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Transplantatentnahme und -präparation

Arthrex offers a complete line of graft harvesting and preparation instruments for hamstring, patella tendon and quadriceps tendon. Arthrex has developed unique tools and techniques to increase reproducibility of graft harvesting while decreasing morbidity through minimally invasive techniques that can be performed through a small incision.

Knee

Product

Mit unserem minimal-invasiven Instrumentenset für die Entnahme der Quadrizepssehne hat Arthrex seit dem Jahr&nbsp;2014 die Entnahme von Quadrizepssehnen-Autografts revolutioniert und so eine wesentlich einfachere und besser reproduzierbare Entnahme der Quadrizepssehne ermöglicht. Der QuadPro™-Sehnenstripper ist die Weiterentwicklung der Transplantatentnahme im Rahmen der ACL-Rekonstruktion und wurde speziell entwickelt, um eine effiziente und sichere Transplantatentnahme zu ermöglichen sowie gleichzeitig die Morbidität und die mit traditionellen Entnahmetechniken bei Quadrizepssehnen verbundenen Herausforderungen zu reduzieren.

John W. Xerogeanes, MD (Atlanta, GA), demonstrates a quadriceps tendon autograft ACL reconstruction using the QuadPro™ tendon harvester, FiberTag® TightRope® implants, and 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.

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Human

QuadLink™ ACL Reconstruction Using the QuadPro™ Harvester and FiberTag® TightRope® Implants

John W. Xerogeanes, MD (Atlanta, GA), prepares a quadriceps tendon graft using the FiberTag® TightRope® implant system.

Quad Tendon Graft Preparation Using the FiberTag® TightRope® Implant

We have several new devices here. One is a GraftPro board, which makes it very easy to prepare a graft. We have multiple clamps which could hold the buttons and the graft as well. We have our quad tendon graft. All soft tissue graft right there. Here we have the FiberTag TightRope dt. You can see the button and then the FiberTag as well. And it's all combined in one. We have a nice stout needle which could pierce the graft very easily. Over on this side we have the FiberTag abs and this is all attached together again making it very easy to use and eliminating steps. Here we have the Graf clamp. This is specially designed to hold the graft and also the FiberTag system. These slots are used to hold the card and the FiberTag while we're applying it to the graft. This is a notch which will help hold the FiberTag. So again making this very easy. So it comes in a nice package. We can easily unwrap it. And it's self-contained. So we can slide it into the clamp. And then we'll take the sharp tip of it. And you can see the length is perfect. And it can pierce the end of the FiberTag that's hooked on to the TightRope loop. This will fit in that notch so it doesn't move and it's locked in place. We then place this on the graft about 2 to 3mm from the end, and it pierces and holds it very well. The FiberTag portion of the implant is between 18 and 20mm in length. Notice that we pull when we pull these sutures, we pull them together. And that is so we don't split the graph. Then we loop around. We're holding tension. Obviously this could be easier if you have someone else to help, it can be easily done by yourself. And then we go about almost halfway up the graft. Pierce the FiberTag. And this causes a rip lock type system. And watch here we'll pull with two hands on this and that will tighten it down. So we pull hard, it tightens it down. Then we take the loop. Go around. We then put the needle through at the junction of the FiberTag and the TightRope. Again we're pulling these strings together to tubular eyes. The graft you can see it's very nicely tubular eyes there. We then flip the paper over, put the needle through the hole, pull it through, and then this reinforces that junction between FiberTag and TightRope. We then pierce the location between the previously thrown stitches and tighten it. When we throw the next stitch here, you can see it rises it, we pull hard. We then cut one limb of the suture so the needle remains on one part of the suture. You'll see where that's important. Right here. We then make a simple tie, tighten it down, throw another loop to lock it. Then we cut the end without the needle, and we take the needle and bury the knot. This is important so it does not get caught on the aperture of the tunnel when you're placing the graft. We then go to the other side. Cut it. And the nice thing about this is we can take the very proximal end of the graft and trim it. You don't want to get your cut your graft stuck at the aperture of the tunnel when you're pulling it in. You don't want that binding in the tunnel. So this will allow us to get the whole graft well seated in the tunnel. And this process is not only stronger than any construct we've previously described, but it's a much faster technique. We then placed it in the button holder. This eliminates the need to have another set of hands. This is the FiberTag abs TightRope. We use this on the tibial side. It comes without the button, which we add later for tibial fixation. Again, it works exactly the same way. We lock the card in. We pierce the FiberTag and we're ready to place it on the end of the quad graft. The FiberTag portion of the implant is between 18 and 20mm in length. We go up about halfway. Place a second throw and notice again how we're pulling it. This is key. We come through. We go around. And again, if wanted you could stop right here and tie it off. We want to show you the technique during this video. So we're throwing multiple multiple sutures. Then again we bury the knot. And you're done. You have a completed graft. Quad grafts tend to be rectangular in shape. Then we used a graph compression tubes to take the rectangular quad graft and make it circumferential. So we tubular it here. This makes it very easy to pass into the tunnels we created with round drills. You can see we can size the graft as well. We can see both distance and the circumferential measurement. Now this graph is ready to place.

Justin Boyle (Arthrex Group Product Manager) demonstrates tips and pearls for a successful harvest of a quadriceps tendon autograft using the QuadPro™ tendon harvester.&nbsp;

Putting the “Pro” in QuadPro™ Harvester: Tips and Pearls for a Successful Quad Tendon Harvest

Hi, I'm Justin Boyle, group product manager for the knee ligament team. And today we're going to be demonstrating tips and pearls for a successful quad harvest using the QuadPro tendon harvester. The first thing to keep in mind is leg positioning. If you're doing a cadaver lab, you want to make sure the knee is 90 degrees or in the operating room. You want to ensure the surgeon is aware of how the leg is positioned on the table. A lot of surgeons use the leg holder, and when they use a leg holder, what ends up happening is the knee is above the pelvis, so it ends up kind of dropping the femur. And the femur is at kind of an angle going down towards the floor. So it's very important to keep in mind how the femur is positioned when you're doing your harvest. If the femur is tilted and you're directing the QuadPro parallel to the floor, that's where you could run the risk of transecting anterior. So always keep in mind how the femur is positioned. You want to make sure you're following the fibers and running in line with the femur with your harvester. The next thing that's really important is you want to make sure you have a tagging suture inside the proximal muscle belly. This is going to allow you to apply tension to the quad to make sure you have a nice, efficient Sufficient harvest. This is going to better recreate normal anatomical scenario. And lastly, it's important to remember the more flexion and tension you apply to the quad, the more efficiently the quad harvester is going to core out the graft. It's really important to find the sweet spot with the right amount of tension. You don't want to have over tension or hyperflexion, because that could run the risk of amputating the graft too thinly proximal or thinning out of the graft. The next important thing to talk about is the incision. Some people like a longitudinal harvest. Some people like a transverse incision for their harvest. It really doesn't matter. I found in my hands a transverse incision is a little bit easier to work with. The important thing is you want to make sure you can release enough graft initially to get your tagging suture in and have the correct trajectory of your QuadPro harvester. There's also research that's been published showing you can get a little bit more length by cheating your harvest a little bit lateral from the midline of the patella. So you can see here we marked out the midline of the patella. I like to cheat my transverse incision up a little bit. So about one finger width above the patella. This is going to allow you to get plenty of length of graph to initially dissect. And as you can see here, we're about a centimeter, centimeter and a half above. But it's going to allow you to get plenty of length with your harvest and give you a really nice trajectory to advance the QuadPro harvester. You can see here we're using a about a 2.5cm incision. This will allow us to really nicely dissect the quad and give us plenty of length to use. The QuadPro harvester. One of the important parts here is once you make your skin incision, it's really important to get all the subcutaneous fat out of the way. If you don't, you're going to be fighting it. It's really going to be a struggle to try to visualize the tendon nicely. So I like to do a wide kind of excision here and make sure you can really nicely see the tendon. I've also found as you're doing this subcutaneous fat excision, the more you can keep it intact, the better off you're going to be and the easier it is to take it out. If you start trying to break it up initially with a cob, elevator or your finger, it can really be a struggle trying to get all this fat out of the way. So I like to try to just keep everything intact. This big fat globule that you're taking out, as you can see here. It's really a large amount of subcutaneous fat that you're trying to take out. And once you do that, you get a really nice visualization window here. So with two sin retractors you can see really nicely the entire quad here. So the next thing after you get all that subcutaneous fat out and you can see really nicely the quad tendon, I like to prepare a little bit proximal on the quad. So a nice way you can do this is you can take an army Navy. You can take your cob elevator, and then you can just run the cob and really break up any adhesions you have proximal on the quad tendon here. So just a few times kind of back and forth. And then you can use your finger as well to also try to break up any adhesions. Another nice trick is you can take a raytech, put it on your cob and drive this up in your incision. This will also help clear out any subcutaneous fat that's still still there. So after you've cleared the quad distal and proximal, you can actually run your scope up as well Get a nice view of the quad proximal. So another trick you can do is you can take your standard ruler and trim it down to size to fit for a perfect graph length. Here I've trimmed the ruler down to about a seven centimeter length, and then we can go inside our incision here, and then lay down the ruler and really visualize how our graph length is going to be. We can then use our scope and then go right in to our incision with the scope. So you can see we've put our ruler here. You can see the VMO here on the right. We can drive all the way up the graph length here to see the proximal portion. Another thing you can do here, you can either turn the scope and use your light to make a mark on the skin. Another little trick you can use is use a spinal needle. You can see the spinal needle here proximal. And then take the tendon proximal. That's going to give us a a visual cue from the outside and a trajectory to guide towards as we're using our QuadPro harvester. So now that we've marked the graph proximal, the next thing we're going to do is we're going to use our pushrod to create a stamp on the tendon. So you can use your marking pen here. Kind of just go around the outside of the pushrod. And then inside our incision here we're going to go ahead and stamp down on the quad. The positioning here as we mentioned earlier we're going to be a little bit lateral to the midline. And with our trajectory of the harvest we're not going straight up the leg. We're going a little bit lateral with our trajectory. This is going to ensure that we have the best possible length for our quad tendon harvest. The next thing to keep in mind as we're doing these longitudinal incisions in the tendon down towards the patella, we don't want to go straight with our incisions. We don't want to go straight. We want to have a little bit of a taper similar to this kind of a V shape here. This taper is going to allow the end of the graph to fit really nicely inside the QuadPro. So now we're ready to start dissecting out the graft. And we get the question a lot. Does it make a difference between full thickness and partial thickness? If you look at the literature, there's really no difference in outcomes between partial and full. We have found that a full thickness graft is much more reproducible to take a full thickness graft the entire length, where partial thickness graft can be a little bit more challenging to get an appropriate graph diameter for the entire length of the graph. So when we're making these longitudinal incisions in the tendon, I like to do both longitudinal incisions first and then connect them across. Sometimes we see people do one longitudinal and then try to start to peel it off the patella and then go back up. I think it's just much more challenging to get a consistent graph doing it that way. We're setting our width here, coming down until we hit bone. Once we start to hit bone, then we're going to bring our incision across to start to dissect it off. Another important part here is the actual blade that you're using. I found that a 15 blade is a much better option versus using a larger ten blade for this. Let's see. We're starting to peel the tendon off. So after we get the initial distal part of the vertical incisions connected across, then we can start to work a little bit more proximal. Start to tease out the graft. Another thing I found is some people will reflect the graph back as they're doing their incisions. You got to be a little bit careful because this can throw off how you have the tendon position. So sometimes I like to pull the tendon towards me. And then you can start to peel off the undersurface of the tendon. So you can see we've dissected about two to maybe three centimeters of graft here. And then at this point I like to put in the tagging suture. So we're going to use a FiberLoop suture with a straight needle. It really doesn't matter what type of suture you use here. You want to make sure you get a good bite of the tendon. So with my last pass in the suture, one trick I found is if you try to exit the suture kind of towards the distal end of the graft, this will allow the graph to fit really nicely inside the QuadPro harvester. One thing with the design of the harvester, we actually put the reference size of the device on both the harvester and the pushrod. So you can see here the ten and ten. So if you're ever in a case and you have multiple harvesters open for whatever reason, this is a nice thing to kind of keep in mind that you can always quickly reference that. One of the nice things we found when using the FiberLoop with a straight needle, you can use the weight of the needle and drop all the way through the calculation of the device. Then it'll come out the bottom. Once it comes out the bottom, then you can cut the needle off. And then here it's important to really guide the tendon in. Make sure you can get past those stitches. You don't want to cut your stitches and damage the end of the graft. As you're trying to use the harvester. With the QuadPro harvester, we found the more rotation that you have in the device, the more efficiently it's going to core out the graft. So if the surgeon is just trying to push the device, that's when you can run the risk of it starting to transect through the fibers instead of following the fibers. Initially, when we were working on the device, we were just doing a back and forth movement, and that seemed to work well in cadavers. But we found in live patients you get a much better harvest of the graft when you do full continuous turns. I like to try to do a quarter turn and advance a couple millimeters at a time. Remind the surgeon to be patient with the harvest. You're not trying to fly up the leg. Just be careful. Advance in a few millimeters at a time. And it is important to point out, especially with the soft tissue surgeons, it's a totally different feel than a hamstring harvest where you're kind of running the harvester all the way up the leg, and then you're kind of breaking through some of the adhesions here. It's really careful. We're actually coring out the graft to take a nice cylindrical graft. So now we're ready to actually do the harvest of the graft. So you can see we've pulled the graft into the tip of the harvester. Now it's all about positioning. We want to make sure from a medial lateral standpoint we're in line with that trajectory route that we put in with that spinal needle. We're going to make sure we're in line. Once we're aligned here now we want to make sure we're in line from an AP standpoint. So once we feel like we're in line with the femur, in line with the fibers of the graft, now we can go ahead and start advancing the harvester. So as we mentioned, the quarter turns is going to give you the most efficient coring out of the graft or harvesting of the graft. And we're just going to be very patient. We're going to let the device do all the work, and we're just doing quarter turns one direction. So you can see the graphs start to pull into the window here. And we're just carefully advancing it. Quarter turns being very patient with the device. We're typically going to shoot for a 65 total graph length for an all inside procedure. So I normally like to take a little bit more graph length wise. And then we can trim it down on the back table. So we've got adequate graph length now. So we're going to back the device up. And then once we can see the graph in the end of the window or inside the window, that's where we're going to retrieve the graph here. We don't want to go all the way out because then we're going to fight. Trying to get the graph back inside the tip of the harvester. So now we can find our tagging suture. Retrieve that here outside the window. Carefully advance the device back up the leg, up the graft, until we get back to our length that we want to harvest for the graft. So you can see here we're at an appropriate length. We're going to add our push rod here in the back. So one of the things that we found clinically is when you're ready to amputate the graft. If you extend the knee a little bit, that'll unload some of the tension, and that'll give you a much cleaner amputation of the device. Sometimes in cadavers, it's a little bit opposite because you don't have appropriate anatomical tensioning on the tendon. So you can see our graph here. We've got a perfect length. We're shooting for that 6570 range. And so when we turn the graph here you can see we get a really nice cut of the graft. We extended the leg. That's going to take off some of the tension on the graft. And we get a really nice cut. And it kind of bevels into the graft here. That step is really important when you're ready to do your amputation, to not pull too much tension on the graft because you'll be fighting against the device. So for this demonstration, we used a ten QuadPro harvester, and we'll run it through the sizer real quick just to kind of show what size graft we got. So we're going through a ten as you can see kind of a nice snug ten pulling it through. At the end we've got a nice 65 to 70 graph length. We've got a nice solid ten diameter the entire length. And at this point, you can move forward to do your quadriceps tendon closure. We'll do a quick peek with a scope here just to show our quad defect. It's kind of a nice partial thickness graft all the way up to our amputation mark here. After we've done our quad tendon defect closure you can take the graph to the back table. You can apply your FiberTag TightRope on both sides. And then we really like to use the graph tubes. This is going to allow you to end up with a perfect graft. You can compress it down in size to ensure you have a perfect press fit graft inside your tunnels. So you can see you were a solid ten if you wanted to. Here to really compress the graph, you could try to go down a half size, go down to like a nine and a half. So after we compress the graft, typically it's going to be a half size or a size. This is going to allow you to have a nice press fit of your graft inside your sockets to prevent any synovial fluid from leaking down inside the sockets. And that includes the tips and pearls of how to use the QuadPro harvester for a successful quad tendon harvest.

Quadrizepssehnenentnahme und -präparation

Child (D)

Es stehen zahlreiche Produkte zur Verfügung, die Operateur:innen bei der BTB-Transplantatentnahme und -präparation unterstützen.
Mit dem Doppelskalpell für Transplantate – mit parallelen Blades zur Erzeugung eines präzisen Schnitts in einem einzigen Durchgang – lässt sich die Patella- oder Quadrizepssehne während einer ACL- bzw. PCL-Rekonstruktion entnehmen.
Die Sägelehre für Transplantatentnahme und die Sägeblätter ermöglichen es, einen idealen trapezförmigen Knochenblock mit vorgebohrten Nahtlöchern aus Patella oder Tibia zu entnehmen. Mit den Knochenblockschablonen lassen sich bei der Sehnenentnahme konsistente, reproduzierbare Ergebnisse erzielen.
Weitere Instrumente für die BTB-Transplantatpräparation, einschließlich eines Knochenblockmeißels und ACL-Knochenblockformers sind ebenfalls erhältlich.

Instrumente für die Entnahme und Präparation des BTB-Transplantats

Arthrex® bietet die derzeit fortschrittlichsten Techniken und Instrumente für die Entnahme und Präparation von Hamstring-Sehnen. Mithilfe der minimal-invasiven Hamstring-Sehnenentnahmetechnik und speziellen Sehnenstrippern kann die Entnahme sicher und reproduzierbar sowohl über den klassischen ventralen Zugang als auch über einen dorsalen Zugang erfolgen.
Die Arthrex Graft Prep Station ist mit einer Reihe von austauschbaren Klemmen und Schrauben erhältlich, die das Spannen und Vernähen des Transplantats erleichtern.
FiberLoop®-Nahtmaterialien und die SpeedWhip™-Technik haben die Transplantatpräparation revolutioniert. Mit den durchgängigen #2 oder #0 Fadenschlaufen und den freigängigen geraden oder gebogenen Nadeln kann das Transplantat doppelt so schnell vernäht werden wie mit den herkömmlichen Fäden.

Instrumente für die Hamstring-Transplantat- entnahme und -präparation

Eine jahrzehntelange Erfahrung in der Transplantatpräparation und Feedback von Operationsteams haben zur Entwicklung des GraftPro -Transplantatpräparationsystems geführt. Das GraftPro-System verfügt über zahlreiche Funktionen, die die Transplantatpräparation von Weichteilgewebe, BTB-, QuadLink- und GraftLink-Transplantaten vereinfachen und beschleunigen.

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GraftPro® Graft Preparation System

Foot and Ankle

GraftLink® ACL Reconstruction Using the InternalBrace™ Technique

Today we're going to go over the graft prep for the BioACL at the Andrews Institute. We're working on a prospective study to evaluate the effectiveness in increasing maturation of an ACL. Autograft. We use a three by six thick amnion wrap. There's a notch to the upper left. It helps you keep it oriented, allowing you to keep the epithelial side up. Three centimeters allows us to cover the intra-articular segment of most ACLs and most knees perfectly, and the six allows you to get three wraps around it. We're going to show you how to do essentially a water tight wrap. We're going to do it with a dyed suture. We normally use a monocryl with thought to dyed suture would be easier to see. So what we do is place it in the center of a soft tissue graft. Sometimes on a BTB you may have to move it depending on the length of the graft. But here we're going to place it on the center and then moisten it. You moisten it and it allows it to work very well. This is a very workable tissue. Holds the suture very well. It looks like it might be friable, but it's actually very workable. And so we wrap it carefully like this. It usually takes about ten minutes on the back table to prepare this. And you see the way I wrapped it. The end comes around almost exactly the same spot you started on most graphs. What we start with is first is circumferential wraps around either end. And like I mentioned, this is usually a water type construct which makes it really nice. So we wrap it really good. Like so. I'm going to cut the end to make it a little easier. And tie this. You want to make sure you go through both layers. Get it tight as close to the end as you can get without having it come off. Thank you. Now we'll go to the other end and do the same thing. So if you're going to inject biologic solutions, we found this to be a nice construct to hold whatever solution you put it in where you want it next to the graft. What we're going to do is make a little running stitch along the free edge. I don't know if you can see that, but there's a little free edge there. We want to catch both. Tie quick knot and then run it. So now we're just going to run it up along the free edge. The goal is not to constrict the inner space too much, because we want any solution or fluids you put inside to be able to. Go all all throughout the the casing, so we don't want to compartmentalize it, if you will. This technique has allowed us to inject these and watch the whole rep swell up with with biology. Okay, we're almost done here. And we'll tie it off. And this is the completion of the amnion wrap for the BioACL. Again, I don't usually use a colored suture. I just thought it would be helpful today. And that's it. So you can see the center. The center, three centimeters is wrapped with an amnion wrap and a four row suture. Now that we have our graph prepared with the amnion wrap, we're going to load it with the internal brace. This is a double loaded TightRope RT. We're going to take off the larger of the two pull sutures to allow more room, leaving the other pull suture. I've loaded a graph parser in here. Now you take the ends toward the graph as you see we're doing here. Take them toward it. And then we're going to get the other side. Really not that hard. Using this little graph parser makes it pretty easy. Drop it down like so. Try to even up your ends. And not tangle anything. We'll do that. Like so. This completes the internal brace construct of the amnion wrapped soft tissue graft. And as you can see, loaded like this still has a good profile that's easily delivered. We have not had any problems delivering it with the standard technique with the TightRope TT. So here we have our amnion wrapped hamstring soft tissue construct with the FiberTape on the TightRope TT. We've drilled we've passed sutures and we're now going to deploy the femoral side so we can see where the TT button going into the tunnel. We've measured it at about 35. We've successfully deployed that. Now I'm going to hold tension on the graft while Adam shortens it into the tunnel usually about 15 to 20. Go ahead. You can see the wrap coming into place. And right at the edge. We've got 20 in the femoral tunnel, which is great. Now we're going to deploy the tibial side. And you see there it pops into the tibial side. As you can see the wrap covers the intra-articular portion. Tighten it up a little bit on the femur. I'm pulling down. We're going to get that a little bit closer. The notch plastic could have been a little bit bigger, but there you go. From tibia to femur with an internal brace which we're going to tighten separately like so. So we've got the graft in place. We're going to put the leg in extension and tighten the internal brace separately. So what you see here is I can tighten that and fix it to the tibia with a swivel lock or however you prefer. I prefer a SwiveLock. So I've got the internal brace. And then we'll flex to about 30 and tighten the abs TightRope on the tibia. And we're fixed. So the steps for injecting your biologic fluid underneath. First you need to dry the joint. So I'll typically use just any any type of suction device. I've cut my water off. And I'm just going to take all the fluid out of the knee. It'll kind of collapse down because of the suction, but once you let it off, then you'll have a nice little dry space in there. The other trick is to take a spinal needle and hook it up to suction. So this is an 18 gauge spinal needle. And I typically park that spinal needle down here near the lateral meniscal root. And then once it's parked down there, it kind of keeps everything sucked out. If you turn your eyes down, you can usually get to a nice dry spot and you want to get underneath the wrap and then just start injecting and see how it nice balloons up and creates almost a blood blister. Some of it will come out, but I think that the viscosity and the stickiness of the graft, as well as the injectable, keeps the majority of it where we want it. Typically you'll get two milliliters into your construct.

Decades of graft preparation experience and feedback from surgical teams have culminated into the GraftPro™ Graft Preparation System. The GraftPro system has numerous features that simplify and accelerate graft preparation of soft tissue, BTB and GraftLink® grafts.

GraftPro™ Graft Preparation System

Decades of graft, preparation, experience and feedback from surgical teams have culminated into the GraftPro graft preparation system. The GraftPro system has numerous features that simplify and accelerate graft preparation of soft tissue bttb and GraftLink grafts. The GraftPro instrument case is efficiently housed in a small footprint case that occupies minimal space on the instrument table. The graft prep board sits above the attachments and is removed first. The graft prep board and attachments are laid out logically and clearly marked for simplified setup and quick assembly. All attachments fit into custom bracketing with matching graphics and open matte area allows additional instruments to be added as desired. A graft sizing block is also included. The GraftPro board is lightweight and has non-slip feet to facilitate usage on side table or mayo stand. A large graft cleaning board facilitates removal of unwanted tissue and graft trimming. Five quick release connections are Connections are located both in fixed and sliding positions and will accommodate all attachments. Dual tracks with ratcheting sliders allow one handed movement of attachments. Sliders are released by squeezing tabs and allow movement in the opposite direction. The board also includes a well for BTB preparation, which secures bone blocks while cutting and drilling. Two graft clamps come with the set and have been designed to effectively hold tissue grafts. A dramatically narrower jaws also help facilitate loading of grafts into the clamp. Quick release attachments facilitate SpeedWhip suturing technique with FiberLoop by permitting one side of the graft to easily be removed from the board, allowing passage of the FiberLoop around the graft. The graft can then be resecured into the board, so both hands can be used for needle passing and suture tensioning. Graftpro attachments can be rotated in any direction, allowing graft positioning in several directions. Two posts are included in the GraftPro set, and can be used in a variety of ways to hold and tension grafts and graft sutures. The smooth surface and curved recess is ideal for a traumatically securing soft tissue grafts as shown. The button holder with ruler secures ACL, TightRope and RetroButton implants, and allows measurement of the loop and graft to facilitate button flipping and graft advancement. The spring loaded latch is depressed to load the button into place. The latch then automatically closes over the top of the implant and holds it securely during graft prep and tensioning. The tensioning strands of the TightRope rt are accessible from the end of the attachment, and may be pulled to customize loop length. The built in ruler allows measurement and marking of the implant loop and graft for later reference during implant and graft passing. The GraftLink attachment secures an ACL TightRope button into place, with a spring loaded sleeve that closes over the button to hold it securely during graft prep and tensioning. There is also an alternative rubber grommet option for attachment of the ACL, TightRope, ABS loop, or graft sutures. Additionally, this attachment incorporates a potentiometer to approximate tensioning force. Note when loading ACL TightRope implants into the button holders, the inferior limb of the blue passing suture should not be positioned superiorly as shown here. This will make button loading more difficult. The inferior limb of the blue passing suture should be positioned inferiorly, as shown here, to facilitate button loading. The BTB well helps to secure bone blocks during cutting and drilling. Rulers along the top and side help approximate graft sizing during preparation. The open center slot allows passage of drill bits and needles through the bone block. The graft sizing block helps approximate graft diameter from 4.5mm to 12mm in half millimeter increments. When placing the board into the case, orient the board so that the cutting board portion is directly over the attachment brackets. The sliders must be positioned over the open pin mat area for the board to sit, flush, and allow the lid to be seated.

GraftPro™-Transplantatpräparationssystem

Die Arthrex&nbsp;Transplantatkompressionshülsen sind durchgehende, durchsichtige Röhrchen, die die Kompression, Größenbestimmung&nbsp;und Präparation des Transplantats erleichtern. Durch die speziellen durchsichtigen Röhrchen mit integriertem Lineal ist das Transplantat bei der Bestimmung von Durchmesser und Länge gut zu erkennen. Eine trichterförmige Öffnung und ein ansetzbarer Handgriff erleichtern den Einzug des Transplantats in den Größentester und ermöglichen eine Kompression von bis zu 2&nbsp;mm. Kleine Löcher in den Transplantatkompressionshülsen ermöglichen die Hydrierung des Transplantats über die gesamte Länge. Durch die konische Spitze kann das Transplantat direkt in den tibialen Bohrkanal oder das mediale Portal eingebracht werden.

Transplantatkompressionshülsenset

Die Hamstring-Platzierungshülse für die Entnahmestelle ermöglicht die Verabreichung eines Anästhetikums direkt nach der Entnahme des autogenen Hamstring-Transplantats während der ACL-Rekonstruktion. Die Hülse ist insgesamt 247 mm lang. In den distalen 90 mm befinden sich 16 versetzte Öffnungen, um das Anästhetikum über einen großen Bereich effektiv verabreichen zu können.

Transplantatentnahme und -präparation

Quadrizepssehnenentnahme und -präparation

Instrumente für die Entnahme und Präparation des BTB-Transplantats

Instrumente für die Hamstring-Transplantat-entnahme und -präparation

GraftPro™-Transplantatpräparationssystem

Transplantatkompressionshülsenset

Hamstring-Platzierungshülse für die Entnahmestelle