Name: BioUni™ OATS® Technique
Uploaded: 2016-03-01T00:00:00Z
Channel: Arthrex

Orthobiologics

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VID1-00691-EN | A | BioUni™ OATS® Technique

Matthew T. Provencher

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A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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BioUni™ OATS® Technique

This is the BioUni OATS Arthrex instrumentation set. This is a brand new set that incorporates the ability to do basically an oval type of osteochondral allograft for the medial femoral condyle of the knee. So here's our lesion right here. And you can see the areas of this lesion. We'd obviously like to get this all covered now. Usually this would be to you know round snowman or overlapping snowman type of Osteoallograft. But this is a typical medial condyle lesion that extends posteriorly within each of the sizes small medium large and extra large. You have several choices for additional width changes and a little bit of length change, but mostly it's a width change and you can see the size of the defect. Here we're trying to cover which is which is from here to here. And you can see that this will cover this very nicely. There's the bottom of it. Even if you take a little bit of that cartilage, it might be abnormal right there. We're going to mark this so that we're completely covered. The other thing is that this gives you plenty of coverage medially and laterally, so that you get a very good press fit, and you're not blowing out any of the borders of the condyle or cortex of the condyle. You have plenty of room to put this in. So from the tray we're now going to chose the donor harvester. And so we've already sized this to an M14 which is the medium for curvature. And then the 14mm on the width. And so you can see really nicely right here. These are the products we're going to use to harvest it. And you can see the M14 in this part of the tray. So the first thing to do is when you have this is to check your M14 sizer to make sure that you like this. And this is going to work. I'm going to first of all we're going to put this here. We're looking for that ability to be completely flush superiorly, inferiorly, and that the radius of curvature is well conserved works well for this whole whole device. So now you're going to take a marking pen, making sure that you're flush on all aspects of this device down to the cartilage. And so now we're going to use this device. And it's really important to make sure that you have this lined up correctly. Again you have this plastic insert in place. And that's going to help you extract the graft at the end at the end of the procedure. And so now we have a secondary check of how this fits and is flush all the way throughout. So I'm holding this right here. And what I want to do this will help fix this in place. So this is the impactor handle. And we screw the impactor handle in right here. Your assistant can make sure you hold the graph station. And then with some gentle taps we're going to start advancing this. So you're constantly making you're constantly making subtle adjustments to make sure that sure that these laser lines are going down. Exactly. Flush all the way around. Next we have a screwdriver, which is just going to help us harvest the graft. And basically what this does is just pushes up against the plastic insert to help take this graft out. So this is basically what you're left with. Next thing we're going to use is a sagittal cutter guide. And this is what accommodates the sagittal saw. This is going to come into the appropriate depth. And you'll see how this comes in has some depth stops both here on the side top bottom medial lateral. And those are the depth stops are important because that's going to harvest our depth depth. And then you'll be able to take this graft out. One thing you can do is take out the pin if if it's not going down very easily. And so sometimes I'll do that just to accommodate. You already have the osteotomy there. So it's really safe to do this. It's just a matter of coming down without having pin interference. The pin is really just for the first cutter. Now that we have all of this down here, we have this flush here, and we have this flush here. Now we can use the fin to do the cutting just for cooling purposes. We'll also draw some, drop some irrigation on the saw. Now we're going to see how the overall harvest did. So we just pop this right into the trial. And what you can see here is it's perfect. Now that we have a really good graft, what I do is we're going to first of all pulse lavage this. So we pulse lavage this with five liters of lactated ringers. We'll simulate with this. But I use this to remove all of the marrow elements and make sure it's protected so that the graft doesn't go anywhere. But do it in a kidney basin or some kind of basin to protect the graft. The next thing I do is I soak all of my fresh osteochondral allografts in ACP. And so we draw peripheral blood, we spin it down with the Arthrex ACP system, and then we're left with anywhere from 5 to 6 CCS of platelet rich plasma, which I now soak in the graft while I'm doing and preparing the rest of the of the case. So now we're back. Now we're back to the knee and our defect here. So obviously you see our defect. And again this is a very typical medial condyle defect. It's not just cylindrical but this is a perfect system to accommodate many of those lesions which are oval in nature. And so now this is another key part of the case. And I said I was going to cheat this up just a little bit. And the reason is I have plenty of room in the back here and also a good fit. So I'm just going to cheat this up just to the top of my mark. And while I hold this here, the key part is while you're holding this here, making sure that it's completely flush on the cartilage. Now we're going to put in our four millimeter guide pins. And this is critical to make sure you get these in correctly. Again that's our position. So now we're going to hold this here okay. Go ahead. Just a hair more good okay. Good. So now we got the first one. And one of things you got to be careful of is that you don't rotate this. You have the ability to do that. So you can make some compensatory changes if Changes if you need to. But again, what we're going to do down here is just make sure that we like what's going on down inferiorly. We see our marks down there. We're going to line those up really well. And now we'll put that bottom pin in place. What you're what you're seeing here is really nicely how this is completely flush flush flush. That's the goal as well as on the other side which we already looked at as well. So next is the the score. And this is we'll score the cartilage. We recommend putting this to a depth of approximately 2 to 3mm. We do is going to slide this right over here. And now just put this down and score the score the cartilage. So now we recommend a depth of about 2 to 3mm here. So one of the things we're looking at here is that we're parallel. We don't want to be like that. We don't want to be like that. We want to be straight parallel with these two pins. In addition you want to be parallel looking down on yourself. So in two planes you want to be parallel with this cartilage score. So next thing is the differential offset guide. And so making sure that this is all the way down in cartilage. See I've tweaked this down a little bit. That's a nice little maneuver right there to make sure this is all the way down. The tolerances on this are extremely tight, which is good for the system. But just make sure you're coming down exactly parallel. Ream in. What you're going to see here is now I'm stopped right there I can't go I can't go anymore. That stops right down there. So now we're going to do is use the same zero medium. And now put it on the one that we just drilled. So we can now complete the other circle. And now put the reamer over the bottom pin again being very gentle that you get this correct. Coming down. You got a good trajectory on this. There's no torque. And doing this little maneuver ensures that there's no torque. And start starting the reamer off the bone full speed. And now that stops right there. The next device is now the side cutter. And so now I'm flush at both the top and the bottom. And so now we can take this out. And it's okay now if the pins come out. So now we've got the box cutter down on the side. We've got the bottom and top. And now this scraper can just basically just pull this right out and scrape this out pretty easily. So now this is the dilator which now should be exactly flush both at the top of the bottom. This is the M14. So a medium size 14. And so we're going to put this into the lesion. So as we take this down what I'm doing is making sure that this goes down parallel. One of the things I like to do is you can see the base here is really nice. But one of the things we like to do is to pick this and do a microfracture just to help stimulate some healing microfracture. We're going to put this on forward, and I just go around in a peripheral area in a very circumferential fashion. Good. So now we microfracture the base. The other thing we can do is used a demineralized bone matrix gel. And this will help enhance the healing process at the interface. And usually I just squirt a small amount in here. One of the things you can do with the graft it depends how the harvest is. But sometimes if you just do just a tiny amount, don't. You don't need much, just a tiny bullet to the graft. And you just want to do a gentle tamp on this. You don't need that much. So that's what we have is just basically, you know, totally confluent. This is the picture you want right here. I think the closure is also important. But basically just just we have that tissue that's two millimeters here. And I just use some number two. Number two high strength suture here a couple figure of eights. You don't want to over constrain this because you don't want to constrain the patella. But just a 2 or 3 figure of eight number two sutures. And then maybe some absorbable suture and then a layered skin closure.

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