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Daryl C. Osbahr, MD (Orlando, FL), reviews the contents and use of the Onlay MPFL Implant System with Knee FiberTak® anchors for patellar fixation and the FastThread™ interference screw for femoral fixation.

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MPFL Reconstruction Using the Onlay MPFL Implant System With the FastThread™ Interference Screw

Hi, I'm doctor Daryl Osbahr. I'm with Rothman Orthopedics of Florida at AdventHealth. Today we're going to be talking about the knee. Fiber tech only Mpfl kit with the fast thread screw. So I'm going to explain to you what's in the kit. We're going to use the hybrid knee fiber tech with the one knotless tensioned loop and sliding suture tape with needles. We also have a new and exciting patella ratcheting knee fiber tech guide, and we have the 2.8 hard bone drill you can see here on the table. We also have the sutures that we're going to be able to put through the graft. We have the disposable fast thread screwdriver. We also have the drill bit and we have the seven millimeter reamer. We have the guide wire. And then we also have the two fiber standards to be able to pass the graft. In addition we have the Mpfl template as well as the disposable graft board for graft sizing to give orientation. This is the medial side of the knee and the lateral side of the knee. So some of our landmarks this is the patella that I've outlined. This is the medial epicondyle that I've outlined. So this will give us our access to the patella side of our fixation in the femoral side of our fixation. I'm going to make the patella incision first at the medial aspect of the patella. To give orientation this is the medial side of the patella. We can see some of the mpfl tissue and retinacular tissue coming in. And we can see the vastus medialis obliquus coming in to enter the attachment site. For the medial side of the patella. There are several goals of what we can establish here. If we're considering doing a VMO advancement, we can make our medial parapatellar arthrotomy slightly extending up into the vastus medialis obliquus to be able to advance that medially. If not, we can do a standard peripatellar arthrotomy on the medial side. Here you can see I'm keeping the vastus medialis obliquus intact and not actually advancing it. In this case, once I have the medial side of the patella exposed, I will use a combination of a curette and a rongeur to prepare a good bony surface here, so our reconstruction can heal against this surface. Staying extra articular and along the mpfl. We can see this interval that we're able to develop to be able to get right down to the femoral side. Now I'm going to mark the superior medial border of the patella, as well as the midpoint on the medial aspect of the patella. These are our two fixation points for our knotless technology on the patella side. Now I'm going to show you the patella ratcheting guide. We can see the button right here which you can push down and allows you to telescope. So that way when we get this fixated to the patella, we have a better grasp to more effectively and easier drill our tunnels. I'm going to first start with the superior drill hole. You can see here drill ratcheting it down. I have great grasp of the patella. Now I'm going to drill before placing my anchor. The new technology on this plant allows us to actually push the implant in without sometimes even having to use the mallet, because it's so easy to deliver it. This black suture has the needles for which ability use this to pass through the structures later in the case to repair those in tension compared to our mpfl reconstruction. This is the tension loop which will be able to actually use this to fixate the patella graft to the medial aspect of the patella. When we're setting the tension on this and actually pulling back to set the implant within the bone. We want to make sure we just pull the black sutures to do so. So we don't tension down our loop. So now we're going to fixate our ratcheting patella glide into that distal location on the patella. And we're going to drill. In place our second anchor. So you can see how easy that was to be able to actually fixate the graft into the patella using the ratcheting guide. And this new knotless fiber tack again. Now we're going to set the distal fiber tack. And you can see how well this is fixating the bone. In fact when I pull has great fixation. Now you can see we're putting the guide to be able to find shadows Point for our approach to the femur. Now in terms of Incisional approach you can make one incision or you can try to make two smaller incisions. This incision is usually about two times the size that I make on the medial aspect of the patella, especially now that we have the patella ratcheting guide. And then I'll make a small two centimeter incision over here to try to stay more minimally invasive while passing the graft. But the goal of this guide, along with x rays, to be able to find our shadows point so we can make sure that our orientation for our tunnel is in the right position for an isometric graft placement, I'm going to now make my femoral approach incision. I want to be careful to stay right at the level of the skin. Always want to be careful about the medial saphenous. I will now take a Metz. Try to develop a plane down to the medial epicondyle. I will then use my finger to identify the medial epicondyle, which is right here. And that helps me make sure that I can localize shadows point. This is the point in time that I'll actually use this guide along with x ray. I usually will have the knee at about 90 degrees of flexion and identify the perfect approach for shadows Point as I place either my guide wire or my anchor, depending upon if I'm using Knotless technology or I'm actually using the screw. Now that I have my drill pin in the correct location at Shadows Point, I will now drill, making sure to aim in the appropriate orientation. At this point, I will often make sure that I have a good plane of tissue identified around my tunnel and my guide wire to make sure that I'm able to pass the graft easier. In the case. Now, I'm going to take the reamer and drill over the guide pin. As you can see, I sometimes cycle it to make sure that I've eased of graft insertion because I really try to make sure the graph fits nicely. Now I'm going to take my fiber snare. I'm going to pass this through. And I'm going to have my assistant pull. And this will enable me to pass the graft into the tunnel later in the case. Now you can see I have everything set up the patella side with our knotless hybrid fiber tacks. And I have our socket on the femoral side to place our intraosseus screw. We can see here we have a disposable graft board. And this allows us to put tension on the graft, but also to mark the center point of the graft. This will enable us to identify the right point to put between our patella fixation sites. In this case, we're using the 6.5mm slotted tunnel. And we can see the graft passes nice and easy, which is perfect for our seven millimeter hole within the femur that we drilled. At this point, I'm going to make sure that I have a passageway for my graft around the interval of the mpfl within the medial structures. I'm going to be able to pass my hemostat down, and then I'm going to pass a fiber snare, which will enable me to pass the graft. Now we're going to pass the graft through our two tension loops right here. Now we have the area we marked. That would be the center point of the graft, right in between our tension double loops for the fixation. We're now going to tension our superior loop, which is going to fixate our graft to meals side of the patella. And we're going to do the same thing with the distal loop. Now that we've tensioned our superior and inferior tension double loops, we now have great fixation of our graft to the medial side of the patella with our knotless knee hybrid fiber tack. Now we're going to pass the graft limbs through the fiber snare, where we're going to pass this down through the layers on the medial side of the patella. This enables us to pass the graft to the femoral location that we're going to fixate. So now we can see we have the graft fixated to the medial side of the patella. Our graph limbs are entering the medial structures within the plane of the NPFL and going down toward the femoral side. We can also, later in the case, use this graph limb to fixate to the VMO, which is right here. So now we can see we have the graft which is now been passed through the medial structures. We have the hole that we drilled with the socket and our suture coming out of it. We're going to be able to pass the graft into the hole for which we have great visualization. At this point in time, you can actually pass the guidewire and then pass the graft, or you can pass the graft and subsequently the guidewire to make sure that you get a good plane to place your screw. Now we're going to use this 90 degree snap as a pulley to be able to pull the graft into the tunnel by first passing the sutures. And then we're going to pass the graft. Now I can visually see that we have the graft going into the tunnel and the graft appears very tight. Now we can see both limbs of the graft successfully going into the tunnel with appropriate tension. Now we're going to pass the guidewire, and we're going to place it in the tunnel and pass it in, where then we feel the opposite cortex and we know we're in bone. This is now going to enable us to be able to pass the screw over the guidewire, to fixate the graft on the femoral side. You can also use the tightrope, as well as the knee knotless fiber tack, to be able to fixate the graft on the femoral side as well. In review. Now that we can see we have great fixation with our inlay technique to the medial side of the patella, with our graft going through the medial structures and entering the tunnel in the femur, we have our assistant being able to hold tension on the graft on this side. And we make sure that we have a good one. Plus stability of the kneecap. So we're not over tensioning. We have our knee at 30 degrees and making sure that both the medial and lateral side of the patella have good fixation in both the medial and lateral planes, with the good end point but not over tensioned. Now we're going to take our disposable tri lobe fast thread screwdriver with our screw loaded on top of it. We're going to pass this down to our tunnel to be able to successfully fixate our graft within the femoral tunnel. We want to make sure we have tension on the graft while placing this. We want to put a little bit of force as you initially get it into the tunnel, and then usually it passes very easy. We want to make sure that we're able to see it actually go into the tunnel and to get great cortical fixation, which we can see right now. At this point in time, I will usually use a mallet to just lightly back this off. And then pass the guide wire back out. So now we can see the graft going into the femoral tunnel. And this is the hole for the screw that has great intraosseous fixation. Now I'm going to use my black suture tapes to be able to pass these through the medial structures. If I have a high riding VMO, I'm going to make sure that I be able to get a good grasp of this tissue to be able to advance it. You can see here I'm going to pass it through. And I'm going to take every single limb and pass it through. So that way I can tension this to match the tension of my graft for the tension sutures. You can also use these for additional fixation with an empty needle to be able to pass it as well and tie it down. In this case we will just use our suture tapes. Now I'm going to tie these suture tapes to be able to get great fixation of my mpfl tissues to match the tension of my graft. At this point, I have tensioned my repair back to the patella using the suture tapes. Sometimes in a pants over vest fashion, I will also pass one of the limbs around this tissue to be able to further tension. If I feel like I need that to dial it in, and I can do that both proximally and distally. The knee knotless fiber tack technology has enabled me to do this surgery in such an easy and reproducible way. The patella ratcheting clamp has enabled me to pass the suture anchors within the patella in a much easier fashion, making the surgery so much more efficient. And with this, I can actually do it in a way that minimizes any bone loss to the medial side of the patella and inherently lowers fracture risk.

MPFL Reconstruction Using the Onlay MPFL Implant System With the FastThread™ Interference Screw

Raffy Mirzayan, MD (Los Angeles, CA), demonstrates his technique for harvesting bone marrow aspirate from the proximal humerus using the Vortex™ threaded recovery needle for processing in the Angel® system.

Proximal Humerus Bone Marrow Aspiration

Speaker  I'm Rafi Mirzaian from Los Angeles, and I'll be demonstrating a bone marrow aspiration from the proximal humerus for an augmentation of a full thickness rotator cuff tear. We have a right shoulder here, and my starting point for the bone marrow harvest is going to be just off the edge of the acromion, and I can localize that with a spinal needle. And my starting point is going to be just posterior to the biceps tendon off the articular margin, where you would typically put your anteromedial anchor for the rotator cuff repair. Now, typically the entry point of this trocar has been at a 45 degree angle relative to the head, and the harvest is performed from the humeral head. What I like to do is be more parallel with the humeral shaft and advance the trocar into the humeral shaft and harvest the marrow from there. And I typically do this in a lateral decubitus position with the arm abducted at 30 degrees. So it is critical that at this point that the arm is adducted all the way down. You can see how by doing that, that trocar becomes perfectly parallel with the humeral shaft. I prefer to use the vortex needle because it provides better directional and depth control. It also provides a watertight seal, which is critical in an arthroscopic harvest of bone marrow. The vortex needle is then twisted in by hand just to break that cortical bone, and it's also important to note that I did not prepare the the tuberosity whatsoever. I left the soft tissue on it. I did not use a burr and I'm using my hand. Speaker  We're not mounting this in. We're not forcing this in. We're letting the guide find its way into the canal. And I can advance this as far as I can before I can feel. Hitting the inner cortex of the humeral shaft, which would be my stop. And you can see how deep we've actually inserted this trocar to be able to get into the shaft of the humerus. All right. So what we can do now is back this guy up. Get the fluoro in here and then shoot to show this is going down the canal. So we've now inserted our vortex needle all the way down the canal of the humerus. We will remove the trocar. And attach our vac lock syringe onto it and push back all the way. Look at that arrow. And it helps if you rotate this back and forth so you can aspirate from multiple sites through the canal. There you go. You see how quickly that aspirated. Once you're done with the aspiration, the vortex needle is removed and you can now insert your anteromedial anchor into the same hole that you just removed the needle from. So the important note here is that you do not want to do any tuberosity preparation. This includes removing of soft tissue or burning down the bone. It's also advantageous to do this at the very beginning of the case. Aspirate the bone marrow. Hand it off to the staff so they can prepare it through the angel system. So it'll be ready by the time you're done with the rotator cuff repair.

Proximal Humerus Bone Marrow Aspiration

The Lapidus I-Beam plate features an integrated internal beam that spans the 1st TMT joint to increase strength and stiffness across the fusion site.1 A novel instrument offering allows the surgeon to reduce the intermetatarsal angle, correct the sesamoid position in the frontal plane, and prepare the joint for the internal beam.
 
Reference&nbsp;
1. Arthrex, Inc. Data on file (APT-07508). Naples, FL; 2025.

Lapidus I-Beam Plate Animation

Lapidus I-Beam Plate Animation

Asheesh Bedi, MD (Ann Arbor, MI), demonstrates a comprehensive cam resection of the femoral neck using the Hip DiamondCut™ burr.

Femoral Neck Cam Resection Using the Hip DiamondCut™ Burr

Today, I wanted to feature two great products that you have as part of your armamentarium for hip arthroscopy and preservation surgery from Arthrex. And that's the four and the 5.0mm diamond cut burs. So here's a close up. Some of the huge advantages here is its ability to work as a finishing bur. It can function well on hard bone or soft bone with great control and precision, and it avoids skipping, which is sometimes what happens on those harder surfaces with a fluted bur. It works reliably in both forward and reverse. Another advantage over fluted technology is sometimes the ability for it to protect and not wrap soft tissue in the capsule, which is at a premium during hip arthroscopy. All right. So now we have this more focused view. And just to orient everyone this is a right hip. We've completed our central compartment work as you can see here. Nice labral repair using the knotless fiber tack anchors getting a good suction seal of that labrum. And now we're just working to our peripheral compartment. There's our acetabular sided capsular limb and the rectus. And here's our femoral capsule here. And we can now start to demarcate for our camera section. Generally speaking for me I like to start superolaterally here right adjacent to the labrum. And here with this diamond burr, we can set a margin. But again, one of the advantages here is this nice demarcation and control even on hard bone in a young patient where we can set an edge and you can see it doesn't skip. I tend to use the labrum as a guide to set that physeal scar. And here I'm just going to work to define that margin of our proximal resection. You can work fairly closely here to the acetabular edge here. And again based on the position of flexion you have, you can set that margin rather nicely here. Here as we go a little bit more anteriorly I come a little further away from the labrum to set that normal angle of the physeal scar. As you can see that defines that nice proximal edge. And we know that everything proximal to that we're going to designate an important weight bearing cartilage. I'll sort of deliberately here, as you can see come in close proximity to this femoral sided capsule. And you can see not only does the hood protect us, but this diamond surface is not wrapping up that capsule as I work in close proximity, which is more likely to occur with your fluid at burs. From there, we can continue to work our camera section here. I can switch deliberately here from reverse to forward, no difference in its efficiency in resecting and setting that margin for our camera section working here from proximal to distal along the edge. We'll continue to work here. You can see here nicely. We can work right next to that labrum with good control. I'm basically abutting the labrum here laterally and can continue to work right around the corner here, even superolaterally up near our retinacular vessels. Here we can change our view a little bit. We'll rotate our eyes. You can see here we can work more medially. Oftentimes this bone here medially is a little bit softer. And this is where the fluidic bur can sometimes gouge or resect particularly in softer bone. But here our diamond burr has excellent control as we continue that resection working from proximal to distal right here towards our capsule. As you see here as I'm resecting bone, one huge advantage is we're not getting the snowstorm effect or the snow globe effect, which can sometimes obscure your view. I'm modulating the suction here, but I have an excellent view and control the entire time. And that polish and design of that diamond burr surface has specifically been designed to minimize the risk of that snow globe effect. You can see here we're working in the camera section from proximal to distal. And I can continue to work my way distally preserving this proximal convexity and then working distally here now to a more concave resection. At this point as I'm continuing to push the capsule away, I think you can see nicely even without changing the leg flexion. I'm not wrapping up the capsule at all. As we continue that resection medially and distally. Just for a moment, I'll show the view. Here you can see where we've defined that proximal margin of resection. Nice margin. And we can continue to work distally here. So as you can see we've continuing our cam resection. We've set our proximal margin. This actually is a pretty good view as you can see here of the Cam lesion. This loss of offset here and asphericity here. As we move over that direction you can even see your superolateral extent of the Cam lesion. Those are your perfusing retinacular vessels there. For the sake of this video, we've deliberately done a little mini T here so that we can see and visualize this camera section to show the value of this burr, But here I can work with great precision and even drive here up in superolaterally work right next to the labrum with great safety. Here I'm going to continue that resection proximally. And here we can work right up and next to the retinacular vessels here and actually remove that bone without worrying about winding up those vessels, even those anterior perfusing vessels. Then here, as we work our way back, I can set another margin here of resection. Again. Good control. It doesn't skip. Finishes medially and laterally with precision. And we'll continue to define that cam lesion so that we don't stop proximally. But we restore that offset here distally all the way along the head and neck junction as well. You can see it works very well working from proximal to distal. And we'll continue to work distally right here towards the distal neck. So we feel like we've restored normal sphericity and offset in all of these different planes. I'll deliberately here bring the the bur as I wouldn't right up on the capsule here deliberately try to wrap up the capsule with the bur. And if you notice it's avoiding that wrap up even when I'm intentionally trying to go towards and blur the soft tissue. It just won't wrap up the tissue the way a fluted burr does. So truly an inherent additional layer of protection to protect the capsule for your later closure. So, as you can see here, as we've progressed through our camera section, we've got a nice proximal demarcated margin for the weight bearing cartilage. We've restored offset and sphericity here in the area of the typical Cam deformity. We've had a great control here with this diamond burr. You can polish out any areas as you're inspecting around to make sure that you've been thorough in all planes. You can actually see a little impingement cyst here that we have great control over to make sure that we've gone to the right depth there. So this is a nice and thorough camera section that's well controlled using this diamond Burr technology that allows us to do an excellent pincer resection proximally and an excellent cam resection distally. Now, as you can see, because we've preserved our capsule so nicely, we can just come here and nicely repair this mini T side to side working from here to here. And then we still have our proximal capsular flap for our inner portal closure.

Femoral Neck Cam Resection Using the Hip DiamondCut™ Burr

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

Steven J. Lee, MD (New York, NY), demonstrates the use of the lateral biplanar plate from the Arthrex Elbow Plating System. The plate provides direct lateral fixation on the epicondyle and posterolateral fixation along the shaft, and a removable tab facilitates capitellum fixation. Dr. Lee uses the lateral positioner from the ElbowLOC® arm positioning system.

Distal Humerus Fracture Fixation With the Arthrex Distal Humerus Lateral Biplanar Plate

Hi, I'm Steven Lee from Lenox Hill Hospital in New York City. I'm going to talk about arthrex cool new contoured plates for the distal humerus. And this particular plate is the Biplanar lateral plate system. A couple of cool features about these plates is the one, of course, the anatomic contouring of the plate to the bone, but also the addition of special different tabs that are added to the distal aspect of the plate, which allows for more screw fixation abilities, especially for those hard to treat distal humerus comminuted fractures. Each one of these screw holes can take either a 2.7 or 3.5 locking screw, and the crew lock screws are a variable pitch locking screw, so it gives some mild compression and at the same time can also lock into the plate at the same time. A couple more features that I really like about this plate are that the distal end of the plate has scallops to it, which allows us to bend the plate a little bit more easily to help contour it, just in case it doesn't perfectly fit the bone. There are also suture holes to allow for you to put sutures to repair your ligament and or tendon, and you can also add suture underneath the tab as well. Some of the features that I really love about this set are that it's been very well thought out, especially the instrumentation. So there's a bunch of different reduction clamps that you're probably used to using, but also this one reduction clamp called the tooth choker. Especially like this because of the fact that it has sharp ends on the on the tip, sort of like your pointed reduction clamps, and yet is not bowed out so that when you are dealing with fractures and trying to reduce them, the Kocher clamp tooth choker would will hug the bone and it doesn't get caught up in soft tissue or the nerve here or whatever. And so it holds things very, very nicely. There are instrumentation, thoughtful features for which there are each. Most of the instruments are double sided. So I do like to use different sized freezer freezers. So there's a wide area on one side that you can use to help scrape the soft tissue off. It's appropriately sharp and soft and dull enough, and then you can flip it around and use the smaller end or the thinner end for your regular, freer application. Same thing for the other cool tool, which is the curette on one side, and the dental toothpick for reducing your fractures at the same time. And it's wonderfully balanced. You can spin it in your in your hands very easily. Also the screws in the set are all stadium seating screws, which means that they don't need to be measured by your surgical tech. Only if it sits flush on the set, then that only that screw can fit in there. So they don't. You don't have to wait for each screw to be measured, which is a very time saving feature. Often we'll put in a tack first, and I'm going to go ahead and put in my first screw in the oblong hole. This is going to be a 3.5 screw cortical screw. So that's going to be a 22. So this does come with a torque limiter. And of course to if you want to go ahead and tighten by hand as well. So I'm going to put in a 2.7 non-locking screw in distally. Again you can put either locking or non-locking screw in each one of these holes. This is a variable angle locking drill guide. So it does give you a 24 degree arc of variability. I do like reading my screw lengths directly off of the drill guide. But to note, there's two different lines on the drill. There's a single black line that you read for up to 50mm of length of the screw, and anything over that you would read off of the double black line that's on the drill. So. Hopefully you can just start seeing the double black line coming into view. So again we're going to put a non-locking screw in first. Okay. So I'm going to go ahead and put in a 2.7 non-locking screw into one of these tabs. This is a 2.7 non-locking screw going into one of the tab holes. It looks like that's conforming really nice onto the bone as well. This is our screw in locking tower guide. You can use this tower to also bend the tab. If for whatever reason, the tab is not conforming perfectly down onto the bone. So this is a 2.7 locking screw going into the tab hole distally. I'm going to put in a 2.7 distal locking screw using the screw in locking guide. So this is the distal most screw. This is going to be a 2.7mm locking screw. There is a torque limiter on the drill. This is a AP with some of our screws in. You can see the plate sits really nicely on the bone. And very importantly the screws that are put in distally are missing the olecranon fossa and providing extra fixation distally, which is my usual biggest concern with these type of injuries. This is a lateral provisional x ray. I think it looks unbelievable how well it sits on the humerus. It's very well contoured and screw positioning of where they go is optimal. This is the final AP x ray for the biplanar lateral plate. The cool thing to note here is that we have a total of five screws that are distal to the olecranon fossa, just the angle of where those screws go. Just I think are perfect. They miss the olecranon fossa and gives us extra fixation for those really difficult distal humerus comminuted fractures. So very happy with the way that looks on the bone. This is the final lateral x ray for the biplanar lateral plate. Again getting five separate screws distal to the olecranon fossa is absolutely amazing. The plate is very skinny. It's low profile, it's smoothened on the ends and the ability to take both locking and non-locking screws either 2.7 or 3.5 and any of the holes gives us so much flexibility on treating what is often very difficult fractures to treat.

Distal Humerus Fracture Fixation With the Arthrex Distal Humerus Lateral Biplanar Plate

At the Hand and Wrist Fellowship Forum, Asif M. Ilyas, MD (Philadelphia, PA), reviews the latest literature-supported treatment strategies in carpal tunnel release, including open and endoscopic techniques, coupled with a focus on WALANT surgery.

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WALANT Surgery for Carpal Tunnel Syndrome

OrthoPedia: WALANT Surgery for Carpal Tunnel Syndrome

After fighting through the pain and struggling to lift his arms for over 20 years, Jerry Blackstone regained his freedom and ability to command the podium after undergoing bilateral anatomic shoulder replacement surgeries.

Grammy Award–Winning Choral Conductor Back to Leading Orchestra After Replacing Both Shoulders

I will say that a definition of conducting is the communication of musical ideas through pantomime. How does it sound? How can we make it sound better? How can we make it tell stories from the very beginning? We conduct with our face, with our eyes, with our hands, with our arms, with our whole body. We have to become the music. In the fall of 2019, I had a new conducting position, and just before that started, my left shoulder really began to hurt. I couldn't really lift my arm higher than this, but when I was conducting, I didn't feel pain. And I mean that seriously. When the lights are gone and you're back home and you think, wow, that that really hurts. It's very hard to not allow that stress to enter into the rest of your professional experience. Wear and tear probably played a good amount of part of it. A recent survey of 700 conductors and band directors revealed over 65% reported experiencing shoulder pain or discomfort. The repetitive upward swing of a conductor's arms puts them at very high risk. This constant motion can worsen existing pain, preventing proper healing over time. For Jerry Blackstone, conducting was more than a passion. It was a career spanning over 35 years. After exhausting his options, shoulder replacement surgery was the best way to reclaim his place on the podium. A procedure he ultimately underwent for both shoulders. Before surgery, I had had quite a bit of physical therapy. When my shoulder was diagnosed as frozen shoulder, I would do some medications to help alleviate the pain, especially after a good amount of conducting. And when my shoulder was bothering me, I didn't talk about it. I didn't really want pity. I didn't also want to get in the way of possibilities. I just did it. And then Covid came and I had time. I had no idea if I was ever going to conduct again. And I thought, let's just get this done. Jerry elected for anatomic reconstruction surgery with the Arthrex eclipse system in both shoulders due to advanced glenohumeral osteoarthritis. This innovative procedure uses a stemless design, allowing for a less invasive approach and preserving more of the patient's natural bone. With shorter surgery time and quicker recovery, the eclipse system offered Jerry a chance to regain his strength and return to the podium just months after surgery. I started physical therapy after the surgery about two weeks later and it was just very gentle. I knew better what to expect of the process and what to expect of myself. The recovery is is a small price to pay for the relief and the freedom and the ease that you'll enjoy for a long, long time. I'll never forget the day when he said, just raise your arm over your head. I'll probably even get emotional today talking about it. And I could, and I hadn't been able to do that for 20 years. There's nothing that says to me now. Oh, you had that surgery. Both of my shoulders have been replaced or fixed. The way that I experience that is that I don't have to think about it either side. I'm grateful for the opportunities that I have to still do it for a while. Pain free.

Grammy Award–Winning Choral Conductor Back to Leading Orchestra After Replacing Both Shoulders

Expanding on the trusted Syndesmosis TightRope® platform, the Syndesmosis TightRope PRO implant is the next generation in syndesmotic fixation. Updated instrumentation and lower-profile implants provide efficiency by design, enabling effective treatment of syndesmotic injuries.

Experience the Syndesmosis TightRope® PRO Difference

Experience the Syndesmosis TightRope® PRO Difference

Michael A. Gallizzi, MD (Vail, CO), describes the importance of careful dissection of the scar tissue left over from multiple radiofrequency ablations (RFAs). Slow hemostasis is key when dissecting through the scar tissue.

SpeedPearl: Endoscopic Approach for Revision Medial Branch Nerve Transection

When performing the approach for a revision. Medial branch transection. It is really important to identify the anatomy. The first thing you're going to notice is there's an entire wall of scar that is present over the lateral aspect of the facet joint, covering the transverse process. So during this, it's really important to perform slow hemostasis of all the areas that could be bleeding due to the previous radiofrequency ablation. This causes a significant amount of scar tissue around the medial branch, all the way from the mammillary process to the lateral wall of the facet, the cranial and caudal edge of that transverse process. So when you're doing your approach, it's very important to start identifying these landmarks slowly dissecting through that soft tissue, because you never know if there's going to be a bleeder or the medial branch itself underneath that large wall of scar. So in this video, we're looking at this entire scar ball that's formed from repetitive rfas. And this is why we believe that the medial branch transection is a more effective procedure in general, because we're doing a surgical and precise removal of the medial branch instead of ablating and scarring up this entire area.

SpeedPearl: Endoscopic Approach for Revision Medial Branch Nerve Transection

The All-Onlay MPFL Kit includes everything needed to complete MPFL reconstruction procedures, including three Hybrid Knee FiberTak® anchors and a ratcheting guide to stabilize the patella while drilling and implanting anchors.

All-Onlay MPFL Reconstruction Using Hybrid Knee FiberTak® Anchors

Hybrid knee fiber anchors feature one pre converted tension knotless suture tape loop and one sliding 1.3mm suture tape with swaged needles. The all online Mpfl kit features three hybrid knee fiber anchors on tapered non self punching inserters for easy anchor implantation, and an included ratcheting guide. The knee fiber tack ratcheting guide stabilizes the patella while drilling the pilot hole and implanting the anchor. To begin the technique. Make a two centimetres skin incision from the superomedial corner, extending to the center of the medial edge of the patella. Create a groove on the medial patellar edge using a rongeur or powered burr. Place the spike of the knee fiber tack ratcheting guide firmly on the lateral rim of the patella, and slide the ratcheting drill sleeve down to the medial rim of the patella. Create a pilot hole for the anchor by advancing the 2.8mm hard bone knee fiber tack. Drill until it bottoms out against the back of the drill sleeve. Insert the hybrid knee fibrotic anchor by hand, advancing the tip of the anchor until it is within the pilot hole. Using a mallet, gently advance the inserter until the inserter handle bottoms out against the back of the drill sleeve. Remove the anchor inserter and ratcheting guide. Gently pull the black suture limbs to set the anchor in the patella. Repeat the drilling, insertion, and setting process to place a second anchor, spaced approximately 15mm to 20mm from the first anchor. Pass the prepared graft through the blue knotless loops of both anchors. Tension the graft down to the medial patella by pulling the blue tensioning strands. If using the fluoroscopic template, place the template on the area of the medial epicondyle on the distal femur. Provisionally advance a 2.4mm zebra pin into the femur to a depth of approximately two centimetres, and at the trajectory of the intended anchor placement. Remove the template and create a small medial incision where the pin enters the skin. Slide the drill sleeve from the ratcheting guide down the guide pin and hold it in place on the bone. Remove the zebra pin while maintaining the trajectory of the drill guide sleeve. Advance the knee fibrotic drill until the hub bottoms out against the top of the drill sleeve. Insert the hybrid knee fibrotic anchor by hand, advancing the tip of the anchor until it is within the pilot hole. Using a mallet, gently advance the inserter until the handle bottoms out against the back of the drill sleeve. Insert a curved clamp down to the medial epicondyle and turn the tip of the clamp toward the skin. Using the clamp, pass the looped end of the fiber snare suture back to the patellar insertion area. Loop the whip stitched graft ends through the loop of the fiber. Snare suture and pass the suture from the patellar origin to the insertion point at the medial femoral epicondyle, deliver the sutures out of the medial incision, and pull the graft down to the medial epicondyle. Load the graft sutures through the blue knotless tensioning loop of the anchor with the knee in 30 degrees of flexion. Pull the blue tensioning suture of the femoral anchor to provisionally fixate both limbs of the graft. Take the knee to full extension and, using the attached curved needle, pass the black 1.3mm sliding suture. Tape limb from the anchor through both limbs of the graft. Tie the suture limbs and amputate the excess graft. The black 1.3mm sliding suture tape. Limbs with swaged needles from the patellar anchors provide added versatility and can be used to close the retinaculum, pass through the graft for additional fixation, or to accomplish a VMO advancement as needed.

All-Onlay MPFL Reconstruction Using Hybrid Knee FiberTak® Anchors

This animation demonstrates the use of ArthroCell™ Plus viable bone matrix for spine fusion procedures.

ArthroCell™ Plus Viable Bone Matrix for Spine Fusions

Speaker  Arthur Sell is a viable multiple cellular allograft that is intended for use as a nonimmunogenic cellular bone matrix for bone repair. When combined with the Arthrex graft, gun delivery of the Arthur cell into the disc space is simplified. Once the graft gun is appropriately positioned, actuate the trigger to begin deploying the Arthur cell into the disc space. Arthur Cell provides the three key elements necessary for bone repair osteogenic cells, and an Osteoconductive scaffold with Osteoinductive potential. The Osteogenic components of Arthur Cell include viable mesenchymal stem cells and osteoprogenitor cells. Arthur Cell also contains a blend of microparticulate bone, including a demineralized cortical and cancellous matrix that serves as an osteoconductive scaffold. Osteoinductive growth factors from the scaffold and the defect environment send signals to initiate osteogenic activity that supplements the patient's innate healing processes. Arthur Cell is an alternative to autograft and is intended for use in bone remodeling and repair of bony defects, fusions, and nonunion orthopedic applications.

ArthroCell™ Plus Viable Bone Matrix for Spine Fusions

Elizabeth G. Matzkin, MD (Boston, MA), demonstrates an ACL reconstruction using a GraftLink® construct with RT TightRope® SB implant with FiberTape® suture for the InternalBrace™ technique.
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.

GraftLink® ACL Reconstruction Using the TightRope® SB Implant for the InternalBrace™ Technique

Hello, I'm Elizabeth Matzkin from Boston, Massachusetts, and today we will be demonstrating an ACL graft reconstruction with internal brace technique and the new tightrope SB. As you can see here, we have our graft out on the table on our Graph Pro ready to go. We have a hamstring semitendinosus that's been quadrupled using a standard grafting technique. And we have our new tightrope SB on both sides of the graft you can see the yellow suture which is the soft button. This is just like our tightropes we've been using for the last ten years, but there's no metal. So for patients that may have metal adversity or a metal allergy, this is going to be perfect. There's also some other advantages to using the soft button, which you will see in our demonstration on our tightrope SB. You can see our blue passing sutures, our white tensioning sutures, our internal brace sutures, and these sutures which are used for elongating, which you will see as we pass the button into the knee for our ACL reconstruction. On the tibial side of our graft, we can see our blue passing sutures. These suture tapes here in the middle are from our graft prep. So there are saved sutures. We can see our white tensioning sutures. And then again, we can see the suture that we're going to use for elongating the suture button when we pass it into the knee. So we have about a 30 millimeter femoral tunnel. So we've marked 30mm from the end of this soft button. I also like to mark my graft around 15 to 20mm. It's often where we have these sutures wrapped around the graft itself. But that will help us as we pull the graft into our tunnel. And we'll mark it also on our tibial side. So here we are. We're in our right knee. We've already prepped our femoral and tibial tunnels. We have sutures passed through them so we can get ready to pass our graph with the new tightrope SB. So we're going to pass this through our suture here on the outside. And then we're going to shuttle our white tensioning sutures and our blue passing sutures through the knee here. As you're doing this, you're going to have one hand pulling through the sutures through the femoral tunnel and your other hand holding on to the the graft. And the extra suture in order to feel the tension as the graft is passing, as we're getting ready to pass our tightrope, SB, we have one hand holding our tensioning and passing sutures and our other hand holding the trailing sutures. This allows us to keep the tightrope sb lengthened as we pass this through. We've also switched our scope to the 70 degree so we can watch this go up our femoral tunnel. So again we're holding both ends of the tightrope. We're watching it up the tunnel. We can see it just passed through and we could feel it flip right there. And the other thing we can look at is we can see our mark that we made. On the sutures, which is also a second way to check that we're at the same length to flip that tightrope. Sb now, to deploy our tightrope SB we can either pull on the implant or pull on the internal brace, as you can see here and now, if I go to pull on my graft, you can see that tightrope is flipped and it's not going anywhere. One nice advantage of the tightrope SB is that once we've flipped it, if we're not happy, or for some reason, we've flipped it on the outside of the Iliotibial band, we can actually elongate it and flip it by pulling tension on both sides of the suture, and we can watch it unfold and we can see we can pull it back down our tunnel and we can start all over. So this is a very nice advantage, which we can't do with our metal tightropes. And you can watch this go flip one more time again, holding both sides of the tightrope. Now that our tightrope SB is flipped on our lateral femoral cortex, we're going to shuttle our graft up into the knee. We'll watch it kind of go up into our femoral tunnel. And here comes our beautiful hamstring. Quadrupled graft link. And see our internal brace here. So graph going into our femoral tunnel we have marked it at 15 to 20mm. So we know how far to pull it in okay. So we have our graph passing to our femoral tunnel. Now we're going to pass it into our tibial tunnel. As you can see here. We're going to keep our tiger trailing sutures outside of the passing suture. We're going to send these down our tibial tunnel. We'll pull some of the slack out of our internal brace suture. And again, we've left behind our trailing suture because that's what allows us to pass our soft button in an elongated fashion. We can remove our femoral trailing suture at this point, because that side has already been docked, and we will hold some tension on our tibial trailing suture as we reduce the graft into the tibial tunnel. Now that our tightrope SB is outside of our tibia, we can remove our tiger trailing suture and our blue passing suture. Now we're ready to tension this inner tibial tunnel. So I have a small hemostat here to take some of the tension off our tightrope, SB, as we provisionally take some of the slack out of it so it doesn't bunch up too much. It'll allow it to lay a little bit more flat when we get down to our tibial bone. Now you can actually put a little pressure on that button and kind of flatten it or pancake it out on the tibial bone. So it lays a little bit flatter as we completely deploy it. And our final tensioning. So now we are going to fix our save sutures from our graph prep, along with the internal brace in our 4.75mm swivel lock anchor. So we have our swivel lock in that has fixed our saved sutures from our graft as well as our internal brace, and we can cut those and then we can still retension our tightrope SB on both the tibial and femoral sides to complete the procedure. So here's our final construct. We have our graph link ACL with tightrope SBS on both our femoral and tibial side with an internal brace technique.

GraftLink® ACL Reconstruction Using the TightRope® SB Implant for the InternalBrace™ Technique

At the Orthopedic Technology and Innovation Forum (OTIF), John D. Adams, MD (Greenville, SC), reviews the latest literature highlighting trends in the surgical management of intertrochanteric fractures and the associated clinical outcomes.

Intertrochanteric Fractures: Literature Review on the Management of Intertrochanteric Fractures

OrthoPedia: Intertrochanteric Fractures: Literature Review on the Management of Intertrochanteric Fractures

What's NewJUN 12

MPFL Reconstruction Using the Onlay MPFL Implant System With the FastThread™ Interference Screw

What’s New This Week and Prior

JUN 11

Proximal Humerus Bone Marrow Aspiration

JUN 10

Lapidus I-Beam Plate Animation

JUN 9

Femoral Neck Cam Resection Using the Hip DiamondCut™ Burr

JUN 8

QuickPass™ FiberTape® Cerclage System

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Patient

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What's NewJUN 12

MPFL Reconstruction Using the Onlay MPFL Implant System With the FastThread™ Interference Screw

What’s New This Week and Prior

JUN 11

Proximal Humerus Bone Marrow Aspiration

JUN 10

Lapidus I-Beam Plate Animation

JUN 9

Femoral Neck Cam Resection Using the Hip DiamondCut™ Burr

JUN 8

QuickPass™ FiberTape® Cerclage System

NanoNeedle™ Scope 2.0 Gains National Spotlight Through

Star MLB Pitcher's Recovery

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Medical Education

Corporate

Corporate

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Resources

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Patient

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