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John Zvijac, MD (Miami, FL), demonstrates the use of the NanoNeedle™ scope 2.0 and the PassPort Button™ cannula with auxiliary lumen for Nano shoulder arthroscopy labral repairs.

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Labral Repair Using the NanoNeedle™ Scope 2.0 and the PassPort Button™ Cannula With Auxiliary Lumen

Speaker  Hi, I'm John from Miami, Florida, and today we're showcasing a label repair technique using the Nanoneedle scope 2.0 and the accessory Lumen Passport. This setup allows for ultra minimally invasive access and enhanced maneuverability. We've already established our portals, and the accessory Lumen Passport is positioned to facilitate suture management and instrument passage. You'll see how this design improves efficiency and flexibility during the repair. Here is what the accessory Lumen Passport looks like. We have a center hole for instrumentation, and then there is an accessory lumen, which allows for passage of a multitude of micro instruments for suture management. Here we see the nanoneedle scope in the posterior shoulder portal and the accessory passport lumen anteriorly in a rotator cuff interval. A little pro tip the accessory portal. If you can leave this inferiorly or posteriorly, it makes it a little bit easier for suture management. It's not that big of a deal. You can always put it in any position, but that's a little pro tip to help as you're moving this along. You can see the soft tissue bankart lesion that's occurred. This is the labrum all the way down. And we're well past the 6:00 position to allow for bringing the capsule both superiorly and laterally onto the articular surface. The labrum often falls not only medially but inferiorly while you're doing these type of surgeries. Speaker  So it's important to free all of this up for proper mobilization and tensioning. We'll be repairing this labral tear with the 1.8mm knotless fiber tack anchor. This is being done through the central lumen of our passport. And now we're going to pass the suture retriever through the accessory portal in our passport. You can see it coming through, and we can easily pass our stitch with the use of a scorpion through our central portal. And now we're going to just easily shuttle our loop stitch through our center portal. And now we're ready for shuttling a repair stitch. Keeping very nice suture management, preventing entanglement of the stitches intra articularly. We're going to take this stitch out through our center hole to allow for final cutting of the stitch. Here we're using the flush cutter, and we can just bring this down to central portal. And we can cut our stitch flush. And we're ready for the next stitch. The repair is completed with precise suture placement and minimal disruption to the surrounding tissue. The accessory Lumen Passport enhances suture management and expands our instrument options for suture passing during a label repair. Combined with the Nanoneedle scope 2.0, we're moving closer to an ideal solution for the ultra minimally invasive arthroscopy.

Labral Repair Using the NanoNeedle™ Scope 2.0 and the PassPort Button™ Cannula With Auxiliary Lumen

Sanj Kakar, MD (Rochester, MN), shares how the NanoNeedle™ scope 2.0 can aid in visualization during wrist arthroscopy procedures.

SpeedPearl: DRUJ Arthroscopy Using the NanoNeedle™ Scope 2.0

Speaker  The trampoline hook and suction test provide an indirect assessment to the foveal insertion of the Tfcc, which is the most important static stabilizer of the Druj. Given how tight the DJ is, the Nanoneedle provides an ideal indication for its use to examine this space and the Foveal insertion of the Tfcc. Using the percutaneous kit, you can access the DJ in a safe and efficient manner.

SpeedPearl: DRUJ Arthroscopy Using the NanoNeedle™ Scope 2.0

At the Orthopedic Technology and Innovation Forum, John J. Christoforetti, MD (Bethesda, MD), and Benjamin G. Domb, MD (Chicago, IL), review the evolution and application of knotless all-suture anchor technology in hip arthroscopy, highlighting its advantages in reproducibility, safety, and adaptability to the anatomical constraints of the hip joint.

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Femoroacetabular Impingement (FAI) and Labral Tears: Literature Review on All-Suture Anchor Outcomes in Hip Arthroscopy

OrthoPedia: Femoroacetabular Impingement (FAI) and Labral Tears: Literature Review on All-Suture Anchor Outcomes in Hip Arthroscopy

The Arthrex ElbowLOC® positioner is a modular, upper extremity positioner that gives the surgeon the choice of supine, lateral, or supine-suspended positioning for elbow surgery, as well as a wrist traction device for wrist and hand arthroscopy. The ElbowLOC positioner is easy to use and set up, and housed in a space-saving single autoclavable tray.

The Arthrex ElbowLOC® Elbow and Wrist Positioner

The Arthrex ElbowLOC® Elbow and Wrist Positioner

The Arthrex Graft Gun features an optimized design for enhanced visualization of graft delivery during minimally invasive and tubular spine surgeries. It is validated to deliver 100% autograft chips.1
Reference
1. Arthrex, Inc. Data on file (APT-1022220). Naples, FL; 2025.

Arthrex Graft Gun

Arthrex Graft Gun

The MaxForce™ MTP fusion system features a unique gear mechanism along the plate, allowing for controlled, dialed-in compression across the joint. Featuring 18 different plate options of varying sizes and curvatures for primary and revision cases and multiple Arthrex plating-screw and cross-screw options to best address patient needs and anatomy, the MaxForce MTP fusion system provides a comprehensive solution for 1st MTP arthrodesis.

MaxForce™ MTP Plating System Features and Benefits Animation

MaxForce™ MTP Plating System Features and Benefits Animation

Julie Bishop, MD (Columbus, OH), demonstrates the innovative bone block cerclage surgical technique for securing a distal tibia allograft to the anterior glenoid for treatment of critical glenoid bone loss. This subscapularis-sparing arthroscopic cadaveric demonstration shows the procedural steps and technical pearls for safe and reproducible metal-free fixation of the bone graft using interconnected FiberTape® cerclage sutures.

Bone Block Cerclage With Distal Tibia Allograft Surgical Technique

Bone Block Cerclage With Distal Tibia Allograft Surgical Technique

The BioACL™ technique augments ACL reconstruction with an unmatched combination of the patient’s own biology, the highest-quality biologics, and the proven technology of the QuadLink™ technique with the InternalBrace™ procedure to maximize healing potential.&nbsp;
 
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.

BioACL™ Technique Animation

The bioassay technique enhances ACL reconstruction by integrating next generation Orthobiologics to improve functional outcomes and reduce tunnel widening. Begin by performing a bone marrow aspiration from the proximal tibia, which will be processed using the Angel system. The Angel system uses proprietary 3D sensor technology to develop a customized, patient specific formulation of CRP from BMA. Prepare for Autograft bone collection by connecting the Graphnet device to suction and an arthroscopic shaver. Identify the desired femoral tunnel location and advance the flip cutter three reamer. Introduce the arthroscopic shaver with the graphnet tissue collector attached into the joint and ream the femoral socket while collecting bone debris, The autologous bone debris will be collected in the graphnet sterile chamber. This autologous tissue is highly viable, demonstrating osteogenic significant capacity. Transfer the collected autogenous bone to a sterile dish and add five cc of pure demineralized bone matrix. Titrate three cc of c PRP from BMA prepared with the angel system into the dish. The bio composite mixture is complete and ready for delivery. On the back table, prepare the quad link ACL graft. Elongate the femoral tightrope to ensure the quad link ACL graft sits outside the joint after passing the femoral tightrope button. This positioning allows clear visualization of tunnel fill. The tightrope two implant is preloaded with fiber tape. Suture for the internal brace technique. Begin ACL graft passage by pulling in the femoral tightrope button through the socket and flipping onto the cortex with the elongated femoral tightrope. The quad link ACL graft should be sitting outside the joint from the medial portal, insert the delivery cannula preloaded with the ACL composite and completely fill the femoral tunnel, then move to the lateral portal and deliver the composite into the tibial tunnel. The bio composite graft compresses around the quad link ACL graft. Fully filling both tunnels with this composite has demonstrated a reduction in tunnel widening. Post reconstruction. Fully seat the quad link ACL graft into both femoral and tibial tunnels. Complete internal brace. Final fixation in full extension. After cycling the knee several times, complete femoral and tibial tightrope. Final tensioning.

BioACL™ Technique Animation

The Arthrex Knotless 1.8 FiberTak® soft anchor is our smallest knotless anchor option. This animation demonstrates the unique tensionable knotless technique for arthroscopic glenohumeral joint instability. With a curved guide and 1.8 mm flexible drill, use the Knotless FiberTak soft anchor to create a small, low-profile knotless repair.

Shoulder Labral Repair With the 1.8 Knotless FiberTak® Soft Anchor

The Arthrex knotless FiberTak soft suture anchor is designed with a unique tension able knotless technology, allowing the user the ability to control and tension the repair under direct visualization. A curved guide is introduced through a cannula. After locating the position on the bone surface. A flexible 1.8mm drill is introduced to create the bone socket, leaving the guide in place. The knotless FiberTak anchor is inserted and impacted until the handle is flush with the guide. Remove the handle and drill guide, leaving the number two repair suture and two shuttling suture. Set the anchor by grasping all suture limbs and pull at a slow, consistent pace until the anchor is firmly set in bone. Retrieve the repair suture through the anterior-superior cannula with a suture retriever. Using a QuickPass SutureLasso, pass a nitinol wire loop through the labrum. Retrieve the wire loop and insert the repair suture through the wire loop. The wire and suture are retracted back to the tip of the lasso and shuttled through the tissue. Retrieve the repair suture and the looped end of the two shuttling suture. Load the repair suture through the suture loop. Fold the repair suture limb at the indicator mark on the suture. Pull the tape end of the shuttling suture to shuttle the repair suture. Use repeated light tugs to pass the repair suture through the knotless mechanism. Continue to tension the repair suture until the desired repair is achieved. The suture tail is cut flush, creating a secure, low profile knotless repair.

Shoulder Labral Repair With the 1.8 Knotless FiberTak® Soft Anchor

At the Orthopedic Technology and Innovation Forum, Paul Brady, MD (Knoxville, TN), discusses key diagnostic and surgical principles for managing subscapularis tears and associated biceps pathology, emphasizing improved visualization techniques, knotless anchor repair methods, and strategies to optimize healing.

Managing the Subscapularis and Biceps Tendon

OrthoPedia: Managing the Subscapularis and Biceps Tendon

Rachel M. Frank, MD (Denver, CO), demonstrates the Synergy Power™ system.

Synergy Power™ System Product Demonstration

I'm Doctor Rachel Frank, a sports medicine and shoulder surgeon from the University of Colorado, and I would like to provide an overview of the Synergy Power system. This system was designed and developed in-house by Arthrex Product Development engineers, and is assembled at the manufacturing facility in South Carolina. I'm excited to walk you through the system and my favorite features of Synergy Power. The Synergy Power system is a medium and large bone system comprised of two handpieces, a dual trigger rotary drill, and a dedicated sagittal saw. These two handpieces are designed to cover a wide range of orthopedic applications, including sports arthroplasty and trauma procedures. Both Handpieces are ergonomic, lightweight, and durable, making them easy to use and comfortable for all hand sizes, even during long and complex cases. My favorite feature of the drill is the twist collet mechanism. This design is intuitive and allows for attachments to be quickly changed during a case. This feature saves time in the O.R., which increases our efficiency and creates a smoother experience not only for me as the surgeon, but also for the staff. Synergy power includes a comprehensive attachments portfolio for all drilling, reaming, sawing, and burring needs. The system will offer keyed and hybrid drill chucks and three different sized wire and pin drivers for optimal wire or pin retention. With the three different sizes clearly labeled S, M, and L, one features that you no longer have to adjust the attachment to accommodate your pin. So for example, here we have the medium attachment for the wire. Pin driver easily pops in and you can see that this tells you exactly what size that you're able to use in terms of your K wires. And for example, we'll place a two for k wire into the attachment. And that's all you need to do. And if I move around or the scrub nurse or scrub techs handing me the drill, I don't have to worry about the pin falling out, getting lost on the floor and having to scramble for another pin or another wire. We'll take the pin out when we're done and say we want to. Now put in a smaller pen, simply use the twist mechanism. And now we're going to use the smaller attachment. And we can see it's clearly labeled with an S. Easy to pop in. And we'll take a smaller wire in this case. And again as long as it's within the size that this particular attachment allows which is very clearly labeled, you no longer have to worry about where your pins or where your wires are going. And this makes it so much easier for both you and whoever's handing you the instruments. There are also two attachments micro, sagittal and reciprocating for making smaller cuts. Various other attachments along with several attachments, including a Hudson modified Trinkle reamer. The drill and ream functionalities are built into the attachments, so I don't have to switch between drill and ream modes during a case, and in general, I don't have to use as many handpieces when operating. Synergy power is all about providing greater ease of use, flexibility and ultimately cost savings. Now moving on to the sagittal saw. This handpiece is intended to be used for heavy duty cutting, and my favorite feature is the open hub design. No more blind insertion, as this design allows for easy visualization and confirmation of blade placement. As you can see here. Take the blade, push the button, insert it and done. Very easy. You can see exactly what you're looking at, and you don't have to guess that the blade is fixed. In addition, this ensures that the area has been properly cleaned after undergoing sterilization because you can see into every nook and cranny quite easily. The SOC features an indexing head that rotates every 45 degrees. Offering eight different cutting positions, and comes with a wide variety of large sagittal blades to meet all sawing needs and preferences. Next, let's discuss the Synergy Power battery packs and charger. The battery packs are sterilizable and offered in both a small and large size. Small for light duty procedures and large for heavy duty procedures. The charger has a simple user interface to easily determine the state of charge and offers fast charging. Charging a small battery pack in up to 30 minutes, and charging a large battery pack in about 120 minutes. One of the most unique features of Synergy Power is that this is a modular system with two handpieces. It has everything you need, but takes up so much less space than you're used to. That's better for your surgery center, better for speed, better for your entire team. This system is going to save money and be more efficient, which is going to make you as the surgeon and your team at the surgical center much more happy and ideally provide cost savings to the entire system. Finally, Synergy Power, of course, fits in nicely with Arthrex synergy family of products. Overall, Synergy Power is a powerful, versatile, and reliable powered instrument system, and I encourage you to experience synergy power as soon as possible.

Synergy Power™ System Product Demonstration

This animation demonstrates unicondylar knee resurfacing using the iBalance® UKA system, which helps improve operative efficiency due to the expanded flexibility provided by the new adjustable spacer block.

iBalance® UKA Technique

iBalance® UKA Technique

Marc W. Gerdisch, MD (Indianapolis, IN), demonstrates his preferred thoracotomy closure technique with FiberTape® sternal closure using a dual-tensioner approach. He highlights the advantages of FiberTape Cerclage, noting its broad footprint helps reduce the risk of bone cut-through compared to traditional suture, while the enhanced closure method minimizes the potential for lung herniation.

FiberTape® Sternal Closure for Rib Approximation After Thoracotomy Incisions

I'm Mark Curtis. I'm chief of cardiothoracic surgery at Franciscan Health in Indianapolis. We're going to show you our method for using the fiber tapes for Rib approximation in any size thoracic incision. So for anyone who does thoracotomy surgery, whether that be lung surgery or minimally invasive valve surgery, no matter what size incision you make, if you make an incision in the intercostal space and you spread the ribs even a little bit, you are then vulnerable to lung herniation. So for folks who have been doing thoracotomy surgery of any variety for a long time, they've encountered a lung herniation at some point. So what we've been doing now is using the fiber tapes for our rib approximation for any thoracotomy. We do that as a figure of eight. We use the blunt tip needle, and we always start at the middle and work our way out. So in this case I'm going to use two figure of eights. And the first one will go here below this rib. And then the second is going to go a little bit farther medial. And we can really travel. We can cover the whole space of the incision. So one of the things that you'll notice of course, about the fiber tapes is they're considerably wider than the heavy suture that we would typically use. And that gives us a couple of things. It gives us the power to approximate those ribs as much as we choose. We don't want it too tight, but we want to bring them together. And then also because they're wider, they're much less likely to cut through the rib when you tighten them down. So we have the ability to be a little bit more vigorous with the tension on the closure than we would with suture, because it won't cut through or it's less likely to cut through. And also you're going to see that it's a titratable amount of tension so that we can really decide just how tight we want it and how close we want the ribs when we finish. So now we're finishing our figure of eight. We're going to come around. We started in the middle, worked our way out medially and again. This could be for any size incision. Then our final bite takes us back laterally to where we started. So take another tape and then again starting toward the center of the incision. We'll pack our first pass. Next bite is going to go way lateral out toward the end of the incision. Another lateral bite. And then we're going to finish in the middle again. So now we've got our fiber tapes in position. And we're going to go ahead and start to pass them through. So we can take all our retractors out. So we've passed the tail of the fiber tape through the little cinch knot that's built into it. And Then if we just want to take some of the slack out, we pull up on the one that's farther medial, the farther past that we did earlier of the same suture we pull up on that, we go back and forth a little bit and we get them close together. And again, same thing. Pull up here a little bit. We'll grab this side. We're work that down a little bit now. So now you can decide how you want to approximate this. We can do this by hand just by doing this. And the ribs have come together quite a bit already. So again here push that down. Pull this back so it can be done most of the time completely to close that way if you want to. But you can also go ahead and use the Titratable tensioner so that you can set the amount of tension that you're going to have on the sutures as you approximate the ribs. And I think this is the ideal way to do it, really, because it is more powerful if you tighten it all the way. So you have to be cautious Yeah, but it also is something you can do in small changes. So I tighten this a little bit. So the tensioner allows us to kind of titrate the amount of force that we're putting on there. We can feel the space between the ribs. We don't want the ribs right together because we don't want them to rub against each other. That can actually cause pain for the patient. And then you can have your assistant hold this one and then take the second tensioner. The fibertape is passed up from the tip of the tensioner. We aren't separating the tapes. There are two strands. The two strands go all the way up through the wheelhouse here. And then as I turn the handle, the wheelhouse turns and it closes the space. So now I can feel in there. I've got just about a finger breadth of separation there, and we're going to stop there. So and the different surgeons will want this, you know, different approximated differently with greater tension. But this is fine for us. We've got it nicely closed there, and then we release the tensioner and then we cut these strands. And we tie on top of our slipknot. So there's a slipknot that's built into it that's already there, that holds. So it's not moving. And then just in order to secure it, I'll put three knots on top of that and then we'll cut this one. So here I can feel and I have my gap here that I think is reasonable, which is just barely maybe the height of my, my index finger. And so the ribs aren't rubbing together, but there's also not a gap there that would pose a problem later. We put three knots on top of that and we cut both of those. And then that's our closure for the inner space.

FiberTape® Sternal Closure for Rib Approximation After Thoracotomy Incisions

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

Noman A. Siddiqui, DPM (Baltimore, MD), demonstrates a minimally invasive Akin osteotomy using a controlled percutaneous wedge cut to finalize the great toe alignment after bunion correction. Under fluoroscopic control, specialized burrs and a 3.5 mm bevel screw are used to main stability, while preventing soft-tissue trauma.

Minimally Invasive Akin Osteotomy for Bunion Correction: Surgical Demonstration

Speaker  To complete the hallux valgus correction. I always perform the osteotomy, and when I say always, I mean it nearly 95% of the time. I recommend performing the osteotomy to complete this. In this case, it's demonstrating a good example of a halux interphalangeus deformity, which contributes to the valgus position of the toe. So it's definitely indicated. But in general, after you do this correction, you want the toe to sit straight. That's what the patient sees. And it provides not only a clinical outcome that's better, but for the patient a cosmetic outcome as well. For my osteotomy, before I even make the cut on the bone, I get my wire started in the trajectory I would like to place my fixation. I utilize my incision that I use for the osteotomy of the metatarsal, and guide that 1.4mm guide wire to the base of the proximal phalanx. As you see here. Once I'm satisfied with the position, I advance it just a little bit X-ray, so it perches into the condyle there, and then I leave it there. And then I, in my mind's eye will think about an osteotomy perpendicular to the long axis of that wire. As you can see, I've placed the wire into the base of the phalanx. I've confirmed my position, the lateral view. And what I'm going to do with the osteotomy. The common error is to dorsiflex the phalanx. Once I complete the osteotomy, I want to make sure I keep it neutral to slight plantar flexion so I don't create an extension deformity of the phalanx itself. Speaker  I like to make my incision at the metadiaphysis of the phalanx. This gives me the benefit of the cortical strength as well as the metaphyseal bone for healing. And it allows me to greenstick the osteotomy really well. So my incision is made right down to bone, relatively percutaneous. I deepened that incision with a hemostat, and then I introduced the burr. The burr I'm utilizing in this method is the Shannon burr, which is two by two millimetres by 13mm. And I try to use this to complete the osteotomy in the dorsal planter and medial cortex while leaving the lateral planter hinge intact. Now, when you're completing the osteotomy, this can be done in a straight transverse fashion X-ray where you're doing a transverse osteotomy. You can oblique it through the same incision X-ray and create a larger wedge. Or you can orient this in a pattern that works for your screw fixation, but I try to be near perpendicular. And you can see here that that wire is going to be perpendicular to the the cut of the burr. I pinched the skin to move it away from the burr. A little reminder though our irrigation is not active, it is critical to all mis procedures. I've completed the dorsal portion of that cut. I'm going planter to complete that planter cut, and at this stage I want to make sure I hinge on that cut. Speaker  And I can test that initially by putting manual compression right at the osteotomy site and then take an X-ray X-ray. You can see I'm able to hinge that open X-ray, and then I can hinge it close X-ray. And if I want to kerf it just a little bit, I place the burr back in. And like I said, I want to hinge a little planter. So I'm going to make sure I'm removing a little bit more bone plantarly. And then I bend it a little bit more X-ray. I can see that I'm getting my correction. And at this point, I oscillate my wire and I'm making sure the toenail is sitting straight ahead. Oscillate that please. So let me see this. At this stage we've near perpendicular to our osteotomy line. And I can manually compress on this to kind of smush this corner X-ray. And that's what our compression will be. At this stage you can fixate with a non-compressive beveled screw or a compressive 2.5ft screw. I prefer minimal compression at this level. So I'm going to utilize the 3.5 beveled feet screw. At this stage you can see we've corrected the mechanical axis of the first metatarsal. We've corrected the halux interphalangeus deformity in the phalanx. And what the benefit of this correction is the soft tissue realignment at the extensor tendon at the capsule, and a more rectus digit, which is minimally invasive, cosmetic in appearance and allows the patient to weight bear immediately.

Minimally Invasive Akin Osteotomy for Bunion Correction: Surgical Demonstration

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