The combined use of CeMend™ molds and spacers allows for complete customization to create a mono block spacer for complex revision cases.

Arthroplasty Shoulder

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CeMend™ Spacer Molds With Arthrex Bone Cement for Two-Stage Revision

The arthritic cement shoulder spacer system, including molds and arthritis. Bone cement provides customized spacer solutions for complex revision cases. The external frame is used to securely hold the selected mold. Two humeral head size options provide a smooth articular surface. Six insert options are available for varying mold sizes. The customizable molds allow for 46 different configurations between four stem diameters. Nine stem lengths. And two head diameters. The metal core is standard and available in all sizes. The optional extension may be added if additional reinforced length is desired. Using the Arthrex Virtual Implant Positioning System, bone defects found in complex revision cases with existing metal can be visualized using metal segmentation and revision planning. To maximize efficiency. Assembly of the spacer mold and mixing of the cement by an assistant may take place during the removal of the preexisting prosthesis, at the surgeon's discretion. To begin building the spacer. Place the selected insert into the external frame. The accompanying mold is placed into the insert. At this time, an optional metal core extension can be placed under the existing metal core, followed by the selected head diameter. The set screws are then used to close the external frame, which is now ready for cement. The Arthrex bone cement kits include the necessary materials to mix and inject cement into the assembled mold. To begin mixing the cement, place the funnel on the mixer. Empty the first ampoule into the mixer. Both cement packets are poured on top of the liquid. The second ampoule of liquid is added last. Using the plunger, mix the cement for about 45 seconds. Once proper consistency is reached, remove the plunger cap and bass from the mixer to assemble the gun plunger. Inject the cement into the prepared mold to the desired length of the spacer. Wait for cement to harden completely. After the cement has polymerized, remove the prepared mold and remove any excess residue with a rasp or Roger. The final spacer is ready to be inserted into the humeral canal. If infected bone voids exist in the glenoid side, the calcium sulfate bio beads can be used as a bone void filler that is resorbed and replaced with bone during the healing process.

CeMend™ Spacer Molds With Arthrex Bone Cement for Two-Stage Revision

John M. Tokish, MD (Scottsdale, AZ), demonstrates the CuffMend™ technique using a biceps tendon autograft prepared with the Autograft Tissue Compression System and fixated with FiberStitch™ RC and Self-Punching PushLock® anchors. View the graft preparation video <a href="https://www.arthrex.com/resources/VID1-006270-en-US/graft-preparation-for-auto-cuffmend-augmented-rotator-cuff-repair">here</a>.

Shoulder

CuffMend™ Augmentation Technique Using a Biceps Tendon Autograft

My name is J.T. Tokich from the Mayo Clinic in Scottsdale, Arizona. And today we're going to be demonstrating for you an augmentation technique using the patient's own autograft biceps smash using the Arthrex autograph compression device. So you can see that we've been able to harvest about 40mm of tendon. This gives us plenty of length for our biceps to smash, because what we want is about 27mm of tendon for the patch. Once that you're happy that the graft is nicely centered within the tissue plate, we simply cover it. And then we're going to load it on top of the biceps smash press. Once that's done, then we will start with putting the tension down. We're then going to leave that at the max point for four minutes, and the graph then will stay compressed. Once we've given it that four minutes, we're going to loosen it up and the patch is ready to go. The patch is beautifully formed. Now we have to just load it onto the introducer with the graph now prepared and we're back inside, you can easily see the repair that we did viewing from the From the back side portal. One of the things we've learned is that it's better to come in fairly low and parallel. So for the standard placement of the biceps smash autographed patch, we will generally make in addition to this standard lateral working portal, one additional anterolateral portal that you can see is placed by the passport cannula here. This will allow the graft spreader with the patch to sit on top, so viewing from the outside you can see the graft and the graft spreader is prepared nicely. And then all we have to do to insert it is simply slide the wheel back. And this allows us then to enter into the passport. Once it's inside the shoulder, we're going to bring it directly into the top and center it upon the place that we want to be. We can then open the graft here and set it exactly where we want the graph to go. So oftentimes the medial row can be fixed by using standard anterior cannula which we're demonstrating here. I prefer to use simple stitches so that it puts a little bit of tension on the graft. So my first stitch is going to be to come inside of the purple line. I'm going to come in and cheat just inside that, and then we're going to insert the FiberStitch RC until it goes down to the depth stop. Once it's there, I will rotate backwards outside. You can see this until I get a very satisfying click. I then simply go forward and then my second arm of this is ready to be deployed. I back this out. I'm going to come and use this guy over the top of the front side. That guy drops in and I send my FiberStitch wheel back again. And this deploys the second pledget and then we all we have to do is remove the FiberStitch. This gives us a loop and a double mattress. I'll turn my attention to the free end of the suture as shown here on the outside. I then simply have to pull this guy down. It's the second limb of our mattress stitch, and it will allow us to come in and compress. This gives us an excellent first anchor stitch medially on the patch. We then bring the tensioner cutter and this will give us a FlushCut down against the patch. We're now going to repeat that step for our second FiberStitch I back this guy out, I'm going to just simply come over the top of the patch again. Again, coming just over the top so I can secure with a medial stitch right over the top on the other end of this. Once I feel like I've got that patch down, I simply bring the other limb of the mattress suture in place and it will cinch that down completely. Once I've gotten that, we're going to cut the excess edge. Additional stitching is quite easy. One could remove the tissue passer, which is what I generally do now. We can bring the spreader completely out and now we have our patch in place. Two stitches we found is plenty to do this, but if you want to really spread out the graft or if you want additional fixation, we found that this technique of throwing in some of the extra stitches has been an excellent way to really spread out the graft over the top. Now I've got a fourth stitch, one on the outside corner. There's our third stitch symmetrically on the anterolateral aspect for the lateral row. We want to be able to be just slightly distal and lateral to where the patch will naturally step down. You're now getting into pretty hard cortical bone. So we felt that that was best done through the traditional lateral portal. And so I'm going to have to retrieve our stitch through this passport. We're now simply going to load it on our PushLock. You can see we have the Self-punching PushLock for our lateral row. Now one thing that's important is that we leave some slack in this lateral row so as not to over tension it on the patch. So what we like to do is pass point quite a ways to leave this slack in place and then come back. And we can always take up slack. Then this guy can be punched in directly. This nicely restores the patch directly on top of the tendon. We then cut the excess suture off the graft and our posterior lateral row is complete. The self-punching PushLock can then again be introduced into the portal. We then decide where we want this PushLock to go, and then we're going to just tap it in. And then an open cutter comes in and finishes up the edge of this. This completes the patch laterally and medially. And you can see that we have now SpeedBridge repair. And it is now augmented by an autographed biceps tendon. It has my favorite configuration of two stitches medial that are simple to spread the patch out one suture anteromedial and one suture posteromedial again, which does a beautiful job of spreading the graft out. And then we've got the critical portion of the rotator cuff repair covered. This is where the tenocytes need to be. And so we want to be in that position. And we've got our posterior lateral PushLock in place and our anterior lateral PushLock in place as well. And this completes the construct and the repair.

CuffMend™ Augmentation Technique Using a Biceps Tendon Autograft

The Synergy exoscope is an autoclavable and reusable 0° 4K scope used to provide real-time visible light and near-infrared (NIR) fluorescence imaging during open surgical procedures.

Imaging and Resection

Synergy Exoscope Imaging

Synergy Exoscope Imaging

John Xerogeanes, MD (Atlanta, GA), demonstrates how to use reusable sliding GraftClamp instruments with the GraftPro® system during a quad tendon ACL reconstruction using FiberTag® TightRope® SB implants. The reusable GraftClamp instruments simplify graft preparation by allowing single-user graft preparation.

Knee

Quad Tendon Graft Preparation Using Sliding GraftClamp Instruments

Quad Tendon Graft Preparation Using Sliding GraftClamp Instruments

The Arthrex ultra-minimally invasive endoscopic spine portfolio is a comprehensive solution that includes enhanced visualization with the Synergy camera system and operative endoscope, ergonomic WishBone™ and ring-handled instrument options, a steerable electrosurgery probe, and an endoscopic instrumentation system.

Spine

Arthrex Ultra-Minimally Invasive Spine Portfolio Overview

Arthrex Ultra-Minimally Invasive Spine Portfolio Overview

Asheesh Bedi, MD (Chicago, IL), discusses the evolution of inlay to onlay procedures and relates the progress to knee procedures using all-soft implants.
To learn more about inlay vs onlay literature and applications, read the <a href="https://www.arthrex.com/resources/DOC1-001585-en-US/inlay-vs-onlay-meniscal-repair-and-ligament-reconstruction?objectID=human.resource.en.e3224bf8-c6b3-4362-a73d-02891a13ba21.3&amp;queryID=ded5d0f4f84a213c82e3f2f0638d86d2" title="https://www.arthrex.com/resources/DOC1-001585-en-US/inlay-vs-onlay-meniscal-repair-and-ligament-reconstruction?objectID=human.resource.en.e3224bf8-c6b3-4362-a73d-02891a13ba21.3&amp;queryID=ded5d0f4f84a213c82e3f2f0638d86d2">scientific update.</a>

 Inlay vs Onlay for Knee Repair Surgery: What Does the Data Tell Us?

&nbsp;Inlay vs Onlay for Knee Repair Surgery: What Does the Data Tell Us?

G. Russell Huffman, MD (Orlando, FL), reviews key literature supporting biologic rotator cuff augmentation in addition to discussing how graft choice may affect retear and reoperation rates.&nbsp;

Hidden

Rotator Cuff Tears: Literature Review on Graft Options for Rotator Cuff Augmentation

OrthoPedia: Rotator Cuff Tears: Literature Review on Graft Options for Rotator Cuff Augmentation

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.

Hand and Wrist

The Arthrex ElbowLOC® Elbow and Wrist Positioner

The Arthrex ElbowLOC® Elbow and Wrist Positioner

J. Chris Coetzee, MD (Minneapolis, MN), demonstrates his surgical technique using the Arthrex DualCompression hindfoot fusion nail, highlighting joint preparation, a step-by-step approach, and how he uses the Arthrex graft gun to deliver ArthroCell™ viable bone matrices.

Foot and Ankle

Orthobiologics

DualCompression Hindfoot Fusion Nail Surgical Technique With Chris Coetzee, MD

DualCompression Hindfoot Fusion Nail Surgical Technique With Chris Coetzee, MD

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

Peter J. Millett, MD (Vail, CO), uses the Knotless 1.8 FiberTak® implant system in a cadaveric demonstration of a knotless Bankart repair. Dr. Millett reviews a range of tips and pearls from portal placement to sequential repair tensioning. Tensionable Knotless FiberTak implants of varying colors provide multiple points of fixation to restore anatomic tension to the glenohumeral soft tissue.

Tensionable Knotless Bankart Repair Using the Knotless 1.8 FiberTak® Implant System

Tensionable Knotless Bankart Repair Using the Knotless 1.8 FiberTak® Implant System

Vincent Hagel, MD (Zurich, Switzerland), performs a unilateral, endoscopic cervical laminotomy for bilateral decompression of central canal stenosis in the cervical spine.

Cervical Central Stenosis Decompression

My name is Vincent Hagle. I'm from the spine center in Zurich, the university hospital, as well as head of a smaller spine unit in Germany. The procedure we will perform today is called cervical endoscopic unilateral laminotomy for bilateral decompression. It's a procedure that is suitable for central canal stenosis in the cervical spine. So we have the patient in prone position in a Mayfield clamp, which is not always necessary. A lot of times a head frame is also suitable. It's important to straighten out the patient, which I usually check with the fluoroscopy in a view to make sure I have the spinous process in the center. Pedicles symmetric to the side. The first step is to define a skin entry point. Therefore we have to mark different lines. First line is midline. Either we mark that by palpation or we do it under Fluoroscopic guidance. That's the floor shot we want to save for midline. Next line is the facet joint line. It's a line along the facet joints usually about a centimeter and a half of midline. So now you see that instrument covering the medial aspect of the facet joints. So that's the second line we want to mark under AP fluoroscopy. So we have defined that facet joint line now. Second line in order to find a crossing point is a line that we take in lateral fluoroscopy through the or parallel to the disc space of our target level. Okay. Chart. So now we have second line parallel to our target levels. Disk space. Our target level is c6 C7. So we mark that line on the skin as well. Now we make more or less a stab incision depending on the size of the of the working cannula. After having made the skin incision. First step is to bring in the guiding rod on to our target level, which is the posterior surface of the facet joint at our level C6, C7. The safest way to do so is under Fluoroscopic guidance in AP, to make sure we really hit that facet joint and don't accidentally slip off toward the canal or lateral of the facet joint. So we place the guiding rod just a little bit. And before we go all the way down. Double check that in AP fluoro to make sure that we are still on the trajectory. Now, you see the tip of that guiding rod pointing towards the facet joint line. So here we are safe, and we can advance the guiding rod down onto that facet joint. Now I have bone contact. So we take another shot to make sure that we're still on that facet joint. And you see again the tip still on the posterior surface of the facet joint. So we're good now with this AP check. And we'll turn to lateral. In lateral position. We double check the position of that guiding rod. And as we see it's on the posterior surface of the facet joint at our target level c67, which is exactly where it's supposed to be from now we can continue with dilating the soft tissue. So after having placed the guiding rod, we use three more soft tissue dilators you carefully rotate them down all the way until you feel bone contact. Now, after having placed that guiding rod, we're using a series of soft tissue dilators. You could also use a switching stick. However, the soft tissue is a little bit tougher in the neck to where a series of dilators are usually safer to dilate that soft tissue. So you introduce that dilator, rotating it down until you feel bone contact introduced the next one and we have one more. Once we have dilated the soft tissue. Next step is to introduce that working cannula over those soft tissue dilators. Again, usually rotating them in is safer than just trying to push them down. The further down, you can push that working cannula onto that posterior surface of the facet joint, the less soft tissue you have in your way. Once you introduce your endoscope now once that working cannula is in place, it's necessary to double check with fluoroscopy the final position of that working tube before we start with the endoscope. So now we see the dilators as well as the working cannula on the posterior surface of that facet joint at our target level. C67. Also I do have bone contact right there to where we are pretty sure to be in the right position with that working cannula. And therefore we can remove our soft tissue. Dilators. Now, after having verified the correct position of the working cannula, we will introduce the endoscope. And the first step is to make sure that we're still on the facet joint. So we'll take any kind of instruments to tap down and make sure that we have bone contact underneath which we do. And typically we do have a layer of soft tissue still covering that facet joint right there. So first step is to remove that soft tissue. Safe way is to use that bipolar just to shrink that soft tissue. If you're not sure that the working cannula is still in the correct position, you might want to verify that with a fluoroscopic shot. However, here we nicely see the facet joint. This is the cranial part of it. Then we have a little bit of a step down before we see down here already the lower part of the facet joint. So we just keep cleaning up that soft tissue until we completely expose the facet joint. And eventually go a little bit towards medial, where we will find the so-called V point. V point is the main landmark that we want to find, which is more or less the interlaminar window. And here you already see the beginning of it. Again we have caudal lamina down here, cranial lamina here. And we have here right in between the inter lamina window, which mostly looks like a V shape and therefore is called V point. Now, since we want to eventually decompress all the way over to the contralateral side, we'll just clean up a little bit more of that soft tissue towards the spinous process to make sure it's not in our way later on when we do the contralateral decompression. Now, to effectively remove that soft tissue, you just go back and forth between cautery and pituitaries. Exactly. So again we have lamina here, lamina here. You see the facet joint moving right here made up with the inferior articular process here, the superior articular process here. And if I push a little bit against it, you see the facet joint moving like the cranial lamina is moving away from that lower lamina right there. So again this is the actually nicely looks like a V shape right here. And that is the V point which again is the landmark. We want to have to start our procedure. Now. Once we get more towards midline we start to see spinous process which we do also want to expose a little bit just again to not have that much soft tissue in our way when we will do the contralateral decompression. I'm just doing a laminotomy like removal of the bone of the lamina. First I start towards cranial toward the upper lamina, and usually at some point I reach the cranial end of the yellow ligament right there. So that's my orientation as far cranial as I want to go now after having done Laminotomy, Ipsilaterally will move over to the contralateral side, undercutting the spinous process and doing a laminotomy over to the contralateral side. Apart from using kerosene punches as we just did ipsilaterally, we alternatively have the option of using burr. Most suitable for the cervical spine is diamond burr, and here we're using a coarse diamond burr to do that. Undercutting. We were finished with performing this contralateral laminotomy, which means we have widely exposed the yellow ligament ipsilaterally from the caudal end all the way here to the upper end and the same over to the contralateral side. Here we have the upper end of the yellow ligament on the contralateral side. And the same thing down here on the lower end. So after having widely performed this laminotomy, Next step is to remove the yellow ligament after bony decompression. Nice view on the yellow ligament. Widely decompressed here. Ipsilaterally. And then over here to the contralateral side. So next step after laminotomy bilaterally is now to remove the yellow ligament. So first step is to detach it just to make sure that no adhesions to the dura to the thecal sac underneath right there. And once it's detached we start at midline with a kerosene sponge to step by step remove it when removing the yellow ligament. I try to not bite all the way down with the kerosene, but just get a good hold on it and then twist it. Try to pull it in order to remove larger pieces at one time. As you see here, it's not just a bite, it's a larger piece of yellow ligament removed, which overall makes the ectomy just more effective and faster. So now we see the lateral edge of the thecal sac right here. We have the exiting route in there in between. And that's the lateral edge here in the upper part. And again here we have the exiting route. Now if I do a forearm anatomy I don't do it now because I concentrate more in the central stenosis on a bilateral decompression first. So we'll come back later. But now you nicely see the dura there. Ipsilaterally widely exposed. Now, usually in a pressurized thecal sac, we would not see the lateral edge, and especially not exiting route on the contralateral side. However, here in the cadaver where the thecal sac is collapsed, we now do see the lateral edge of the thecal sac here. This is already the contralateral bone right there. The pedicle we're tapping. Happing. And this here is the lateral edge of the thecal sac. The same down here caudal of the exiting route. We also have here the lateral edge of the thecal sac. And in between here we have the exiting route running out into the foramen. And when we lift up a little bit of that soft tissue now you can appreciate the exiting route running out there. So after being done with that contralateral phlebectomy we have now widely bilaterally performed the decompression. And we see the complete thecal sac right there from here, the ipsilateral edge all the way over to the contralateral edge. So again we have the lateral edge of the thecal sac here on the ipsilateral side. We go across midline. We have the lateral edge here of the thecal sac on the contralateral side as well, in case we have an associated foraminal stenosis. We can also perform a foramen anatomy. Usually we turn the endoscope 180 degrees around to make use of that off axis view. Looking from medial to lateral into the foramen. And here we see the exiting root running out of the foramen being stenotic right here. So we'll do a little bit more of bony decompression here as a frame anatomy. And we see the facet joint line running along right there to where we have now superior articular process here inferior articular process here. We see the joint actually right here running back and forth here. That's the cartilage of the joint right here of the superior articular process. So we'll just take a few cares and punches along the exiting route right there to also decompress that out into the foramen. So again now we can nicely probe out into the foramen, with the C7 root being sufficiently decompressed. Also, when we turn it back now, we nicely see exiting from the thecal sac the exiting root with some fat tissue up there on the shoulder. That's the shoulder of that exiting root here and down here. We're in the axilla of it. This bilateral decompression procedure is a challenging procedure, especially the contralateral decompression. Therefore, it's level three procedure, especially crossing the thecal sac. To perform that contralateral decompression has to be performed very carefully, because slight compression on the thecal sac can easily cause severe neurological deficits, and therefore a certain amount of experience is necessary before performing this procedure.

Cervical Central Stenosis Decompression

This animation reviews a thoracic transforaminal approach for discectomy procedures, which is performed with the Synergy Vision™ imaging system and a spine-specific endoscope. It also highlights the unique WishBone™ instrument handle, which is designed for improved ergonomics, and FlexTip electrosurgery probe.

Thoracic Transforaminal Endoscopic Discectomy

The endoscopic thoracic transforaminal discectomy approach from Arthrex is an ultra minimally invasive surgery ideal for patients with certain thoracic disc herniations. In this procedure, the endoscope is used to assist in the approach for access and visualization. The patient is placed in the prone position using an orthogonal AP fluoro image. Draw a line at the midline. Then draw a line through the center of the disc. Next, from a lateral view, mark a line to the front of the disc space, giving an orthogonal view of the disc. Mark the apex of the rib, which is the lateral boundary for making the incision point and needle insertion. Insert the needle at approximately 35 degrees, depending on the location of the disc. Pathology. Make an incision along the along the introducer needle. Next, insert the guidewire and remove the needle. Insert the dilators while rotating. Next, insert the cannula while rotating with the open side towards the foramen. Remove the dilators and insert the endoscope. Use the cup graspers and the flex tip bipolar probe to identify bony landmarks and remove soft tissue to expose the foramen. Use a bird to resect a portion of the inferior pedicle to create a working channel for the endoscope and cannula. Next, if necessary, to reach the midline, create a trough from the superior end plate to the inferior end plate through the disc and above the disc in the vertebral body. When the working channel has been created, the space underneath the cord allows for removal of any fragments ventral to the cord using a downward and outward motion. Confirm the decompression has been completed using direct visualization and palpation. The endoscope and cannula are then removed, followed by wound closure and placement of a JumpStart bandage.

Thoracic Transforaminal Endoscopic Discectomy

Anand Vora, MD (Chicago, IL), presents a detailed overview of clinical evidence supporting evolving treatment techniques for insertional Achilles tendinopathy.

What's NewJAN 23

CeMend™ Spacer Molds With Arthrex Bone Cement for Two-Stage Revision

What’s New This Week and Prior

JAN 22

CuffMend™ Augmentation Technique Using a Biceps Tendon Autograft

JAN 21

Synergy Exoscope Imaging

JAN 20

Quad Tendon Graft Preparation Using Sliding GraftClamp Instruments

JAN 19

Arthrex Ultra-Minimally Invasive Spine Portfolio Overview