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VID1-000101-en-US | B | ACL Primary Repair With InternalBrace™ Ligament Augmentation and AlloSync™ Demineralized Bone Matrix Augmentation

Patrick A. Smith

Human

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ACL Primary Repair With InternalBrace™ Ligament Augmentation and AlloSync™ Demineralized Bone Matrix Augmentation

So you can see here where we've taken, I take 230 cc syringes for our bone marrow aspirate to concentrate it with the Angel system. That's the first thing I do. And that's going to be used for our AlloSync sponge to impregnate that with the growth factors. Next thing we're going to do is I'm going to do a microfracture of the notch to stimulate a healing response with the PowerPick. But the first thing I want to do is I want to identify where exactly I want to reattach the proximal ACL tear fibers to the femoral wall. So my very first hole, I want to be right about here, and this is where I'm going to reattach those native ACL fibers back to the wall. And then what I'll do is I'll just do a standard microfracture of the notch here. So I kind of do this little move right here. It's between 30 and 40 generally. So I know right here it's starting to change pitch. Right. Right there. So that's my interosseous distance. So I know the button is going to flip at 35. So we're going to make a little incision here for the IT band over the pin. So what I'm doing here is just dilating the IT band. So when I use my knot pusher at the end it makes it a lot easier. And I don't have to make a big incision. So now we need our passing suture, which will be blue. This orientation we're actually repairing the Am bundle. And so that's the orientation for the Am bundle. And it's the most isometric we know. It's the most isometric part of the ACL. And for me, always putting the internal brace in, I like to be in the most isometric point. And so that's why this is really important for me having that position. So I try to come through the this side, I pass a TigerLink cinch first. And I'm trying to be on each side of the proximal ACL fibers. Again I'm focusing on the anteromedial bundle fibers. So I come from each side here. So there's my FiberLink. There's my two sutures. So I'm using the tibial marking hook here. And I'm going to push it up into the proximal aspect of the ACL, then we're going to mark the skin. And one of the key teaching points here, Pearl, is we're going to make an incision here. This is going to be our fixation for the internal brace. We'll make it a little bigger incision than normal just to see. And the key point is holding this a little bit flexed to be right in the pathway of the ACL. Do it. So now we're going to exchange the pin for our TigerStick passed up through the native footprint with the guide sleeve tapped into the bone. This is our passing suture for our internal brace. We're going to bring our two proximal sutures out. Okay. To help the healing process for the primary proximal repair that we're doing today. I'm going to add an AlloSync DBM sponge and that will be treated with BMC. Here's our sponge. What I like to do is I like to cut the sponge so it's not too big. So that's the first thing we're going to do is open up our package for our sponge. I'm going to cut just enough to fit the proximal footprint here. So there's our sponge. So we're going to drop it into our little basin. And add our BMC. So now we've got our stem cells growth factors being incorporated into the sponge. Now we have to prepare our internal brace. I use a college encoded FiberTape. And I want the bulk of that collagen coated FiberTape within the native ACL fibers that we left on the tibia here. We're going to measure 35mm from this side of the button. My interosseous distance that I measured on the femur at 35mm earlier with the measuring pin. So we're going to pass our collagen coated FiberTape through the loop of our TightRope. Again, I want to make sure that the collagen coding portion of the tape is within the tibial fibers. So next thing I'm going to do is I'm going to remove the large number five suture here in the TightRope. Because I don't need that to pass because I have the additional flipping suture, the black and white tiger suture. That can be my passing suture. So I'm passing the TigerLink through the sponge so I can pull this up once I tie my sutures. So that's going to get pulled up. Now we're going to load our button. You got to make sure you're in the same orientation. So you need to make sure that the sutures that we tie with the sponge and the proximal ACL fibers are on the top of the button. Now go through the other side. To summarize what we've got to go through the passport. The black and white and blue link sutures are in the approximate ACL fibers pass through the patch. Very important that the two sutures. We're going to tie the tiger and the blue exit on the top of the button with our shortening strands. Here's our passing suture. The black and white here, of course, is our TightRope loop. We have our collagen coated FiberTape. Okay. Little slack now okay. So we see our little blue mark. We expect the button to flip. [00:07:42] There you go. So now we're going to pass the internal brace into the tibia. So there's the internal brace coming to the tibia okay. [00:08:00] All right. Okay. So we're pulling up the patch. The internal base is in place. I got my two sutures. So we've restored the ACL. The internal brace is down below. So I fix this in extension. The internal brace always fixed in full extension. So here's our 4 or 5 bit. Let's cut that. So first thing I'll do is I'm going to get rid of the passing suture. So I pull that out. Next thing we're going to cut our shortening strands for the TightRope. Okay. Now we're going to tie. So I have a free lane to tie to my button. So this is our final ACL repair. You can see we've restored excellent tension. There's the ACL. You don't see the internal brace because it came right out at the top right. So I have some additional BMC. Will come through my passport. Finish the impregnation waters off of my sponge.

ACL Primary Repair With InternalBrace™ Ligament Augmentation and AlloSync™ Demineralized Bone Matrix Augmentation

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