Fixation for Extra-Articular Pathologies 
• Minimize hardware complications 
• Reduce risk of tunnel convergence 
• Preserve bone stock 
• Facilitate precise handling

Background

Human

Introducing Knee FiberTak® Anchors &nbsp;&nbsp;

Rajit Saluja, MD (Franklin, WI), provides technique pearls for treating a bone marrow lesion of the knee with the IntraOsseous BioPlasty® (IOBP®) procedure. Dr. Saluja mixes AlloSync™ Pure demineralized bone matrix and Angel® concentrated platelet-rich plasma from bone marrow aspirate (cPRP from BMA) to treat these defects.

Orthobiologics

Knee

Not Hidden

English  - en

video

Treatment of a Knee Bone Marrow Lesion With the IOBP® Procedure

I'm Doctor Rajit Saluja, and today we're going to perform an intraosseous bioplastic of the medial femoral condyle. This patient has a bone marrow edema lesion in the medial femoral condyle. We have identified it on an MRI scan. And typically, as we do this procedure, we've already obtained the bone marrow aspirate from the pelvis, typically from the posterior superior iliac spine. This aspirate we typically obtain about 60 cc's. And we use the Arthrex Angel apparatus to obtain the concentrate. This five CCS is then mixed with five cc's of AlloSync, which is the demineralized bone matrix. To that, we combine a cc of contrast which allows us to visualize the injection procedure. Under fluoroscopy, we have the demineralized bone matrix and the bone marrow aspirate concentrate mixture. We've divided them into five one cc syringes. I like to use one cc syringes because if you have multiple lesions, it's easier to subdivide how much total material you have and you can allocate it depending on where the lesions are the largest. We'll start with having our leg in extension. We already completed the arthroscopic part of the procedure. Meniscal debridement has already been carried out. We'll bring the fluoroscopy on an AP view. We'll typically take a spinal needle, find the entry point and take an image. At this point you can see how we're at a good spot here on an AP view. We've already identified the entry point for the injection site, and at this point, we'll go ahead and make a small nick with an 11 blade. This is the Iabp closed tip delivery cannula. I typically use the closed tip because it allows me to fill the lesion more circumferentially. I like to go parallel to the joint line. As you can see, the ends are pointed downwards. Here we'll take our first injection syringe. We'll inject that into the delivery system. Now we'll gradually impact this in. You can see some of the material is coming out on the image. Then I'll rotate the device and get some of the more anterior portion filling. And we'll rotate it some of the posterior portion. We'll withdraw the delivery system a little bit. We'll take another one CC syringe. On the image on the right you can see how the lesion has been filled with the bone marrow concentrate and the demineralized bone. You can get a lot of views at this time. And you can save the images. And you can see how the lesion is filled to your desired goal.

Treatment of a Knee Bone Marrow Lesion With the IOBP® Procedure

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

The enhanced instruments and reduced tray size for the Eclipse™ total shoulder system are designed to provide a cost-saving solution through a streamlined operative technique and reduced back-table footprint.

Arthroplasty Shoulder

Making the Best Even Better: Enhanced Instruments for the Eclipse™ Total Shoulder System

Making the Best Even Better: Enhanced Instruments for the Eclipse™ Total Shoulder System

At the East Coast Foot and Ankle Summit, Katilin C. Neary, MD (Boise, ID), reviews bimalleolar equivalent ankle fractures and the clinical decision-making behind intramedullary nailing and deltoid ligament repair.

Foot and Ankle

Hidden

Ankle Fractures: Literature Review of Bimalleolar Equivalent Fractures

OrthoPedia: Ankle Fractures: Literature Review of Bimalleolar Equivalent Fractures

Prof Dr med Mazda Farshad (Zurich, Switzerland) discusses the case of a 60-year-old male patient who underwent lumbar decompression using a uniportal endoscopic interlaminar contralateral approach at L5-S1.

Spine

Lumbar Decompression via Uniportal Interlaminar Contralateral Endoscopic Approach

Hello, my name is Mazda Farshad, chair of Orthopedics and Spine in Zurich, Switzerland. Today I wanted to talk about the smart solution for nerve root decompression, where the traditional transforaminal approach is not straightforward, such as in the Lumbosacral area. This is the case of the 60 year old male patient with acute right sided radicular pain and weakness due to compression of the L5 nerve root due to an upward sequestered disc herniation from the disc l5-s1. In addition, the patient had L5 lysis and segment degeneration. The diagnosis is a disc herniation that was compressing the exiting L5 nerve root through its upward migration. Located in the macnabs hidden zone. The patient had presented to our emergency department for a second opinion. A spinal fusion L4 to S1 with Tlif l5-s1 on the right side was suggested. Elsewhere, we indicated an endoscopic removal of the compression, as the patient was pain free from lumbar pain and had no other symptoms prior to this event. The risk of necessity of further more invasive procedures in future was discussed with the patient. The decision towards endoscopic decompression was made jointly. Since the decompression was at L5-s1, we identified two potential approaches either the iliac crest approach or the uni portal in the laminar contralateral endoscopic lumbar axis, or euestola to access the macnab's hidden zone. As the iliac approach often requires extensive imaging or even navigation for an efficient approach. We chose the UIC la. There is a zone which traditionally is achieved with substantial bone removal in open surgery, often requiring additional fusion due to the iatrogenic creation of instability. The so-called hidden zone is the intra foraminal zone between the two pedicles of adjacent segment. It is covered by the facet joint with endoscopic approaches. This zone has become more approachable in mid lumbar segments such as L2 three, three four and often L4 five. A standard transforaminal approach with Foraminal Tommy by partial removal of the SAP allows access to this hidden zone. However, in certain anatomical circumstances, traditional endoscopic foraminal approaches is challenging or not possible. This can happen particularly at l5-s1, where the iliac crest occludes the trajectory needed for the transforaminal approach. Even if trans iliac approaches have been described, they often require extensive imaging or even navigation for efficient approach. The Une portal interlaminar Contralateral Endoscopic Lumbar Access, or the UIC LA, is an elegant solution to access the macnab's hidden zone. It includes partial removal of the lamina and base of the spinal process to achieve the contralateral resource and foramen to achieve the contralateral recess and foramen. A dedicated trajectory is needed. This trajectory is different from that of a traditional interlaminar laminar approach with the wrong trajectory, visualization and decompression of the contralateral foramen becomes impossible. The skin incision needs to be more lateral compared to the normal interlaminar approach, around 1.5cm lateral to the midline. The trajectory needs to be at least parallel or even aiming from caudal ipsilateral pedicle to the contralateral cranial pedicle in relation to the disc in the AP view, with the starting point more caudal nearly on the lower lamina instead of the upper lamina or the interlaminar window. The bur is used to create the space over the top of the spinal canal, with removal of the part of the base of the spinal process and the contralateral lamina and IIP, and sometimes sap. After thinning the superficial layer of the flavum and sufficient bony resection, the deep layer of the flavum is removed to visualize the contralateral recess. Often, pathologists, such as disc herniations, are located in the axilla of the exiting nerve root, and those are usually not accessible easily with common approaches. The eudicella allows access without destabilising the spinal segment. Once the lateral resource is accessed and visualized via the interlaminar contralateral approach, the medial border of the dura is identified and followed cranially to find the axilla of the exiting nerve root. Due to the angulation of the approach, the axilla is found by rotating the scope to visualize laterally towards the foramen. Any compressive tissue can be removed easily. Final inspection of the hidden zone includes visualization of the exiting nerve root within the foramen, contralateral recess, and the descending nerve root. The patient presented with reduced pain and improved foot drop in the weeks after surgery. Our postoperative protocol included standard analgesics and some advices for physiotherapeutic treatment. Through this treatment option, the patient was able to avoid spinal fusion.

Lumbar Decompression via Uniportal Interlaminar Contralateral Endoscopic Approach

Thomas Youm, MD (New York, NY), performs a core decompression for avascular necrosis (AVN) of the femoral head using the AVN expandable reamer and AlloSync™ Pure demineralized bone matrix (DBM).&nbsp;

Core Decompression of the Femoral Head Using the AVN Expandable Reamer and AlloSync™ Pure DBM

We are here today to show core decompression of the femoral head for avascular necrosis. The idea behind core decompression is to prevent eventual total hip replacement. We describe a technique that allows for seamless delivery of biologics and bone support into the core decompression tract. These are some examples on imaging of avascular necrosis of the femoral head. We have an x ray AP left hip showing avascular necrosis of the femoral head. Also MRIs both T1 and T2 views of the AVN of the femoral head. The indication for core decompression is to not have any subchondral collapse. In the presence of a crescent sign. You can see the crescent sign on the MRI images on both T1 and T2. We are here at the back table to show you the instrumentation for the core decompression set. We have both reusable and disposable instruments. The disposable instruments include A24 guide pin, A50 reamer, expandable reamer which is torque limited, as well as the application guide for the biologics. For the reusable guides, we have the drill guide with a handle drill guide insert, as well as a t-handle with a torque limiter. Critical part of core decompression is consideration of biologics. These are the biologics that I use. We have the Arthrex, BMA, vortex threaded needle Allison Pure. We have the Kwikset cement. What we do is with the BMA needle draw the bone marrow aspirate, mix it with the Allison Pure to fill the cavity of our core decompression to allow for healing. The quickset is then used to backfill to allow for to prevent leakage of the BMA. This specimen has been prepared with a flush fit cannula inside the joint. We're focusing on the open technique, but we will show arthroscopic pictures of the femoral head in preparation for our technique. I draw my landmarks. We see here is the ASIS with the iliac crest. I draw the inner and outer tables. I'm drawing the anterior femur, posterior femur and the tip, the greater trochanter. I use the Arthrex vortex needle to get my bone marrow concentrate. I do this early in my case so that the bone marrow concentrate is ready to be mixed with the allicin pure to share a pearl that I use to get my targeting and keep the incision small. I lay a guidewire right on top that you can use a 2.4 guidewire from the set. And I want to get my angle. If you can take a c-arm shot here. Another one? Another one. Right. And most lesions are anterior superior. So we'll mimic that in our demonstration today. We are going to draw a line right over the guidewire towards the femur. And that will give us an idea where we're going to start our incision. Next thing I'm going to do to see our starting point is I'm going to poke the guidewire or guide pin right on the femur if you can take a shot there. And another shot there to see on our starting point. So I like my starting point here. I'm also seeing the posterior aspect of the femur where we're going to start a little bit posterior on our incision. I can feel anteriorly, so I know I'm in a good spot. This is where I will center my incision. This will be my incision for our core decompression. So I have my drill guide right on the lateral cortex. And I'm bringing my guide pin right inside. Let's have a shot here. We have our guide pin in appropriate position. As you know, most femoral AVN lesions are anterior superior. You can see we're somewhat superior to the central portion of the femoral head. Now that we have our guide pin in appropriate position on the AP short of the articular surfaces, we're going to check a lateral view accurate targeting of our guide pin into the AVN lesion which is typically anther superior, is critical for this case, with multiple fine adjustments, we see on the lateral view of the hip that our guide pin is somewhat anterior from the center point, which is exactly where we want. Now that the pin is in good position, we are going to take out the drill sleeve and put the cannulated five millimeter reamer over the drill. As we get to the subchondral bone, the bone will feel stronger and more sclerotic. Shot, please. And it's important to make sure you're not engaging the guide pin in the reamer so as to not advance that guide. Pin through the cartilage. Shop, please. Shop, please. Right there. At this point, we're going to advance the stepped five millimeter, five millimeter drill sleeve using our slotted slap hammer. Shot there. Okay. So here we see that the step collar is flush with the cortex. And at this point the sleeve is appropriately inserted. So at this point we will take out the reamer first and then the guide pin. So this is the torque limiting expandable reamer just to show you how it works. This black knob here is to expand it from 6 to 18mm. So to prevent premature deployment of the blades inside the the bone, we hold it right behind the black knob. No pressure from posteriorly on the t-handle and we insert. And we'll confirm with C-arm to make sure that we're at the appropriate position and depth. It's important to note when you use this reamer and start expanding, go up one notch at a time. Have at least a few turns, and if you're feeling a lot of chatter, don't get. Don't prematurely advance too quickly. So here I'm at six millimetres. Turning over to nine. And this is at maximum expansion shot there please. One more time. Good. All right. So now that we're at 18mm, we want to check on the lateral view, which we did to confirm appropriate position. And here what I'm going to do now is I'm going to withdraw this back and still turn to get chatter so that we can create more decompression of that avian lesion. If you can take a calm shot, please. So as we pull this back and keep turning at 18mm, we're creating a larger cavity for filling of our allosyncarpia with bone marrow concentrate. Take a shot, please. And you can hear the chatter shot again please. Good. All right. So at this point I'm going to bring our reamer back down to six and we'll pull this out shot there. At this point with the reamer out, it's a good idea to flush out any necrotic bone and tissue. We use the applicator from our disposable set to insert. Take a shot, please. Calm. One more. Good. I'll remove the inserter at this point. Insert syringe with saline shot again, please. And we'll just flush it out under some pressure. Okay, so this is our 250 millimeter nanoscope needle. We're going to take a look inside our decompression tract and our tunnel to see if we got to the sclerotic bone and necrotic bone. Obviously in this cadaver model you won't see the necrotic bone, but you can see very clearly a very good resolution of the intraosseous space. At this point, we have five CCS of our Allison Pure with five CCS of bone marrow concentrate. I will mix this in a 1 to 1 ratio. I also have the quick set here ready to go. Once we are done with our Allison Pure mixture, we get the quick set ready for backfill preparation. We have our biologics applicator, which we're going to insert into our drill sleeve and we will confirm appropriate depth. I like to be right at the entry point of the cavity. Take a shot please. Good. Take a shot, please. So, right at the entry point of the cavity. I've taken my five cc slurry of bone marrow concentrate and allicin pure and transferred to one cc syringes, which we have here. These will secure themselves to our applicator, and we'll start injecting in the beginning. There's not much resistance because we're just filling our applicator. But once we remove once we insert our plunger, we'll start to see this mixture go into our decompression tract. So I recommend using the plunger slowly so as not to penetrate the articular surfaces in case there's any chondral fissuring. Yeah. X ray please. X ray please. Yeah. You can see filling. I'm getting a little bit of resistance here. I'm going to pull back our applicator x ray please. X ray please. All right. So we got nice filling there. Now what I'll do is just for the backfill for the quick set I'm going to retract our applicator back further x ray please. Right about that level. Okay. Now we have our quick set that's been transferred to a syringe for easy application. I'm going to insert that right into our applicator. And we're going to inject that in. All right good. We'll finish that in. And then we're putting the plunger in here to complete the insertion of the quick set and chat there. Good. Once we're in we'll take this out and we'll take our whole system out at this point. Shot again. Very good. So at this point the surgery is complete. We will have post-op images that will show on x ray. Our decompression tract filled with Kwikset as well as the bone marrow concentrate with Allison Pure, have an x ray view here. We'll also have an MRI view of the decompression showing filling over time. I also have a bilateral hip MRI where a patient has AVN on both hips. On the right hip, you can see there's still bone marrow edema from the AVN on the left hip. This MRI was done over a year after surgery. You can see complete bone healing and no evidence of any necrosis on both AP coronal as well as axial views. As you can see, the core decompression surgery we performed today was done under a minimally invasive technique with about a two centimeter incision. Appreciate you taking the time to watch our video today. Thank you.

Core Decompression of the Femoral Head Using the AVN Expandable Reamer and AlloSync™ Pure DBM

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

Hussein A. Saad, MD (Dearborn, MI), demonstrates a single-portal technique for repairing a posterior labral tear using Knotless 1.8 FiberTak® soft anchors. He passes the nitinol wire from the SutureLasso® suture passer through the capsulolabral tissue before drilling and inserting the suture anchor to minimize suture management steps.

Shoulder

Single-Portal, Posterior Labral Repair Using Knotless FiberTak® Soft Anchors With Minimized Suture Management

Single-Portal, Posterior Labral Repair Using Knotless FiberTak® Soft Anchors With Minimized Suture Management

The PARS Achilles Midsubstance SpeedBridge™ implant system is a percutaneous, minimally invasive technique used to repair Achilles tendon ruptures. Using color-coded 1.3 mm SutureTape, the PARS system makes it easy to create a percutaneous locking stitch in the Achilles tendon, while staying inside the paratenon sheath.

Achilles Midsubstance SpeedBridge™ Surgical Technique

When using the parse jig for the Achilles mid substance SpeedBridge technique, a percutaneous incision is made in a transverse manner just proximal to the palpable rupture. Alternatively, a small longitudinal incision can be utilized. The tendon is grasped and the jig is inserted with the inner arms inside the peritoneum of the Achilles tendon. The first parse needle is placed in the number one hole in the jig to stabilize the construct, while passing the other needles and sutures in sequential order. Lastly, the white SutureTape is then passed through hole number one. The jig can then be removed, which pulls the sutures out of the incision. Separate out each of the five sutures, the white, blue, and black suture tapes, as well as the two green and white FiberLink sutures. Each suture should be tested by pulling light tension through ten cycles to confirm appropriate hold in the tissue. On both sides, past the blue SutureTape under and around both green and white. Fiberlink SutureTak twice and back through the loop, then advance each loop back through the tendon using the free end of the green and white FiberLink sutures. This creates the locking stitch. Two stab incisions are made one centimeter below the superior aspect of the posterior calcaneal tuberosity. Medial and lateral to the Achilles tendon. Within these two stab incisions, insert the guidewire utilizing the drill guide with the white centering sleeve at 45 degrees from the centerline of the Achilles in the coronal plane, and 45 degrees from posterior to anterior in the sagittal plane. Guidewire placement can be checked under fluoroscopy. These two holes are drilled with a 2.6mm drill and tapped for later SwiveLock insertion. A banana. Suturelasso is passed through the distal stump of the Achilles and out of the rupture site. The SutureTape from the proximal portion of the tendon are then passed through the distal stump and out of the stab incisions distally. The suture tapes are then loaded through the eyelet of the Rd 3.9 biocomposite SwiveLock anchors. The foot is plantar flexed 10 to 15 degrees to approximate the tendon ends. The SwiveLock anchor is placed into the prepared hole to secure the suture tapes. The laser line feature on the SwiveLock shaft can be utilized to confirm when the anchor is flush, or two millimeters countersunk. The same steps are repeated for the suture tapes on the contralateral side. The incision is closed. Jumpstart antimicrobial dressing can be utilized and the result is a secure knotless repair of the Achilles tendon rupture.

Achilles Midsubstance SpeedBridge™ Surgical Technique

Mazda Farshad, MD (Zurich, Switzerland), performs a posterior endoscopic foraminotomy at the C4-C5 level.

Cervical Foraminotomy

My name is Mazda Farshad from Zurich, Switzerland. We are performing a posterior endoscopic cervical foramina. The patient is positioned like for a standard posterior approach of the cervical spine. You can use a Mayfield frame to fixate the head. Fluoroscopy is positioned 90 degrees to the patient. This is cranial. This is caudal. So we start first by palpating the midline and drawing the midline. Once the midline is identified by palpation and the line is drawn, we make a lateral fluoroscopy shot to identify the level that we're aiming at here we're aiming at levels four five. So we want to aim towards the disc of the level that we're aiming at. That would be level four, five and 90 degree to the spine. We can then insert the needle. The needle should be inserted approximately one centimeter lateral to the midline. This will allow that later on we can have a nice view on the foramen. Now we want to aim a little bit higher. Approximately 2 to 3mm higher to be able to palpate the upper lamina. That would be the lamina number four here. Once we're happy we cut the skin and do. Skin incisions in a vertical direction from cranial to caudal. So that conversion to open surgery would be possible at any time. Once this is done, the K-wires is installed. Make sure that the K-wires is vertical to the floor 90 degrees. Otherwise, adjust the patient and the table. By Trendelenburg or anti Trendelenburg to achieve this position. After that the dilation is done. This can be done stepwise or directly using the switching stick already with the switching stick. You can palpate the upper lamina Over the switching stick, the canyon can be inserted. A fluoroscopy shot will verify that we're on the right level with the switching stick inside, the lamina is freed up from muscles by going from medial to lateral using the sharp edge of the cannula, then the switching stick can be removed. Now we see the position of the cannula aiming at the disc four five, where we want to be at in approximately 90 degree angle to the cervical spine. Once this is done, we could insert the endoscope. For purposes of visualization, we will now do an AP view. The AP view can be used if one is unsure about medial lateral position of the cannula. The endoscope can now be inserted. And make sure to control the cannula so that it doesn't move. And now the soft tissue can be removed with a large pituitary. So the soft tissue is removed and we start to see the upper lamina C4, the bone of the upper lamina. Here we remove a little bit more soft tissue and identify the lower lamina of C5. Here with the bipolar we can clean up the soft tissue nicely and palpate the upper and the lower lamina. So the upper lamina here the medial border the lower lamina. And then we start to identify a V form. This is the so-called V sign formed by the upper lamina and the lower lamina. And this is the entrance to the spinal canal. Here we already see the ligamentum flavum. So now we want to turn the V into a U by using the burr. I usually start with the upper lamina and then we go. We proceed to the lower lamina. Make sure to remove enough of the lower lamina. No pressure on the burr, but more on the cannula if you want to manipulate the position. So now we have removed the bone and converted the V to a U. A little bit of the upper lamina. More on the lower lamina so that actually the ligamentum flavum, the attachment is disconnected to the lamina. Here we see we are already in the spinal canal. And we can start dissecting the ligamentum flavum from caudally to cranially. Once we have disconnected the ligament from the lower lamina, we can use a kerrison to remove it in a stepwise fashion. Before that, you might want to go more lateral by removing more bone. So then we can change the view a bit to resect the ligamentum flavum. I use the kerosene for that. Make sure to turn the scope so that you verify that you're just removing ligament and nothing else. The aim is to visualize the lateral border of the dura. The best view to remove the flavum towards medial is from caudal to cranial, so you can turn your scope around 70 to 90 degrees to visualize the opening of the kerosene to be able to remove the flavum safely. The identification of the lateral border of the dura is extremely important in order to identify the nerve. Once we have identified the lateral border of the dura as seen here, we can basically glide up to the nerve root, and here the nerve root is identified here. We are now in the axilla of the nerve root. The same can be done from cranial to caudal. Identifying the shoulder of the nerve root as demonstrated here. So now we see the dura, the lateral border. The axilla of the nerve root at this condition would be accessible here. And the shoulder of the nerve root here we are pointing towards the foramen. So with the ball tip we can palpate also the pedicle. Here we are palpating nicely the pedicle of the lower vertebra which is c5 in our case. The ball tip can also be used to carefully palpate into the foramen. Once this is done the foramen can be visualized By turning the scope facing the foramen. Once the nerve root is identified, we have to look into the foramen. For that, we position our canal either on the upper or the lower lamina, and turn the cannula and the camera in order to visualize the nerve, as demonstrated here. So now we're looking into the foramen, and we can use our kerosene to remove some more bone. You can always turn your camera to be able to have a better look for verification of a full decompression. Use your ball tip to palpate along the nerve root. So here we have the nerve root and the foramen which is now freed up. This can be also visualized from another view looking how the cranially. Here again we have the lateral border of the dura. The axilla. And here we are in the foramen. And now I'm palpating all through the foramen, making sure that the foramen is fully free and the nerve is decompressed. Once the decompression is completed and you have verified that visually, and also by palpation, you can pull out your camera and your cannula and close the skin with 1 or 2 stitches. Posterior cervical endoscopic approaches allow decompression of the nerves by foramina or and or discectomy. This is not a beginner level surgery for endoscopy. It allows to avoid acdf in many cases, can usually be performed within 45 to 60 minutes in an outpatient setting.

Cervical Foraminotomy

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;

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 Mini Fragment System is designed to aid in the reduction and fixation of small- and long-bone trauma injuries. The modular tray offers screw and plate options in 2.0 mm, 2.4 mm, and 2.7 mm variants. With a wide array of plates to fit a multitude of trauma needs, the Mini Fragment System is a keystone addition to the Arthrex Trauma portfolio.

Trauma Lower Extremities

Mini Fragment System Animation

Mini Fragment System Animation

Zachary Pharr, MD (Nashville, TN), demonstrates safe hip access techniques using the FlushFit Cannula System and SafeCut™ capsulotomy blade.

Safe Hip Access Using the FlushFit Cannula System and SafeCut™ Capsulotomy Blade

This is doctor Zach Farr with Tennessee Orthopedic Alliance out of Nashville, Tennessee, presenting the SafeCut Capsulotomy blade, one of the latest advances in safe access regarding hip arthroscopy. As we know, the number of hip arthroscopy procedures being performed has grown immensely in recent decades, providing excellent treatment for our patients who historically did not have great options. However, hip arthroscopy is often described as one of the more difficult procedures in orthopedics. It has a steep learning curve and minor complications have been seen which are primarily related to increased traction time and iatrogenic chondrolabral damage. It is agreed that these iatrogenic injuries can be minimized with surgeon experience, but additionally with continued improvements in instrumentation. The flush fit cannula system, along with the SafeCut capsulotomy blade, are two monumental advances when it comes to safe access. The SafeCut Capsulotomy blade is a four millimeter, one piece construction that combines a blunt tip for cartilage protection, along with a blade that is uniquely designed for cutting through hip capsule tissue. Its working length is hip specific at 220mm, and it comes it comes in both straight and curved options, depending on surgeon preference. In addition, it can be used with or without an ergonomic handle for ease of use. My preference is the non handled version, which can simultaneously be used as a switching stick, eliminating multiple extra steps in traditional capsulotomy creation. Here we are performing hip arthroscopy on a right hip. We've got our anterolateral portal and our mid anterior portal created. Currently we are viewing through the mid anterior portal and looking back at our anterolateral portal. We're now going to start performing our inner portal Capsulotomy. Here we're going to show the new SafeCut Capsulotomy blade. And now we can remove our cannula safely with the blunt tip in the joint that protects the cartilage. And now we are ready to perform our inner portal capsulotomy. We can make this as minimal or as extensive as we'd like. We're going to extend this touch posterolateral. And now back towards our mid anterior portal To start our inner portal Capsulotomy. You'll notice that the blunt tip is protective throughout the Capsulotomy cut here. If you'll take my FlexEFit cannula back and we'll switch now back to the mid anterior portal to complete our inner portal Capsulotomy. Go ahead and take out our SafeCut Capsulotomy blade. We're going to now switch viewing portals to our Anterolateral portal, and we're utilizing the new Pano NanoScope for this. Right now we have it on NanoScope. We can also switch it to a traditional 70 if we'd like, or traditional 30. For this case, we're using the NanoScope version, and so now we're ready to easily finish off our inner portal capsulotomy with minimal steps, which again is decreasing our traction time and helping out with our efficiency. Our blunt tip here is just shown on the femoral head protecting that femoral head. In any kind of oscillation that's required as an extra failsafe there. And we're now finishing off our inner portal, Capsulotomy. If we'd like to take it further. This way we can. And that makes a nice, clean and quick inner portal. Capsulotomy. Now we're starting to get better visualization. We can start moving forward with our hip arthroscopic labrum repair. We have now finished our inner portal Capsulotomy. We've been able to do this both safely and quickly, and we have nice clean edges that we can approximate with our capsule closure at the end of the case. To preserve the native capsule. Here you can see our final arthroscopic labrum repair. We have a three repair construct along with healthy cartilage and good clean leaflets with good edges to be approximated to repair our capsule for hip preservation.

Safe Hip Access Using the FlushFit Cannula System and SafeCut™ Capsulotomy Blade

Peter Borden, MD (Torrance, CA), demonstrates repairing a small rotator cuff tear using Self-Punching Double-Loaded Knotless 2.6 FiberTak® soft anchors.

Small Rotator Cuff Repair Using Double-Loaded Knotless 2.6 FiberTak® Soft Anchors

Hi, this is Peter Borden from Los Angeles, California. I'm going to demonstrate with you today the use of the 2.6 FiberTak anchor. Using two anchors for a simple rotator cuff repair. This is a left shoulder, and we have a small laterally based tear. We are going to plan to put one anchor here and one anchor here, right on the edge of the greater tuberosity here. We are going to repair that in a single row fashion. For this case we're utilizing the NanoScope. We've got this ultra wide NanoScope view currently of the greater tuberosity and the small cuff tear. You can see the extent of the cuff tear, but you can see the entire greater tuberosity from front to back in this one view. I can show you with a press of a button that we can cycle through a 70 degree view, so we can look at it from the side standpoint. I can also cycle away from that and do a standard 30 degree view as well. But notice how when we go to the Pano view, we just get a much more global view of the greater tuberosity. Here we've added an ASL portal for suture management. I would like to be able to put both anchors. One anchor here and one anchor here. We're going to go ahead and retrieve our working sutures one at a time, out our lateral portal, and then we'll take the Scorpion. I'm going to add the working stitch to the side loader as we come in. So I'm going to go ahead and take a feel and see how much cuff tissue I want to grab. And I want to pull and reduce. I'm going to go into the anterior extent of the tear. That looks good. I'm going to do one there and let's go ahead and pull that. So we got the first pass done. I'm going to move that out of our working portal for suture management. So now we'll retrieve our blue white working stitch. We will add the second working stitch to the Scorpion. We're going to hold our suture and do our second pass, making sure we stay on the correct side of all the sutures. And we're going to come in and we're going to make an analogous pass. And I'm going to take all these and for suture management purposes, and we're going to take everything out of our ASL portal. There's our passes. So now we're localizing our posterior anchor placement here. So I want to be right off the edge. Kind of similar to my other anchor. And then I'll check the anchor again and make sure I can lift the arm up and I can. So we placed our anchor. We're going to retrieve the black and blue working suture. Now we're going to load a Scorpion passer. We will take a look at our spread. So I don't want to hit the other suture from the first anchor. So I'm going to keep an eye on everything. I'm going to go in, go above it, look and see where my other pass was. There's my other pass. I'm going to go just adjacent to that. So we're going to come in and we're going to go ahead and take our second pass. We will fire it, retrieve it. So we got two sutures there. We're ready to convert. So I'm going to go in I'm going to retrieve this guy. We have the loop suture for conversion of the anchor. At this point I'm going to go ahead and take this. Put it through the loop. And we're we'll make sure that it's where the purple mark is. That's the purple mark. Both sutures are through the shuttle loop, and I've got this ready to go. So I will go ahead and convert this. We will utilize the shuttle suture in order to put a little tension on the loop on the working repair sutures so that we have a little counter tension and this little counter tension that we're doing on here. It just helps us keep this from getting all twisted up. And as I bring it in, look how nice and straight it kept my repair sutures on that tissue. And now that I've got this scenario here, I could remove this suture that was helping me maintain the orientation of the sutures. And now we're going to take both of these sutures, and we will go ahead and seal that down to bone. We will go ahead and use the Mega loader to load our repair sutures in the cutter, and we'll come in and we'll go down to the anchor, give another little gentle tug. Now we'll do the same thing with the other sutures. So that's perfect. We will cut this suture and get out of here. We've got this single row, lateral row repair of the rotator cuff. We've got great fixation of the cuff tissue to the greater tuberosity.

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