin Orthop 356: 134- 138,
61. Patterson BM, Insall JN: Surgical
management of gonarthrosis in patients with poliomyelitis.
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65. Scuderi G, Haas SB, Windsor RE,
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66. Scuderi G, Insall JN: Knee surgery
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74. Shoji H, Insall J: High tibial
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75. Sisto DJ, Lachiewicz PF, Insall
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81. Stern SH, Insall JN, Windsor RE,
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82. Stern, SH, Moeckel BH, Insall JN:
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requests to Giles R. Scuderi, MD, Insall Scott Kelly
Institute, 170 East End Avenue, New York, NY 10128.
Clin Orthop 2001 November;2001(392):3-14 Copyright ©
2001 Lippincott Williams & Wilkins All rights
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