Driving innovation with the latest technological products and procedures to treat a variety of elbow conditions.

The InternalBrace™ ligament augmentation procedure with SwiveLock® anchors and FiberTape® suture is a reasonable alternative that may eliminate secondary hardware removal and provide a more attractive solution for patient comfort and overall cosmesis.
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.

UCL InternalBrace™ System

Young overhead athletes who sustain an injury to their medial ulnar collateral ligament (UCL) complex, isolated to the proximal or distal end of the ligament and without chronic attritional damage, may benefit from a repair rather than a reconstruction procedure.1
Reference
1. Walters BL, Cain EL, Emblom BA, Frantz JT, Dugas JR. Ulnar collateral ligament repair with internal brace augmentation. Orthop J Sports Med. 2016;4(3 suppl3):2325967116S00071. doi:10.1177/2325967116S00071
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.

UCL Repair

Use the all-suture FiberTak button in lieu of traditional metal buttons for both bicortical and unicortical tension-slide techniques. Its 2.6 mm-diameter sheath is preloaded with 2-0 FiberLink™ sutures that are used to shuttle the whipstitch limbs through the sheath.
Features and Benefits
- Button-first technique helps eliminate need to find the drill hole
- 2-0 FiberLink sutures in blue and white/black for easy identification
- All-suture FiberTak button is not visible on x-ray
- 17% stronger than metal buttons1
- 2.6 mm drill reduces the hole 19% compared to the 3.2 mm hole commonly used for metal buttons
Reference
1. Arthrex, Inc. Data on file (APT 04066). Naples, FL; 2019.

FiberTak® Button Tenodesis Technique

A modified SpeedBridge™ construct, with multiple suture passes and knotless SwiveLock® anchors laterally, provides a strong repair that may be applied in many tendon repair indications. An alternate repair technique is the use of whip stitches for the tendon that are passed through two small transosseous tunnels. The sutures are then crossed over the tendon to create a suture bridging construct completed with knotless SwiveLock anchors.

Triceps Technique

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The FiberTak Biceps Implant System delivers an all-suture anchor designed for use in open, onlay-tissue fixation procedures, particularly proximal and distal biceps repairs. The implant is double-loaded with sliding SutureTape and includes 4 attached needles. The system includes a FiberTak biceps implant, drill guide, 1.9 mm drill, and a free curved needle.

FiberTak® Biceps Tenodesis Technique

As part of the distal biceps repair procedure, the tension-slide technique with the BicepsButton™ implant provides a simple, reproducible, and biomechanically stable repair. This tensioning technique reliably draws the tendon against the distal cortex of the bone socket. Adding a tenodesis screw improves the biomechanical strength and allows the tendon to be placed in a more anatomic position.
The all-suture FiberTak® button can be used in lieu of traditional metal buttons for both bicortical and unicortical tension-slide tenodesis techniques.

Tension-Slide Technique

Distal Biceps Rupture

A distal biceps rupture off the radial tuberosity often presents with painful swollen elbow and significant loss of strength in rotation and flexion. Distal biceps tendon repair using the BicepsButton™ and tension-slide technique allows the surgeon to tension and repair the biceps tendon through a single anterior incision.

A distal biceps rupture off the radial tuberosity often presents with painful swollen elbow and significant loss of strength in rotation and flexion.

Primary (B)

After debriding the diseased tissue, securely fixate the tissue back to the bone to assist in healing lateral epicondylitis. The 3.0 mm Knotless SutureTak open repair anchor combines a proven anchor design1 and an anchor-first technique to securely repair soft tissue. Additionally, knotless soft-tissue fixation eliminates knot stacks, which can loosen and cause tissue irritation. 
 

A short drill guide is used with this technique, allowing precision anchor placement. Prepare the bone for anchor placement using the 2.6 mm drill. Following anchor placement through the drill guide, use a needle to pass the repair suture through the tissue in a reverse figure 8. Use the TigerLink™ suture to shuttle the repair suture and create the suture-locking mechanism. The repair suture can control the repair tension under direct visualization. Remove any extra suture slack before performing final suture tensioning and cutting the suture limb. 

 
 
Reference
 
1. Arthrex, Inc. LA1-00017-EN_A. Naples, FL; 2015.

Knotless SutureTak® Open Repair Technique

Lateral Epicondylitis

Lateral epicondylitis, or tennis elbow, is an inflammatory response of the wrist extensor muscles at the proximal insertion site caused by overuse of the extensor carpis radialis brevis (ECRB). This irritation can cause localized pain on the lateral epicondyle, on the ECRB path below the elbow, and decreased grip strength.

Recurrent instability of the elbow typically includes posterolateral rotary subluxation with disruption of the lateral collateral ligament complex. A tendon graft or FiberTape® alone can be used to reconstruct the elbow. Identify the LUCL insertion site on the supinator crest and drill a single 5 mm bone socket at the level of the radial head. The isometric origin on the humerus is identified and a single 5 mm bone socket is made. The graft can be prepared on both ends using #2 FiberLoop® creating a running stitch while ensuring its circumference is 5 mm or less. Capture the one end of the graft with the forked end of the 4.75 mm forked SwiveLock®, dunk it into the ulnar socket and advance the implant in the standard fashion making sure the graft is adjacent to the humerus. Hold the graft taut over the socket in the humerus and insert the forked SwiveLock. For FiberTape reconstruction a 4.75 mm SwiveLock with eyelet is loaded with a FiberTape leaving equal tails and inserted in the supinator crest socket. Both tails of the FiberTape from the first anchor are placed in the eyelet of a second SwiveLock. The FiberTape is tensioned and the anchor is placed in the humeral socket in the isometric location.

FiberTape® Augmentation

Posterior Lateral Rotary Instability After Dislocation

Patients with chronic elbow instability may present with elbow pain and complain of clicking and catching with elbow extension when pushing off from a seated position. Physical examination reveals varus instability, tenderness over the LUCL and have a positive pivot-shift test; a positive apprehension test is also useful in the diagnosis. LUCL reconstruction may be indicated if elbow stability can’t be achieved with reduction and immobilization. The 4.75 mm Forked SwiveLock® is an excellent fixation option to obtain isometric reconstruction with either a soft tissue graft or FiberTape® InternalBrace™. The UCL reconstruction instrumentation set may also be a useful option as it is amenable to LUCL reconstruction techniques.

Arthroscopic treatment of posteromedial impingement utilizes a straight posterior and posterolateral portals. The posterolateral portal is used as a working portal and the straight posterior portal is used for insertion of the arthroscope. After thorougharthroscopic evaluation of the posterior compartment and removal of any loose bodies, the posteromedial osteophyte is removed with a small osteotome taking care to remove bone fragments with a grasper. The remaining tip is finished with a small burr or shaver, only removing enough bone to allow full extension without impingement. Chondromalacia of the fossa is debrided of any unstable cartilage flaps and abrasion chondroplasty is performed if necessary.

Removal of Osteophytes and Loose Bodies

Posterior Medial Elbow Impingement

Posterior elbow pain may be caused by mechanical abutment of bone or soft tissues in the olecranon fossa which leads to osteophyte formation, loose bodies and is often associated with UCL instability. This overuse condition is generally caused by repetitive hyperextension, valgus and supination and is characterized by posteromedial olecranon osteophytes, chondromalacia of the medial wall of the olecranon fossa, tension on the medial ulnar collateral ligament and compression of the radiocapitellar joint. This valgus extension overload syndrome is commonly found in tennis players, boxers, weightlifters, gymnasts, martial arts and football lineman, but the most common diagnosis is in baseball players.

Triceps Repair

Partial tears of the triceps tendon or complete ruptures typically occur in a traumatic fall onto the arm or in players who participate in sports such as weight lifting and football. These tears are rare in the general population, but factors such as steroid use, metabolic disorders and olecranon bursitis can increase the risk of this injury. Proper diagnosis of the severity are accomplished with a discussion about the patient's symptoms, activities and medical history along with other diagnostic tools including x-rays and MRI.

TheDANE TJ (David Altcheck, Neal ElAttrache, Tommy John) Technique is an elbow UCL reconstructiontechnique that combines proximal graft docking with a single distalinterference screw fixation. The DANE TJ Technique can be performed using the Arthrex Elbow UCL Reconstruction Instrument Set. FiberWire and FiberLoop may be used to stitch the graft ends andfor final humerus fixation and an Interference Screw for ulna fixation.

DANE TJ Technique

The “DockingTechnique” was first described by Dr. David Altchek. This techniquereconstructs the UCL by looping a single continuous graft loop throughconverging Ulna bone tunnels and “docking” the sutured graft ends through twohumeral tunnels, after which the two ends of the UCL graft are tied withnon-absorbable suture over a bone bridge. The Dockingtechnique can be performed using the Arthrex ElbowUCL Reconstruction Instrument Set. FiberWireand FiberLoop may be used to stitch the graft ends and for final fixation overthe humerus bone bridge.

Docking Technique

TheInterference Screw Technique reconstructs the UCL by using a looped graftanchored into single bone tunnels in the humerus and ulna. The graft is thensecured with Arthrex Interference Screws on both sides. FiberWire can also beused for suturing the graft to itself for increased tension and/or originalligament repair for added stabilization.

Interference Screw Technique

The ModifiedJobe Technique for UCL Reconstruction/Repair uses a series of tunnels in the ulna and humerus to pass the graft in a figure-8 fashion and secure it toitself and surrounding soft tissue. Repair of the original UCL is added forgreater stabilization. The Modified Jobe canbe performed using the Arthrex Elbow UCLReconstruction Instrument Set.FiberWire and FiberLoop may be used to stitch the graft ends andfor final fixation.

Modified Jobe Technique

Ulnar Collateral Ligament Tear

Ulnar Collateral Ligament (UCL) Tear is an uncommon injury in the general population, but is markedly increasing in the athletic population, particularly overhead athletes. The UCL tear results in pain, dysfunction and instability when a dynamic valgus stress is applied to the elbow. The diagnosis is made via clinical exam and MRI and open UCL reconstruction is often recommended for return to sport activities. Multiple techniques have been developed since the initial “Tommy John” surgery. Arthrex has developed the UCL Reconstruction Set, which includes the equipment necessary to perform the different techniques based on surgeon preference.

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UCL InternalBrace™ System

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UCL Repair

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FiberTak^® Button Tenodesis Technique

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Triceps Technique

Distal Biceps Rupture

Lateral Epicondylitis

Posterior Lateral Rotary Instability After Dislocation

Posterior Medial Elbow Impingement

Triceps Repair

Ulnar Collateral Ligament Tear

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Disclaimers

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What's New in Elbow

FiberTak^® Button Tenodesis Technique

Distal Biceps Rupture

Lateral Epicondylitis

Posterior Lateral Rotary Instability After Dislocation

Posterior Medial Elbow Impingement

Triceps Repair

Ulnar Collateral Ligament Tear