TrueKnee Resurfacing · Clinical framework
Restore. Verify. Learn.
An anatomical objective, a record of its execution, and outcomes that test the result.
Program development
This framework describes the proposed verification and review program. It is not a completed certification system or evidence that every listed surgeon has undergone these assessments. Current application commitments remain available separately.
Current participation criteriaPractice implementationParticipation and program statusThe clinical foundation
TrueKnee Resurfacing is grounded in Stephen Howell’s unrestricted kinematic alignment: using the patient’s pre-arthritic joint lines as the reconstruction target, with measured resections and verification while seeking to preserve healthy ligament relationships.
“Unrestricted” refers to the absence of predetermined mechanical-alignment boundaries. It does not remove clinical judgment, implant constraints or the need to manage compromised anatomy.
One objective. Explicit methods and exceptions.
The program must distinguish required principles from permitted instruments, exposures and implant-specific workflows. Different methods should demonstrate the same required checks; their equivalence must not be assumed.
Preserving healthy soft tissues is an objective. Necessary intraoperative changes should be documented and reviewed. Patient care takes priority over adherence to a brand description.
Major bone loss, ligament deficiency, uncertain references and prior reconstruction require an explicit exception pathway. Technical tolerances, eligible case types and implant-specific protocols require clinical leadership review before adoption.
The proposed operative record
Establish the reference
Identify preserved surfaces, estimate pre-arthritic joint lines, and record uncertainty from wear, deformity or prior surgery.
Account for tissue and instruments
Document cartilage and bone loss assumptions, saw kerf and component thickness. Define how these inform the planned resections.
Verify the femur
Record intended and measured resections, corrections and final checks. Distinguish cut accuracy from accuracy in reconstructing the original anatomy.
Verify the tibia
Record reference selection, intended joint-line level, orientation, slope and rotation. Explain how the plan and intraoperative findings agree or differ.
Assess soft tissues and trialing
Record ligament status, stability through motion, extension and flexion, and patellofemoral evaluation. Document adjustments and their rationale.
Record the final reconstruction
Retain implant details, the operative record and appropriate imaging. Record departures from the plan and arrange follow-up.
This is a documentation framework, not step-by-step operative instruction. Imaging and planning tools support the surgeon’s assessment; they do not establish the original anatomy without interpretation.
Demonstrate competence. Prepare the practice.
- Application: verify credentials, relevant experience and current participation commitments.
- Education and assessment: assess anatomical reasoning, reference selection and verification.
- Initial case review: review operative records, appropriate imaging, deviations and outcomes before broader activation.
- Practice readiness: confirm a named Navigator and backup, clinical escalation, service hours, records transfer and follow-up ownership.
- Ongoing review: review consecutive cases, complications and data completeness; define remediation and renewal.
These assessment stages are proposed. Thresholds, reviewers and activation authority must be established before they are represented as completed credentials.
Measure what matters
The proposed outcomes program pairs operative fidelity with patient experience: KOOS JR, a validated knee-function measure, pain, satisfaction, complications, reoperations and revision. A recovery check-in score is separate from a validated outcome instrument.
Collect consecutive eligible cases across surgeons. Report follow-up denominators and missing data. Comparative research needs a prespecified protocol, appropriate oversight and a suitable comparator; good cohort results alone do not prove superiority.
Research status and participationCare, coordination and research
The surgeon owns clinical decisions and follow-up. Voyage supports coordination and education within the agreed service scope. The Institute supports education and research development. Clinical care, additional service enrollment and research authorization must remain distinguishable.
A clinical lead must own protocol revisions and exceptions. A practice lead must own service readiness. An outcomes lead must own data definitions and reporting. These responsibilities need named owners before activation.