Orthobiologie

AlloSync™ Button

The AlloSync button is a sponge-like demineralized cancellous disk that becomes compressive when hydrated with bioactive fluids. Composed of 100% demineralized cancellous bone, the AlloSync button adds a reliable scaffold at the surgical site for cellular attachment and proliferation. Its unique size and shape make the AlloSync button an ideal supplemental graft.

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AlloSync™ Bone Grafting Solutions

Orthobiologics - New Product Spotlight

Joseph K. Park, DPM (Burbank, CA), shares a Cartiva® implant revision case during which he used an Arthrex cannulated revision bone dowel, an AlloSync™ button, bone marrow aspirate, and the GraftNet™ device in conjunction with the MaxForce™ plate for construct fixation. The surgical incision was managed with Biovance® amniotic allograft and JumpStart® antimicrobial wound dressing.&nbsp;
Cartiva is a registered trademark of Wright Medical Group N.V.&nbsp;
Biovance is a registered trademark of Celularity, Inc.

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Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

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Cirujanos que presentan uno o más casos clínicos.

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Case Presentation Videos

1st MTP Cartiva® Implant Revision With Arthrex Orthobiologics

Hello, I am Joseph Park. I'm a podiatrist in private practice in Burbank, California, and I have a case here for you. It's a Cartiform revision with cannulated revisional bone dowel. Allosync button bone marrow aspirate and GraftNet device. This is a 72 year old male with painful first metatarsophalangeal joint. The patient had a Cartiform placed by another provider two and a half years prior. The patient unfortunately continued to experience pain with absolutely no relief for any period of time. Therefore, we talked about alternative treatment options. And if we look at the literature, this study from Doctor Sheehan, Todd and others showed that the polyvinyl alcohol hydrogel implants did not help the patient on a long term basis, nor did they provide any significant short term improvement. The study also showed that the temporary joint space created by the implant was not preserved by the second post-op visit, which was 5 to 12 weeks post-op. This retrospective study by Ann and others showed that all cases with the polyvinyl implant showed progression of arthritis and radiographic loss of joint space on the MRI obtained 11.5 months post-op. The MRI imaging also revealed peri implant fluid, suggesting instability of the implant and bone interface. With this in mind, we decided to remove the implant and utilize a few biologic products to backfill the resected area to support the fusion of the metatarsophalangeal joint. At the beginning of the case, as the tech is setting up the back table and prior to elevating the tourniquet, I obtained the bone marrow aspiration from the calcaneus. Next is removal of the implant. Joint preparation is important, but take caution not to take too much bone. Solid block bone grafting is an option. Leaving the guide pin in the first metatarsal helps with placement of the hardware, and biologics are easier to pack in. Removing the implant leaves a void within the first metatarsal. Arthrex has prefabricated bone dials in different sizes and diameters that fit perfectly into this void. I often use GraftNet for my fusion cases to aid in healing. Literature has shown favorable results that bone slurry helps aid in healing and fusion, as shown by Wheeler and others. The Arthrex AlloSync button is a demineralized cancellous bone sponge that is placed into the joint and provides a scaffold for cellular attachment and proliferation. After we have all of our biologics delivered, we place the MaxForce plate over the first Metatarsophalangeal joint. You can see here that the MaxForce plate is a great option for compression and stability of the fusion site. The MaxForce plate is low profile, however, I like to give extra soft tissue protection by using Biovance prior to closing. Biovance is an amniotic allograft that acts as a protective barrier to surrounding tissue. After closing, I place JumpStart on top of the incision area as the innovative technology creates a microcurrent that enhances the healing process and eradicates a wide spectrum of bacteria. Here are the pre and post-op x rays. We can see we have proper reduction of the deformity while maintaining length of the first metatarsal. My post-op regimen is 2 to 3 weeks of non-weight bearing, 2 to 3 weeks of weight bearing in a boot and then returning to activities and light exercise as tolerated. Thank you for your time.

AlloSync™ Button Demineralized Cancellous Sponge for 1st MTP Arthrodesis

Foot and Ankle

Steve M. Douthett, DPM (Eugene, OR), demonstrates a metatarsophalangeal (MTP) joint fusion using the MaxForce™ MTP plating system with 3.0 mm KreuLock™ locking compression screws and a 3.5 Mini Compression FT™ screw, augmented with the AlloSync™ button demineralized cancellous sponge.

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1st Metatarsal Phalangeal Joint Arthrodesis Augmented With AlloSync™ Button Demineralized Cancellous Sponge

My name is Steve Douthat. I'm a foot and ankle surgeon based out of Eugene, Oregon. Today we're going over a first metatarsophalangeal joint arthrodesis using the first MTP MaxForce fusion plating system 3.0mm KreuLock screws. A 3.5mm foot screw and the AlloSync button, which is a demineralized cancellous sponge. This is the MaxForce MTP fusion set. You can see that the plates include zero degree valgus, zero degree dorsiflexion plates, five degree valgus, five degree dorsiflexion plates. Revision plates, and also new cortical screws which are lower profile. For this case demonstration, we're going to be using KreuLock locking screws which combine a compressive thread to a locking head. Here we have the AlloSync button, which is a demineralized cancellous sponge. It becomes compressive upon hydration. I hydrate the sponge using BMC. That way the sponge will act as a scaffold for live viable cells. For this procedure I use my standard dorsal medial Deal MTP incision. First step is inserting the guidewire for the reaming system into the first metatarsal. I use this to remove the cartilage along with the subchondral bone plate. Next, I'll insert the guidewire into the phalanx. Next, I'll ream the proximal phalangeal base. I use the guidewire to subchondral drill both the first metatarsal head and the proximal phalangeal base. Next, I'll take the AlloSync button, which has been hydrating in the BMC, and place it into the first Metatarsophalangeal joint. I like to center it right in the middle of the joint. For the next step, I position the first metatarsophalangeal joint where I want the toe to lie and insert a guidewire for the 3.5mm foot screw. Bicortical across the first metatarsophalangeal joint. So I insert the plate. I make sure that the lines in line with the joint usually fixate it proximally with a B-B tack. Today we'll be using the crew lock screws. I'll insert my locking tower distally. We're using crew lock screws today because the compressive threads allow the plate to be pulled down to the bone. Additionally, it has a locking head, which adds further stability to our construct. There is an added step with the crew lock screws. You use a profile drill before inserting the screw. Next, I fill the other two distal lockers. Next, I'll use the offset drill guide. It's important to drill this bicortical. We'll remove the B-B tack. Insert the compression mechanism, compress it two finger tightness, and then insert a BB tack to hold our compression in place. I like the ratcheting compression mechanism because it has a unique ability to have compression built right into the plate. The AlloSync button is compressible. That way when I compress the first metatarsophalangeal joint, the button will compress with the correction. The next step will be drilling our eccentric screw. This is a second form of compression in addition to the compression ratcheting mechanism. We will remove the tack before the head engages the plate for the compression screw. This is a new cortical screw that's low profile, which comes in the MaxForce fusion set. They'll lock the plate proximally. So that. If I insert the 30 degree locking tower cone and in the distal metatarsal locking slot. This allows for angulation to avoid our inner frag screw. You can see on this floral shot that the 30 degree angle allowed for me to avoid my inner frag screw. All right. Now I'm going to measure the screw length. This one looks like it'll be a 26. The next step will be drilling for our 3.5mm fully threaded compression screw. Next step. Insert the screw. This adds another layer of compression and also acts as rebar, reinforcing our first metatarsophalangeal joint construct. Here you can see our final construct using the MaxForce fusion plate. Kreulock locking screws, 3.5 FTS inner frag screw and the AlloSync button which has compressed with our repair.

The AlloSync™ bone grafting solutions product line includes AlloSync Pure demineralized bone matrix and the AlloSync demineralized cancellous sponges and cortical fibers. These bone grafts are derived from 100% human allograft bone and can be hydrated with biologically active fluids.

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

Operationstechnik-Animationen

Visão geral incluindo as etapas relevantes de uma técnica cirúrgica Arthrex. Essas animações sempre incluem uma narração explicando o processo.

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Descripción general que incluye los pasos relevantes de una técnica quirúrgica de Arthrex. Estas animaciones siempre incluyen una voz en off que explica el proceso.

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Surgical Technique Animations

Arthrex. Allosync is a comprehensive bone grafting solutions line derived from human allograft bone. The AlloSync grafts maintain optimal osteoinductive and osteoconductive potential while providing excellent handling characteristics for various orthopedic applications. Allosyncpure is an osteoinductive bone matrix derived from 100% human allograft bone with no extrinsic carriers. The AlloSync line also includes demineralized, cancellous, sponges, and cortical fibers, which are processed in a manner that optimizes the residual calcium level and osteoinductive. Allosyncpure is provided in a ready to use mixing jar and may be hydrated with PRP, BMC, or other biologic fluids to create the desired consistency during preparation. The compression of the graft mixture helps to incorporate the demineralized bone matrix with the bioactive fluid. Alternatively, AlloSyncPure can be prepared using the ABS 2000 mixing syringe. The graft and biologic fluid are added to the syringe and prepared with the internal mixing element until thoroughly mixed. The proprietary rice shaped fiber technology used to process AlloSyncPure allows the graph to resist irrigation and be used in a fluid environment when prepared as directed. Adding additional fluid to the graft allows the clinician to decrease the viscosity of the AlloSyncPure. For injectable applications such as iabp. The accelerated cellular ingrowth with AlloSyncPure has been histologically proven with in-vivo testing at 28 days post implantation. All five elements of bone formation, including new bone, bone marrow, osteocytes, chondrocytes, and cartilage are present. Allosync, demineralized, mineralized sponges and fibers are available in a variety of shapes and sizes, including cancellous strips, cubes, chips, and cortical fibers. These graphs maintain the natural bone architecture with interconnected porosity, providing an optimal scaffold for cellular attachment and proliferation while preserving native bone morphogenic proteins. The AlloSync de mineralized cancellous, sponges, and cortical fibers can be hydrated with bioactive fluids such as platelet rich plasma or bone marrow aspirate during hydration. The graft will naturally wick up and retain the surrounding fluid, making it an ideal scaffold for cells and growth factors. Once hydrated, the AlloSync sponges and fibers become compressible like a sponge, allowing for flexibility to fit in and around different types of bone defects. Allosync pliable handling characteristics facilitate minimally invasive surgical procedures with the incorporation of allograft bone. For fusion cases such as an ankle arthrodesis AlloSync demineralized. Sponges soaked in BMA can be placed at the fusion site for maximum biologic healing. Allosync mineralized sponges can also be interposed at the site of tendon bone repair in rotator cuff tears. The compressible nature of the grafts allows the sponge to be delivered and secured at the repair site arthroscopically. This construct has been shown to result in superior structural and biomechanical properties as compared to a standard of care repair. Histologically. Rotator cuff repairs with an interposed DBM strip have been shown to mimic normal rotator cuff tendon insertion to bone, compared to repairs without an interposition graft. Allosync bone grafts are processed sterile to device grade standards and stored at ambient temperature.

Shoulder

Patrick A. Smith, MD (Columbia, MO), demonstrates a SpeedBridge™ rotator cuff repair augmented with interpositional AlloSync™ button (demineralized bone matrix) and Angel® system cPRP from BMA. He demonstrates using the Knotless SwiveLock® suture anchor, which has a tensionable knotless mechanism built into the eyelet that can be used to easily deliver the AlloSync button to the rotator cuff footprint.

SpeedBridge™ Rotator Cuff Repair With Knotless SwiveLock® Anchors and AlloSync™ Buttons

This is the right shoulder. So we have our passports in place. Post your viewing portal first. Here's our tier. You can see anteriorly. Here's our biceps tendon posteriorly back through the infraspinatus. So muscle tendon junction right about here I like to prepare the footprint. And I've done some of this already. Removing the soft tissue I like to use a curette first to help remove all the soft tissue from the previous fibers that might be left over to get a nice little bleeding decorticated area. And then I also like the PoweRasp. So here's our PoweRasp. Just kind of like to touch it. So at this point we're going to first harvest some bone marrow concentrate. I've already made a portal just off the acromion. This will be our portal that we're going to use for our anchor placement as well. For our medial row we're going to come in here first with our jamshidi needle. We're going to come right into the proximal humerus for a harvest of our of our BMC. So there's our humerus right here. So kind of in the lateral extent of the footprints, we can come down the shaft. So here's a full 30 cc syringe and we get two of these. Next we're going to proceed with our cuff repair. We've prepared the footprint. We're getting our BMC spun in the Angel system. And so we're going to create our medial anchor placement. So first we're coming in with our SwiveLock punch. We're going to make our medial row anterior anchor placement first just behind the biceps tendon to restore the air of the anterior cable to SwiveLock. Now here's our knotless SwiveLock device coming in. And again this is preloaded with our FiberTape. So we bring the SwiveLock anchor down to our hole and insert. So first we're going to go ahead and pass our two tapes in a horizontal mattress fashion through the medial cuff. That way they'll be out of the way. When we utilize the knotless mechanism for the bow button, we're just going to grab our medial tape Anteromedial tape and brings them both out together. At this point, you have an option. You could either pass the two tapes together through a medial spot, anterior posterior, or. My preference is to cut the tape so I have two free ends. We'll take our first tape. So now we're going to come in here through the anterior aspect of this tear. Avoid the bicep. I can see the bicep right there. So this is my more anterior anchor placement. I just want to be just lateral to the muscle tendon junction by a couple of millimeters. So we'll grab now that pass through and bring it out the anterior portal. So it's out of our way. Here's our second pass now. So we'll retrieve that. As you can see, we've made our two passes here and we've left the mechanism free. And so the mechanism, the knotless mechanism is allow us to place our bio button right here at the footprint where we want it. So now you can see we've got our four passes of the tapes immediately through the cuff tissue, a couple of millimeters from the muscle tendon junction, which is where you want to be. Our two anchor placements immediately anterior and posterior. And you can see our two knotless mechanisms are separated. So now we're going to apply the bio button to our Knotless mechanism. So the bio button will lay at the footprint. And then we'll complete the double row repair over the top of the bio button to compress it to the tuberosity footprint. So here's our bio button. This is Demineralized Cancellous bone matrix. This specimen that we're using is three millimeters thick 12mm round. So here's the application of our BMC to the sponge. So we're just going to let it all soak in. So the soaking time recommended is five minutes here for the button in the BMC. So now we're going to come in through the percutaneous portal and grab the three anterior sutures from our To show that they're free from the posterior one. Just. There's no problem. So next thing we're going to retrieve through our lateral portal now, which is where we're going to pass a buy button. I'm going to retrieve my passing end of the repair suture and my shuttle suture. And so we're going to pull on the one we don't need which is posterior. So here we got the two that we need. So again this is the the looped end of the shuttle suture and the repair suture. So this is the SwiveLock passer. Now a repair sutures pass through the loop. And we're going to bring it back through the buy button. We've got the white tapered portion of the repair suture folded to the appropriate point. And now we're going to pass with our shuttle suture. So take a bit of slack out. Create the mechanism. At this point I want to insert the bio button. So here I'm going to insert the bio button through our passport. But I want to be careful with the sutures. So we're doing it Dramatically here. So now we're inserted and now we're going to bring the bow button down. With our shuttle suture. So at this point we can adjust our position. So we're right on the footprint. And the knotless mechanism is going to hold it in place. So this is ideally located. You can see we've covered the entire footprint and it's held in place here. This doesn't have to be super tight. I was able to manipulate with my probe to position it. Now I'm going to cut this suture as I don't need it anymore. So now we have our anterior bio button in position. So I'm going to come in through my lateral and bring out my repair suture and the looped end of the shuttle suture. We're going to repeat the process. This is for our second bio button. So we're going to fold it. This fixation does not have to be tight. This isn't for mechanical purposes. It's just for us to get our sponge for coverage of our footprints. So you can really see now the open pores of the graft and how that's going to help healing of this cuff back to bone. Remember, even though it looks as if the BMC is washed out, Doctor Maisaka has shown us that the stem cells are still there. So we've got complete coverage of the footprint, and we're going to bring the cuff repair of sutures over the top for compression. As you can see, just lateral viewing portal. Good reduction of tissue over the interposition of graft. So at the end of the procedure you can reload the interposition of graft with additional stem cells. With left over BMC. As you can see here adding additional growth factors here to the to the patch with the leftover BMC.

Joshua S. Dines, MD, (New York, NY) demonstrates a SpeedBridge™ rotator cuff repair augmented with an AlloSync™ button graft.

SpeedBridge™ Rotator Cuff Repair Augmented With AlloSync™ Button

So this is a full thickness tear of the supraspinatus, about a centimeter and a half to two centimeter tear. We're going to do a double row SpeedBridge construct augmented with an AlloSync graft. And we're going to show the technique for that. The graft going to be placed on the center of the tuberosity, where the majority of the tendon bone healing is going to be occurring. But first we're going to put in our medial row anchors, as we would do for a standard SutureBridge. This is the anteromedial anchor. This will be our posterior medial anchor. Good. Innovation. So we've got our medial SutureCast and then those will be used later to complete the SpeedBridge. But now in the center of the tuberosity where again the majority of the bone healing is going to take place and where we want it to take place. That's where we're going to add the AlloSync disc, which can be loaded with any biologic that the surgeon chooses from ACP to bone marrow concentrate, or both. This is the drill guide coming in for our FiberTak. Again, I want to be right in the center of the tuberosity there so you can see our previously placed anchors. This will be right in the center, the tuberosity. This is an outside shot of the graft before we before we insert it. And it's basically been hydrating for about five minutes, which is what it takes to become wettable and sort of sponge like and allow it to absorb the biologic of your choice. Again, ACP bone marrow concentrate. And the beauty of this is that that can be done while you're placing your medial row anchor. So you're really not losing any time using this procedure. Now we're going to take one strand of suture from the previously loaded FiberTak and then the other one. And we're going to fade it in through a mattress fashion through this graph, and then use that mattress suture configuration to tie an arthroscopic knot, to then shuttle the graft into place again on the center of the tuberosity. To pass the sutures through the graft, we actually will use a wire anterior limb. So you want to leave enough space in the graft so you can have a mattress suture configuration. We've got about, you know, three quarters of a centimeter of space between those sutures. Now you've got options. You can shuttle the graft into place like this and then tie a knot on top of it. I find that it actually helps to actually tie an arthroscopic knot outside and use a sliding knot that will actually help you shuttle the graft into place. So whatever sliding locking knot you like to use is is fine. And then again, the other option is just to push the graft in first and then tie tie Tying arthroscopic knot on top of it. So now we've got the knot pushing into place, and that's shuttling it right on top to the center of the tuberosity there. And really keeping it centered is key because as you can see, you know, what looks like a lot of space on the tuberosity is not a ton. I'm going to back this up with three half hitches. And the knot pusher works very well shuttling the graft into place. And one of the benefits of this graft is it really does handle well. You can see that it maintains its shape and went into the joint pretty easily. We've now got that fixed at the tuberosity. I'm going to cut those sutures. And then it's just a matter of completing your SpeedBridge technique which which you're likely very familiar with. The theory here, using this AlloSync graft as an interposition, is that the tendon to bone healing occurs from the bone side. So this is going to be a great place to to place your place your growth factors, your your biologics to really kind of place them at the point of of maximal benefit, which is where the healing where you want the healing to occur at that normal tendon bone in thesis. It's not going to impede our rotator cuff repair, which is, you know, one of the concerns with using scaffolds at the bone interface is that sometimes you're worried about putting too much tissue there. That's going to impede the healing. But this becomes a perfect graft at the tuberosity. And so here you see our completed SpeedBridge construct, which looks great. And the graft is buried underneath at the tuberosity. And as you can tell, even during the this was obviously done in real time. The the actual adding of that graft maybe takes an extra, you know, 4 to 5 minutes to the procedure. And if we can add a little time and improve the healing construct and the and the healing rates of rotator cuff repair becomes a huge benefit to our patients.

AlloSync™ Button

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AlloSync™ Bone Grafting Solutions

Orthobiologics - New Product Spotlight

AlloSync™ Button Demineralized Cancellous Sponge for 1st MTP Arthrodesis

BioSurge™ Cell and Bone Graft Processing System

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Orthobiologics - Next Generation in Biologics Technology

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AlloSync™ Bone Grafting Solutions

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1st Metatarsal Phalangeal Joint Arthrodesis Augmented With AlloSync™ Button Demineralized Cancellous Sponge

SpeedBridge™ Rotator Cuff Repair With Knotless SwiveLock® Anchors and AlloSync™ Buttons

SpeedBridge™ Rotator Cuff Repair Augmented With AlloSync™ Button

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1st MTP Cartiva® Implant Revision With Arthrex Orthobiologics

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