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NanoNeedle™ Scope 2.0
Gains National Spotlight Through

Star MLB
Pitcher's Recovery

J. Lee Pace, MD (Plano, TX), demonstrates a technique for medial patellofemoral ligament (MPFL) reconstruction using onlay patellar fixation with Hybrid Knee FiberTak® anchors and femoral fixation with the FiberTag® TightRope® II PF implant.

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Patellar Onlay Technique With Suspensory Femoral Fixation for MPFL Reconstruction

Hello, my name is Lee pace from Plano, Texas. I am an orthopedic surgeon with a specialty in sports medicine and knee surgery, and I'm here today to show the new Mpfl reconstruction technique using a patellar inlay technique as well as a new mpfl fiber tag tightrope for femoral fixation. So we have a graft here on this disposable graft prep and sizing table. And this is really nice when you're using autograft tissue because you can use this as we're going to show here to scrape muscle off just like this. This stuff just comes right off. Just like that. You can see you can really very easily get all that muscle off of a tendon when you're doing your mpfl reconstruction. So here we have a prepared gracilis graft for an mpfl reconstruction. We want to make sure that this portion of the graft is going to fit through a six millimeter femoral tunnel. So we're going to size that right now. So we're just going to bring this through here and pull this up. And there you can see that that fits very easily through that. We can probably pull that all the way through just like that. So we have a good graft size here. And then another thing to highlight on this graft prep table is at any point during graft prep, if you if you need to or want to, you can actually use these cleats to be able to hold the graft steady and add some tension. So I can just wrap this around here just like this. And now this one side of the graft is is going to be held stationary just like that. And then also if I want to I can also do the same thing on the other side as there's cleats on both sides of this graph prep table. So we've done a standard medial two incision approach for an mpfl reconstruction. Here is our femoral incision right here. That's typically going to be made under fluoroscopic control. Here is our patellar incision. And you can see we've got the medial aspect of the patella exposed. There's a medial patella. There's the joint right there. You can see I've marked out our anchor placement. This is about midway on the patella. And this is about 25% down from the superior pole. So we're going to place an anchor here and here. And then we're going to do an on lay technique to secure the graft between these two anchors. So here is the knee fiber tack ratcheting guide that we're going to use to drill our patellar sockets as well as place our anchors. So you can see this has a ratcheting mechanism with a release mechanism right there. And it's got a spike on one side. And that is meant to anchor in to one side. You can do this percutaneously and just kind of stab through the skin. Or if you would like to, you can also get an idea of where you want to put it. And you can make a small stab incision like this. So usually you want to start and get the lateral side in first. So I'm going to get this down. I can feel very firmly that I am on the lateral aspect of the patella. And then this just simply ratchets down. And I'm going to put this right over my purple mark. So I've got the ratcheting fiber tack guide in place. You can see that it's secured against the lateral patella and the medial patella. So I can kind of move the patella back and forth like this. This is very secure. This will allow very reproducible socket drilling as well as anchor placement. This is just going to bottom out. And then this fiber tack has a blunt inserter to allow for easier insertion on the mobile patella. Take this off. Move this. And then the anchor is in. And now I'm going to set it. So I'm going to pull. And you can see that that is very firmly in place. That is not coming out. Okay. So then I can place the second one. So I'm going to just kind of put it over the spot where I want to put the second anchor. I'll take a second. I'll make sure that that gets right down on the patella. That's very firmly on the patella right there on the lateral patella. We're going to come in here and we're going to just retract that up just a little bit. So I can see where that second mark is. And that looks good right there. Ratchet that down again. You can see very firm control of the patella right there 2.8mm hard bone drill. Bottom it out. And then look at that. Look at how much that actually inserts just with hand pressure. Finish it off with the mallet. And now we'll set this anchor. And again that is firm in there that is not pulling out. Okay. We're going to drill and prepare the femoral tunnel next. This is the Radiolucent Fluoroscopic guide for Shuttles Point which you can use at this point with lateral fluoroscopy. We've already determined where we want our femoral socket to be. So we're going to then take our Beath pin our spade tip Beath pin. And we're going to drill this across the femur. That's just going to poke out the skin of the lateral thigh. So now we can take our low profile six millimeter reamer. And we'll take that over the Beath pin. And you can honestly just take this to the next cortex and don't violate that. But that way you've got all the room you need in case your graft is a little long. And then from there we can switch this out to a fiber snare. And then we can just luggage tag this for later. Okay. Now we're going to fix our allograft on the patella. We've made a mark here at the midway of the graft like so. The first thing we're going to do is we're going to shuttle it through these two loops. Okay. And then we can just start tensioning this down. And we just take it each one at a time. And we're just going to make sure that as we get close that we keep that midpoint in between these two loops. And as we bring it down, you can see we've got our purple midway point basically perfectly between those two. And so we can just continue to cinch that down and cinch that down like that. And so we've got very good fixation now of that gracilis graft right on our medial patella. And you can see I can pull very firmly on that. And those anchors are not coming out. We've got very good onlay fixation of that graft on the patella. Now the next step, we're going to take a little measurement of how much gracilis graft we still have. You see if I can drag it down here that it is definitely going to be long enough. The question is, is it too long? The answer is probably not, because we have such a long femoral socket. But if we want to take an extra measure of precaution, we can measure how much length we have here. And you can see that we've got almost 9cm or 90mm of length. And we know that the mpfl is roughly about, on average, 65mm long. So if we want to, we could actually shorten this graph down. Maybe a centimeter, centimeter and a half. And we know that we're still going to get probably, you know, 15, 10 to 15mm of graft inside the femoral socket. So once we've kind of made that determination, if we do want to shorten it or if we're happy with what we've got, we can then remove our graph prep sutures and we can apply our fiber tag tightrope. So next we are going to fix this new mpfl fiber tag tightrope to the free ends of this gracilis graft. Okay, so the thing to point out is that this fiber tag is slightly smaller than what you would use for an ACL. So this is designed specifically for an mpfl reconstruction. And so what we do is we take this off of this backer card just like this. This will unroll. And this comes off. And now we've got this. And this is going to be very similar to an ACL reconstruction. So I'll take the tenaculum clamp next. And so this works just like it would for an ACL is we're going to take keep this little slot on top right there. Keep that little slot on top. This is going to feed into that. So we have the fiber tag now snared through the superior jaw of the tenaculum. And then once we have that then we can get the graft and we can pinch it all down together just like that. Okay. And then from there, it's just a basic suturing exercise. And now once we've got this, take the tenaculum clamp off, and then we can just simply just remove this just like that. And now we have our loop and we have our pull stitch, and we have our tightening sutures right here you can see that this loop is a little short. So we are going to lengthen it to make sure we have enough to get across the distal femur. So that should be we just even this out a little bit. That should be enough to to get us across the distal femur. The last thing to point out is that this is like the original tightrope, in that the tensioning sutures are actually going to be back here, and we're going to tension through the medial side. It's not going to be like an HT tightrope where we're tensioning on the lateral side. Now as we get ready to pass we can go ahead and we can cut these sutures right here. Now we're going to dissect out the plane between layers two and three, so that we can pass the graft from the patellar side down to the femoral side and then shuttle it into the femoral tunnel. So just dissect down like this. And I often will just get my my finger in here and just make sure that I can feel my scissors. I also want to make sure I do not cut my suture and I am. So now we're going to take a snare, bring that up, and then we're going to take all of our suture. Fold it over. Pull it down just like that. Okay. And now what we're going to do is we're going to take our blue sutures only. To pass the graft into the femoral tunnel. Okay. And now we can pull that through. Let me take this. And I'm just going to hold a little bit of back tension here. Okay. Go ahead and pull the button through. And you can do this with fluoroscopy in a live situation to make sure your button flips properly. But it feels like we just got the button through. So I'm going to just kind of pull back. And again we can usually check this with fluoroscopy, but it feels like the button is flipped because I am pulling back on the graft and I'm not getting anything to come back on me. Now we are just going to tighten the adjustable loop of our tightrope. So I like to have an assistant hold this. And we'll just shuttle this down until we're close. And I'll usually stop there. And then we'll bring it up through the under the patellar side of things. And this is my check rein to make sure that I don't over tension it. So I've got the knee flexed roughly 4550 degrees. That way, the patella is solidly engaged in the central to distal trochlea. So I know it's exactly where I want it to be. And now this is going to prevent me from over tensioning the tightrope. So if we look you can watch the graft tension over the clamp. Just like that. And once you feel like you've got some resistance there. Again, this prevents this allows you that one quadrant of translation. Once you've got a little bit of residual slack, you can then take it out. And then you can check your translation. So you can see here that I've got still about a quadrant of lateral patellar translation. So that's going to be pretty perfect. That's exactly what we want. So this is our way with this clamp to minimize the chance of over tensioning. It makes the tightrope technique very reliable. Now, typically what I would do at this point is I would take the knee through a range of motion, and I would confirm that there was no increased tension on the graft in deep knee flexion. And if that is confirmed, we can then proceed with cutting these sutures. We can remove the blue pull stitch. And now we can use these sutures to close our retinaculum. This is a 1.3mm suture tape. And as you can see this is all one long suture with a needle on either end. So we can come through the retinaculum here. So you can see the final retinacular closure here is complete. We've got good knots placed here and that is completely closed down.

Patellar Onlay Technique With Suspensory Femoral Fixation for MPFL Reconstruction

The ACP Max™ system provides efficient concentration of platelets and growth factors from platelet-rich plasma (PRP) for use at the patient’s point of care. Expanding on the previous generation of PRP devices, the ACP Max system allows for a larger blood draw and provides increased platelet concentration using a unique double-syringe, double-spin design.

The ACP Max™ system provides efficient concentration of platelets and growth factors from platelet-rich plasma (PRP) for use at the patient’s point of care. Expanding on the previous generation of PRP devices, the ACP Max system allows for a larger blood draw and provides increased platelet concentration using a unique double-syringe, double-spin design.&nbsp;

ACP Max™ Platelet-Rich Plasma System

ACP Max™ Platelet-Rich Plasma System

Designed to provide anatomic contour with precise instrumentation, the Arthrex Proximal Tibial Plating System features 4 unique plate styles, equipped with advanced variable-angle locking capabilities and KreuLock™ locking compression screws, to optimize treatment of proximal tibial fractures.

Arthrex Variable-Angle Proximal Tibial Plating System

Arthrex Variable-Angle Proximal Tibial Plating System

This video discusses the decision-making process and surgical management options for the treatment of adhesive capsulitis.

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Adhesive Capsulitis: General Surgical Considerations

OrthoPedia: Adhesive Capsulitis: General Surgical Considerations

Gautam Yagnik, MD (Miami, FL), demonstrates a distal biceps tendon repair using the TensionTight™ button.

Distal Biceps Tendon Repair Using the TensionTight™ Button

This is Doctor Janik from Miami, Florida. Today we're going to do a distal biceps tendon repair using the tension tight button to orient you. We have a right elbow. This is proximal. This is distal. This is the radial side and the owner's side. We've marked out the antecubital fossa. And I typically make a transverse incision centered over the radial tuberosity, generally about three centimetres distal to the antecubital fossa. I have the tension tight button that comes preloaded on the inserter with our suture passer. We have our tension tight suture, a Keith needle, our spade tip drill, our appropriately sized reamer, and our seven by ten millimeter biocomposite interference screw. So once we've identified our biceps tendon, I'll get control of the tendon with an Allis clamp. And we're going to go ahead now and whipstitch the tendon using our suture here that's specially designed for the tension type button. And we've brought on our Keith Needle. Go ahead and bring our loop suture through. And you can pass it anywhere between 3 and 6 throws typically allow us to capture the tendon for our final throw. We're going to go just behind our first suture here and lock the suture into place. There we can go ahead and do our final tensioning. And we have really nice control of the distal biceps tendon here. All right. So with some of this excess tendon trimmed off we'll take our sizing guide. And we will size our tendon. And an eight millimeter socket which is pretty typical tends to be the right. So it does not fit through a seven. It goes easy through an eight. So we're going to drill an eight millimeter socket. We're going to go ahead now and load our suture into our tension type button which we've brought onto the field. You can see that it's preloaded on the Inserter with the suture passer already passed through the locking jaw. So we'll go ahead now and pass this suture. And the suture passer helps us to orient the button in the correct orientation and have the sutures passing in the correct orientation through the locking jaw. So you can see the locking jaw right here. So it can pass very easily in one direction but it will not pass backwards. So once we get the suture initially through the button there is a little thicker part of the suture. This little swedge that's coming into our field right here. So we'll go ahead and make sure that we can pass the suture through the button here, getting this little thicker swedge part through the button. And we'll also get a pull just a little more suture through. So we have both ends of the suture coming through the butt. And if we pull perpendicular to the button makes it a lot easier to pass it through the button. So once we get our button set, we're going to go ahead and clamp it here and turn our attention towards exposing the radial tuberosity. So we'll go ahead and identify the center of the radial tuberosity. And I'll kind of if I want to confirm this with fluoroscopy I can go ahead and place this pin. I want to place it by cortically. And once I pass through the second cortex I will stop there. You can use fluoroscopy here. If there's any question I encourage you to do that just to confirm that you're in an anatomic position. So once we've placed our spade tip guide pin, we're going to take our appropriately sized reamer. In this case it's an eight millimetres reamer. And it's cannulated reamer. So it goes right over our spade tip. And then. This will be a unicortical eight millimeter socket. I think it's important at this point to irrigate and remove any bone fragments in order to minimize the risk of heterotopic bone formation. And now we're ready to place our tension type button. So we're ready now to insert the tension type button. I brought this onto the field. It's important to get the orientation correct. We want the locking jaw to be facing up against the the far cortex. And to help us orient, there's a black line on the inserter. So we want this orientation. We want the button to be facing towards the ceiling here. So we'll keep this orientation. So this is the correct orientation. We do not want it going down like this. So we want it coming up like this with the black line facing up. So we're going to go ahead now and insert this into our socket. And then once I get it seated this button is slightly bigger than a traditional tension slide button. So once I get it in the opening I'll go ahead and gently feed it down into the hole, and then I'll give it some gentle taps just until I feel the button get through the cortex. So once I feel it, the button past the far cortex, I'll go ahead and unscrew the back of the inserter, remove the inserter from the field, and then I'll flip the button. So once my button has passed and flipped on the far cortex, I'm able to ensure that it's flipped here by just gently pulling up on these sutures and you can see my tendon starting to advance towards my tunnel. So I'm going to stop here. And just to confirm that my button is flipped on the far cortex, I'm going to get a lateral radiograph here. Here you can see our AP and lateral radiograph confirming excellent position on the button as it rests flat on the far cortex. As we demonstrate here on the live flora we have a very nice position of both our tunnel and our button. So I'll pull tension now on the sutures and advance the tendon to just to the opening of our socket. And at this point, in order to help Facilitate getting our tendon into the socket, we're going to flex the elbow. So we're pulling in perpendicular to our button. And our tendon is going in line and straight and dunking into the socket. So I'm going to go ahead now and do my final tensioning. And as I do this I can go ahead and really seat the entire tendon into the socket here. So sometimes you can help it with a freer. And then you go ahead and then I will also another pearl would be to take each of these sutures and tension them individually, just to make sure you get all the slack out of the system. So at this point, you can see that we have our tendon really well positioned and placed into the to the socket. It's filling the entire tunnel. I can run my freer down. If you would choose not to use a screw at this point, you can cut the sutures and you're done. If you would like to use a screw to either the tendon or further compress the tendon in the tunnel. You can go ahead and do that now. Go ahead and remove your screw. Take a knife here to cut our suture. We have removed our inserter, and you can see that we have our seven by ten millimeter biocomposite interference screw here placed adjacent to the tendon. We have excellent compression of the tendon within the socket. We have easily ten millimeter of tendon in our socket. We have excellent tension here. It's well fixed to the radial tuberosity. And at this point we've completed the procedure. We'll remove our retractors. I like to drop the tourniquet at this point make sure I have excellent hemostasis. And then we'll place this patient into a well-padded dressing. And I like to place the patients into a splint with the arm at 90 degrees of flexion and a neutral wrist rotation for approximately one week.

Distal Biceps Tendon Repair Using the TensionTight™ Button

Seth I. Gasser, MD (Tampa, FL), shares his firsthand experience with the Synergy Power™ system—highlighting how it streamlines workflow within a facility and why it is his preferred powered instrument solution in the OR.

Dr. Seth I. Gasser Surgeon Testimonial: Synergy Power™ System

Speaker  Energy. Power has really changed the way our team works and functions. It's streamlined the work process, including setup times and surgical times with just two hand pieces. It covers our broad range of needs throughout any procedure. It's reliable. Powerful. Versatile. The frequent changes required often during surgery are quick and easy, with a unique design of the hand pieces. It's very easy for the scrub tech to make a quick change. I don't worry about them having difficulty, and my focus is really on the surgery and the patient because I'm confident that the equipment will work as it's supposed to. It provides a balance of comfort and performance. It has a lighter feel. And it's the kind of comfort that really adds up over the course of long, difficult cases. Arthrex has been a leader and innovator as long as I've been in practice over the past 33 years. They've answered all of our questions, guided our setups, trained the staff, and really made sure everything ran smoothly before we started. And this is just another example of how Arthrex has made it easier for me as a surgeon to treat my patients better.

Dr. Seth I. Gasser Surgeon Testimonial: Synergy Power™ System

John Munz, MD (Houston, TX) shares the unique features and benefits of each VA proximal tibia plate, noting how the design, instrumentation, and fixation options are game-changing for treating proximal tibial fractures.

A Deep Dive Into the Variable Angle (VA) Proximal Tibia Plates

Speaker  Proximal tibia fractures are challenging injuries, whether from high energy trauma or low impact falls. Anatomical joint reduction and restoration of alignment and stability are critical, which is why precision and fixation is key. These fractures demand versatility. To truly address these complex fracture patterns, we need implants and tools that are as adaptable as the anatomy itself. Let's start with the lateral plate. There are a number of things that make this plate unique. First, the overall contour. It's designed to match the natural curvature of the tibia in both the coronal as well as sagittal planes. When I place this plate on bone, it feels like it belongs there. The oblong holes are especially helpful. They give me the ability to fine tune the plate's position before final fixation. Approximately. The plate has cutouts that facilitate meniscal or capsular repair, and the holes for provisional wire fixation. They're placed exactly where I need them. The slope and contour of the plate, approximately, is subtle but important. It helps minimize prominence over gerdy's tubercle, which is a common issue with other plates. That lower profile makes closure easier and reduces soft tissue irritation. Post-op, we've struggled for years with plates that don't fit well proximally. This one solves that. It's anatomical, low profile, and it's user friendly. That's the kind of design that changes your workflow. Speaker  Now the high lateral plate takes things a further step. One of the biggest challenges with current implants is getting proximal enough to support the articular reduction. Often we've had to place a separate rim plate just to get that proximal for fixation. This plate eliminates that need. The proximal row of 2.7mm screws is perfectly positioned to hug the subchondral bone. That means I can incorporate rafting screws directly into my dominant plate. That's a huge advantage. It simplifies the construct, reduces surgical time, and improves fracture fixation. The direct medial plate is another thoughtful design with 6 to 14 hole options for high energy bicondylar fractures. I need subchondral support medially as well. This plate allows me to place 2.7mm screws proximally in a very subchondral location. The curvature of the plate also facilitates easy passage distally to match the tibial morphology. The direct medial plate also includes recessed areas and holes for suture placement. Whether I'm repairing the MCL or the Pez anserinus, that kind of integration saves me time and gives me more confidence in soft tissue management and the footprint of the plate. It's ideal for schatzker v fractures. It fits right at the apex of the fracture exit, which is exactly where I need support. Finally, the posterior medial plate. Speaker  This one's all about contour ability. The area at the neck of the plate was constructed to be malleable. That allows me to buttress coronal plane fracture exits more effectively. The oblong hole placement is also strategic. This hole allows for fine tuned adjustments in plate location for maximal buttressing fixation, exactly where the fracture requires. Let's talk about screws. It's one of those things that seems simple. Until you're in the O.R. and you need exactly the right length. Screw links increase by two millimeter increments all the way up to 80mm. That's rare. Most systems jump five millimeter increments after 50, which can leave you guessing or compromising. And if you need more screw length, the system goes all the way up to 95mm. So no, we don't do short screws here. As for screw types, the system includes cortical screws, cancellous screws, variable angle locking screws, and crew lock variable angle locking screws. The crew lock screws are especially helpful. They allow for interoperative compression across fracture sites as you insert them. That means I can compress and lock in one step, and because their variable angle, I can direct them exactly where I need. Avoiding joint penetration and optimizing fixation instrumentation is one of those things that can either streamline your case or slow you down. What I appreciate about this system is how intuitive it is. Speaker  Starting with the color coding, 2.7mm instrumentation is red and purple, 3.5mm is yellow and teal. It's simple, it's clean, and it makes life easier for the entire O.R. team, especially your techs who now don't have to play the guessing game with drill guides, drill bits, and screwdrivers. Everything in this system is calibrated off the drill bits that can save time and reduces error. The option for manual length assessment is also provided with easy to use depth gauges. And what about for percutaneous screw insertion? The percutaneous instrumentation is a game changer. It's efficient, it's accurate, and it keeps the procedure minimally invasive, which helps reduce soft tissue disruption. The ability to place a triple sleeved guide that fits into the plate and then drill, measure and fill without hassle is very unique among systems currently available. In patients with robust soft tissues, this can minimize surgical dissection and prevent intraoperative struggle. From plate design to screw versatility to streamlined instrumentation. This system is engineered for the realities of surgery. Every element reflects the expertise of surgeons who have encountered these challenges firsthand. These are not just tools. They're purpose built solutions designed with precision and insight to support performance in the O.R., where thoughtful design truly matters.

A Deep Dive Into the Variable Angle (VA) Proximal Tibia Plates

The consolidated trays for the Univers Revers™ total shoulder system are designed to provide a cost-saving solution that preserves patient-specific optimization and enhanced operative workflow.

Univers Revers™ Total Shoulder System: Maintaining Global Patient Parameters With Fewer Trays

Speaker  Shoulder arthroplasty is evolving and so are we at Arthrex. We're giving surgeons a streamlined path to surgical excellence. Fewer trays with the same versatility you've come to expect. All to help you treat your patients better. The result? A dramatic reduction in O.R. waste and significant cost savings without compromising implant modularity or patient optimization. Our new consolidated system lets you perform a standard reverse case with just two trays and an augmented glenoid with only three trays, saving you space and streamlining your workflow, all while continuing to use the implants you're familiar with. Backed by over a decade of clinical data. Fewer trays. Same implant options. More efficiency.

Univers Revers™ Total Shoulder System: Maintaining Global Patient Parameters With Fewer Trays

DynaNite® CT nitinol staples deliver active compression for secure sternal closure, applying proven orthopedic fixation principles to cardiothoracic surgery. With two low- profile staple size options, the system offers flexibility to accommodate patient anatomy and surgical technique. Engineered to ensure consistent sternal stability throughout postoperative recovery, DynaNite CT staples work in combination with FiberTape® cerclage to deliver a comprehensive solution for sternotomy repair.

DynaNite® CT for Sternotomy Closure

Low profile Superelastic dynamite CT. Nitinol staples are available in two sizes, designed to accommodate a range of patient anatomies before closure. Measure the thickness of each sternal have to ensure secure fixation without compromising the posterior cortex. Choose a staple that is at least two millimetres less than the thickness of the sternum. With fibertape sternal closure completed, the dynamite drill guide is then positioned centered and perpendicular, setting the stage for precise implantation. The dynamite CT system features a specialized positive stop drill bit designed to safely drill into the sternum, preventing overpenetration to protect underlying tissues using the loading device. The dynamite staple legs are adjusted to match the width of the drill guide. The staple leg should be in parallel or near parallel position to facilitate compression of the sternotomy once inserted. Once seated, the device is released, allowing the nitinol to return to its original shape, delivering targeted active compression to the sternal body. A tamp ensures the staple is fully seated. Additional staples can be placed as needed as an adjunct to fibertape sternal closure. A minimum of two staples is recommended to optimize fixation and enhance resistance to lateral distraction of a median sternotomy. Dynamite CT, nitinol staples and the Fibertape sternal closure system deliver the strength, compression, and flexibility needed to optimally personalize sternal closure for every patient.

DynaNite® CT for Sternotomy Closure

The QuickPass™ FiberTape® Cerclage System features cannulated, slotted passers that allow simplified passage of FiberTape Cerclage suture around bone for fracture management. The QuickPass tube on the FiberTape Cerclage suture facilitates quick insertion through the cannulated hook, and the suture is removed from the slot to complete a wrap around the bone without the need for a separate shuttle suture.

QuickPass™ FiberTape® Cerclage System

Speaker  The Quick Pass Fibertape Cerclage system features Cannulated slotted parsers that allow simplified passage of Fibertape Cerclage sutures around bone for fracture management. A variety of hook sizes and geometries are available depending on the fracture site and surgical approach. The quick pass tube on the Fibertape Cerclage suture facilitates passage through the cannulated hook, and the suture is removed from the slot. To complete a wrap around the bone with the appropriate passer selected and placed around the bone, insert the red quick pass tube through the proximal cannulation of the hook until it exits the distal part of the cannulation. Remove the fibertape cerclage. Suture through the slot of the passer to allow for a second pass through the cannulation. Repeat the previous steps to complete a second pass of the Fibertape Cerclage, ensuring the Fibertape Cerclage sutures have been removed. Remove the passer from around the bone. Pull on the tail of the fibertape Cerclage suture to remove slack and advance the loading device closer to the bone. Cut the quick pass tube from the Fibertape Cerclage suture. Place approximately 2 to 3in of the tapered fibertape suture tail into the nitinol loop of the loading device. Separate the two tabs of the loading device, pulling the nitinol loop and the fibertape suture tail through the pre-tied knot. Unclicked the remaining suture and remove the knot from the loader. Slide the knot down to the bone and tighten by hand to remove the gross slack from the cerclage loops. Position the not so that it doesn't interfere with the placement of other implants, for example, plates and or strut graphs that may be used. Cut the fibertape cerclage near the swaged part of the suture to separate the two limbs. Insert one cerclage suture limb through the bottom hole at the distal end of the tensioner. Speaker  Slide the tensioner down to the knot of the fibertape with a tensioner secure against the knot. Place the other suture limb into the top slot at the distal end of the tensioner, pulling tight on the suture limb. Wrap one suture limb around the main body of the suture wing on either side of the tensioner, making at least one full pass around the suture wing. Then wrap the suture limb around the cleated portion on the side of the suture wing to lock it in place. Repeat this step with the other suture limb on the opposite side of the tensioner. Turn the handle clockwise while holding the tensioner body to tension. The fibertape cerclage suture tension until slack is removed and the desired amount of compression is achieved. The gauge lines on the tensioner provide a reference and aid in applying a consistent amount of tension. When multiple cerclages are used. Caution should be taken to avoid over tensioning and going beyond the fourth gauge line. Turn the handle counterclockwise and unwrap the suture limbs to remove the tensioner. Tie a half hitch knot to secure the cerclage construct. Place additional fibertape cerclage sutures if necessary. After initial tensioning and applying the first half hitch knot, each cerclage can be re tensioned if necessary until the desired amount of compression is achieved. Tie two alternating half hitch knots to complete each cerclage construct and cut the remaining suture limbs. The low profile nature of Fibertape cerclage allows for the flat suture cerclage construct to be placed under or over a plate. The Quickpass Fibertape Cerclage system provides a simplified and quick technique for achieving all suture. Cerclage fixation for long bone fracture applications, including proximal humerus and femur fractures.

QuickPass™ FiberTape® Cerclage System

At the Hand and Wrist Fellowship Forum, Joshua Hustedt, MD (Phoenix, AZ), discusses the use and recent literature surrounding CMC denervation procedures as an adjunct option for the management of CMC arthritis.

Thumb Carpometacarpal (CMC) Arthritis: Literature Review on Thumb CMC Denervation

OrthoPedia: Thumb Carpometacarpal (CMC) Arthritis: Literature Review on Thumb CMC Denervation

Aaron J. Krych, MD (Rochester, MN), demonstrates all-onlay medial patellofemoral ligament (MPFL) and medial quadriceps tendon femoral ligament (MQTFL) reconstruction techniques using the MPFL Reconstruction Kit with hybrid Knee FiberTak® anchors.

All-Onlay MPFL Reconstruction

Hi everyone. My name is Aaron Critch from Rochester, Minnesota and we're very excited to show you all Onli Mpfl reconstruction today. We're going to do both online fixation for the patella as well as the femur, using our new knee fiber Tak Mpfl reconstruction kit. Let's take a closer look at everything that comes in the knee fiber Tak Mpfl reconstruction kit. The first is the very innovative ratcheting Knee fiber Tak guide that's going to help us place our anchors on the patella. We have a 2.8mm knee fiber tak hard bone drill. We have three hybrid knee fiber tacks. They come on non self punching inserters. What we'll use for online fixation on both the patella as well as the femur. We have our fiber snare to help us with graft passage through our soft tissue layers of the knee. We have our familiar Fluoroscopic shadows point guide that's going to help us accurately place our femoral point for the mpfl reconstruction. We have a graph prep board and sizer. And finally we have two fiber loops that come on the 0.9mm tape. Here we have a right knee for our Mpfl onlay reconstruction. So we made a medial incision to the patella. We made it just a little bit longer for visualization. Really wanted to show this technique this online technique. So here we've found our retinacular layer between layers two and three. So we're just going to come down one level onto the medial aspect of the patella. And one thing that's very important with our onlay is we really need a good bone prep. So you can see here where extra articular. Here's the top of the patella. We're down to the 50 yard line. But we have a nice bone prep here. And we really want to encourage that surface healing for the onlay technique. So a couple pearls to be able to place these knotless fiber tacks on the mobile patella. So one is we place the knee into some flexion, which gives some more inherent stability of the patella and the groove. And really the game changer here is our knee fiber tack ratcheting guide. So our ratcheting guide can help us completely keep the patella stable. So you don't need to rely on a lot of back pressure or an assistant while you're doing your drilling. So you can see the spiked edge goes here on the lateral side. And then this ratchets down on the medial side. So we'll place that superior anchor first. So I'm just feeling the lateral side of the patella. And then we're going to ratchet down for our superior anchor. And we can really get some great stability. You can see we have nice and total control of that patella. So then we're going to take our 2.8mm hard bone drill. And I'm doing this without an assistant. So this male has really hard bone. So we're going to make sure that we cycle a few times. And then once we have our knotless fiber tech hybrid anchor, this is non-self punching. So we can just get it started and then just give it a few gentle taps to seat it. So you can really see how our guide stabilizes the whole entire system here for us. So once the anchor is seated then we can unravel our sutures. And again this is the hybrid option. So we have our needles here and we have our blue knotless suture that's already pre converted for us and our little white suture to maintain our loop. So now we can take our guide away. And there's a little slot on the side where the sutures can come out easily. And then we just want to make sure we have really good fixation. You can see we've got complete control of that patella. So now we're just going to separate out our sutures. So we have our two black sutures and they come pre-loaded with needles. So we're going to use this to actually help us reconstruct the nwcfl portion. So we'll put those on the side. And then here you can see the pre converted loop that's ready to go. You can check to see if it slides a little bit. But we want to put our graft directly through this loop. So we're going to come in here and place our second anchor. This one's going to be more distal at about our 50 yard line. So here I'm just really ratcheting again have really good one handed control of that patella. And then we'll come in here with our 2.8mm drill bit. It's really hard bone here. We'll just cycle a couple of times. And these are non punching inserter. So we'll just get it started. And then we'll be able to tap the anchor down fully seated. So that's positive. Stop. So then we'll take off our sutures and be ready to go with our second anchor. So now both hybrid anchors are fully ready to go on the patella. You can see we have our two knotless loops here which we'll put our graph directly through. And then we have our two sets of needles here that we're going to show you how we incorporate these into the reconstruction as well. So now we're ready to pass our graft on the patellar side. So this step is quite easy because we don't have to do really a lot of graft prep. On the back table here. All we did is we placed a mark directly in the center of the graph. So we have our graph center point measured. And we're right between our two knotless loops. We are going to perform an MQ TfL portion of this reconstruction. So what we'll do is we'll take the center point. And we're just going to shift it proximally right into that first loop. And that's going to give us a little extra graft to do our MQ TfL portion of the reconstruction. So once this is set up now we can use our Knotless portion. And we're just going to bring these down one at a time. And again we're trying to line this one up with the Blues. So we'll just set provisional tension. And you can see how this really gets amazing fixation of your graft. So we have that tissue compressed right to bleeding bone. And our fixation on the patella is fantastic. You can see we have complete control here. So we have our two anchors secured on the patella. Right here is the superior aspect of patella. And here's the quad tendon. So what we're going to use is a portion of the hybrid anchor. Now to actually perform part of the reconstruction. So we're going to really recreate the quadriceps portion of our stability. So here we're taking the preloaded needle. We're going through our graft. And here you can see our quad tendon. So we're going to actually dock this right on the undersurface of our quad tendon. And it's as simple as that. And now we're just going to tie a knot for fixation. So once we have the graft fixed here you can see we have fixation above the patella into our quadriceps about a centimeter to 15mm. And that's why we need a little excess graft above. But now our fixation is complete on the patellar side. So now we're sewing both limbs of the graft together. And this is our 0.9mm suture tape. So it's very important that we have both limbs of the graft on equal tension here and clamped. What's nice about this technique is we don't have to worry as much about length as when we're creating a socket. Technique. The onlay technique is a little bit more versatile and flexible that way. So once our patellar fixation is complete and the graft is ready, we'll work on our femoral side. And again this is onlay fixation on the femoral side. We don't want to neglect the most important part of the operation which is getting the anatomy correct. So I still like to use shuttles Fluoroscopic guide. And we have a 2.4mm guide pin just like any other variation of the technique. So we want to make sure that this is lined up really well on x ray. X-ray and we also confirm isometrically with our pin. So once we have our pin placed radiographically, then we want to make sure we're okay from an isometric standpoint. So we're going to pass our clamp here extra Articularly. We have our fiber snare shuttle that we're going to use to shuttle the graft between the layers. So now our sutures are loaded in the fiber snare. So I'm just going to lift up this layer. And then we're going to shuttle our sutures. First they're going to come out our femoral incision. And then our graft is going to follow. So you can see our graph length looks good. Now we're going to check our isometry. So here we're in about 90 degrees of flexion. But we really want this graft isometric from 0 to 90. So I'm going to place my finger on the graft and the pin and make sure that this is isometric through a 90 degree range of motion. And typically the mistake is to place the pin and the point a little bit too anterior or proximal. But this one feels very good. So we're happy with both our radiographic landmarks anatomic landmarks and our isometry. So once we've confirmed our 2.4mm pin placement, now it's time to place our anchor. One of the other aspects of this ratcheting guide is that this guide will completely detach. And then we can slide this right over our 2.4mm guide pin. And this helps protect it. Now if you have really hard bone you could remove this pin and go back to your 2.8mm drill. But in most cases we're able to just remove our two four pin and then place our anchor in that same pilot hole, so we'll tap this in to a positive stop. So again we're we're hybrid anchor on the femoral side as well. So we have both our knotless loop for our graft fixation but also an extra pair extra set of needles to help us with additional fixation. So we're going to set that anchor make sure we have great fixation. And now we're ready for graft fixation. So we're ready to go for graft passage on the femoral side and fixation. It's very important to remember we really want to do a good biologic preparation. So typically I'm really taking a curette here and just kind of really scraping that periosteal bone. Again one of the key elements we need with our onlay fixation. So then we can pass our, our graft sutures through the loop. So we'll typically pass our sutures first. And then we'll make sure this graph is lined up. Now the tension of the graph obviously one of the most important aspects of Mpfl reconstruction. So you can notice our knee here is in 30 degrees of flexion. So our patella is starting to engage in the groove. And then we don't want to over tension. So you don't have to put a lot of tension on this graft. But we'll first tension the loop down and. We'll bring that right down. And that that sucks down the graft really nicely. You can see the fixation that you get there on the surface with our Onlay technique and our knotless fiber tack portion. So now we can use the other portion of our hybrid fiber tack. And we're just going to get some fixation of the graft proximally towards your patella side. So here on the anterior portion we'll just place a simple suture. And then in the posterior portion, we can place a mattress suture through the graft. When we looked at the biomechanics of this construct, this was very much equivalent to a socket type of fixation. So again, a lot of advantages for maintaining bone real estate with this onlay technique. And you get one more point of fixation. With the knotted suture limbs. So if you want at this point you can retension your knotless portion. But everything here is very secure. So we'll just trim our sutures. And then this excess graft at this point you can trim as well. And that's one of the nice aspects of the Onlay technique. The graft length does not matter as much once we have our surface fixation. So once our graft is trimmed, you can see the broad footprint of fixation that we have here against our prepared bleeding bone. So a true onlay technique both on the patella as well as on the femur. Okay. So at this point we've got everything secure on the patella as well as the femur. So we're just going to use the remaining sutures to repair our retinaculum. So these two tensioning limbs at this point we can trim. And then we still have our double loaded needles from our hybrid anchor previously. So we're going to use these to help repair this retinaculum. Sometimes there can be a retinacular injury as part of this constellation of instability. But these do a really nice job of just closing Everything up and securing it to your patellar side. So I typically just place two simple sutures, one on each side of the retinaculum. So at this point our sutures are set and we can complete this retinacular repair. We can also perform imbrication if needed. But at this point our graft is set and we'll trim these. And you can see our final repair on the patellar side. Again we have our fixation not only on the patella but also in the quad tendon as well. So overall very nice online procedure.

All-Onlay MPFL Reconstruction

This animation provides an overview of the features and benefits of the Knotless 1.8 FiberTak® soft anchor for the treatment of shoulder instability.

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What's NewJUL 7

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What’s New This Week and Prior

JUL 6

ACP Max™ Platelet-Rich Plasma System

JUL 5

Arthrex Variable-Angle Proximal Tibial Plating System

JUL 4

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Distal Biceps Tendon Repair Using the TensionTight™ Button

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