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The Apollo&lt;sup&gt;RF&lt;/sup&gt; SJ50 probe is the first optimized aspirating probe designed for tight joint spaces such as the foot, ankle, elbow, knee, and Nano arthroscopy.
<ul>
 <li>360° edge control for precise debridement; designed to minimize effects on adjacent tissue</li>
 <li>Anatomically designed 50° tip allows for better access to confined anatomy</li>
 <li>Reduced probe dimension length and diameter is 17% smaller than the Apollo&lt;sup&gt;RF&lt;/sup&gt; MP50 design</li>
 <li>Low default ablation setting for reduced energy delivery</li>
 <li>Optimized aspiration to remove tissue particulate and lower maximum joint space temperature1</li>
</ul>
 
Reference
 
1. Arthrex, Inc. Data on file (APT05034). Naples, FL; 2020.&nbsp;

Kaitlin Neary, MD (Boise, ID), demonstrates how to prepare the ankle joint for arthroscopic procedures using the ApolloRF® SJ50 probe.

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SpeedPearl: Arthroscopic Debridement of the Ankle Using the ApolloRF® SJ50 Probe

The Apollo Sf50 probe is an essential device in my practice for ankle arthroscopy due to its precision in debriding, the joint allowing for optimal visualization and precise ablation. Visualization can sometimes be a challenge in the confined working area of the ankle joint. A key pearl when using the Apollo sf50 probe is to utilize its contained plasma field, particularly when debriding the anterior compartment. The controlled plasma edge feature on the 3.3mm electrode is designed to minimize the potential for impact to the neurovascular structures at the anterior aspect of the ankle, such as the anterior tibial artery and deep peroneal nerve. Its optimized aspiration and precise ablation allow for targeted removal of synovitis and scar tissue without excessive tissue disruption. This precision enhances surgical efficiency, providing a clear operative field while preserving vital structures essential for ankle function and recovery.

John G. Kennedy, MD (New York, NY), demonstrates a minimally invasive approach to treating anterior and lateral ankle impingement using the NanoNeedle™ scope 2.0, ApolloRF® SJ50 probe, dissector shaver blade, and round burr.

Anterior and Lateral Ankle Impingement Using the NanoNeedle™ Scope 2.0 and NanoResection™ Devices

Hi, my name is Doctor John Kennedy. I'm an orthopedic professor at NYU Langone in New York. We're going to be talking today and showing the new 2.0 nano needle, and we're going to be looking at it specifically in the ankle joint at the anteromedial impingement and anterolateral impingement. And today we're going to be going how do we diagnose this. And also how do we fix it. So we're just inserting this Apollo SJ 50 which is this new and improved radiofrequency ablation device. You can see already that there is a little suction on it, which is very helpful just to pull in the particular tissue that you're looking for. We're using the handheld device here. And we just do small little bursts. And you can see how effective this is. And the other thing is when we remember the old device you remember all those bubbles that you would get. And of course you don't see that here. So just short burst in very short order. We've taken away most of that scar tissue there, and you don't have to be aggressive here at all. Just these short pulses. Clean up that scar tissue in no time, and then occasionally we'll need to go back in and use the the shaver to clean up any of the the necrotic tissue left afterwards, and you can see how effective that is. So we have now moved our camera onto the lateral side. So we have good visualization over medially. You can see one of the things that I noticed really with this 2.0 upgrade is that anytime you have flaring of the light that the onboard sensor actually reduces that. So you don't get those flare outs that you see in a traditional scope. So I think for many reasons, this 2.0 and nano needle is really a massive advancement by comparison to standard arthroscopy. So here on this particular patient you can see that there is contour irregularity. There's a large fibrous and bony impingement here. And of course this is very common in soccer players and runners. So this is true anteromedial impingement. It's a combination of both bone and soft tissue. And this is where Nano is really exceptional for in-office procedures. And you can see right across over into the medial mal. And we're going to be resecting all of that while the patient is wide awake and being part of it. And one of the great things is when you do this in, the patient is awake as you're resecting this and you ask them to move, they get that tactile feedback. They feel that their joint is so much freer than it was before. So we used again the standard 3 or 3.5 shaver. And the first thing we're going to do is just, again, take away all of that soft tissue that we can see there. And fluid management is key here. The pump is typically at around 35mm of mercury. And you'll adjust that as you need to. But you can see that if we put too much suction on this, we can really pull in all the soft tissues. So that's not great. So as we're taking away this soft tissue things to be aware of around here, we don't want to shave upwards. That's where all the name structures are. We want to keep away from that. So you can see that the cutting or the action part of this blade is always facing down, sweeping down the neck of the talus. And there's that exostosis that will be causing some impingement. We'll take that away. It's relatively small in this patient, but we'll be taking that away with a both a shaver and a burr in one moment. So patient or people always ask how much soft tissue or how much bone do you resect. Well the answer to that is on the tibial overhang, which is here. You really want to be getting that flush with the anterior aspect of the medial malleolus which is here. So we're taking away all this soft tissue. And this will bring in the anterior border or the anterior fascicle of the deltoid which is here. And again, as we know the deltoid is a very, very strong robust ligament. And I think we can afford to take some of those fibers away to prevent recurrence. So we're just now going to swap over to a bur. We've taken away all that soft tissue and you can see that already. And there's less soft tissue impingement. And now we're going to go to a bur to actually remove part of this. Almost do a plasty here. So this is a typical this is what we would do normally in office. All of this is done with a patient wide awake and being aware of what's happening all the time. So with the birds, we know the technique for bur is constant motion. We never keep the bur in one place for any period of time. You don't want any troughing to occur, but you're constantly moving it around and taking away millimeter by millimeter. That anteromedial aspect of the joint keeping the horizon. Stable so that you you can always see where the joint is. Avoiding any iatrogenic iatrogenic injury to the cartilage underneath. So again we're just constantly moving that back looking to where our marker is, which is the anterior border of the medial mal. So constantly moving. And again you can see as I'm doing this there are milliseconds of flaring as the as the camera moves in and out. There will be flaring and some glare from the from the sheath of the bur. And then the sensor onboard sensor corrects that right away so you get a constant picture. So we always take a little bit more than you would need on the basis that the body doesn't tolerate a dead space. So it will try to fill this in with, with some scar. Postoperatively. But if you take a little bit more bone then the likelihood of that scar causing any pathology is very low. So then we move over on to the anterior border of the The medial mouth, and we'll take a little bit more bone from there. We don't have to be too aggressive on this. In this particular case, there's not a big overhang. But you can see the tibia now is in line with that anterior border. So that's enough resection on this. Oftentimes you can be here for quite some time taking this away. And then you can swap swap out to A40 shaver if you need to be a little bit more aggressive. But that's pretty good. Now one of the things that we all learn from our mistakes, and one of my fellows, when we're operating on a soccer player, told us I thought the case was over. And he said, well, we should really look down here onto the neck and down here. There was a very large exostosis. So I've always remembered that case that we always want to look onto the neck and again, using the bur, being careful to shield the soft tissues away from this, the cutting blade. And again constantly moving this around. To avoid any troughing. This is typically where you will find a large exostosis on the medial neck, so always look for that. But again, you can see that any time I move the camera in a little too close, so there's a flare or glare off that sheath, the onboard sensor immediately recognizes that and brings you back to a normal picture. The great thing about in-office needle arthroscopy is the patient is awake, and you can ask them now to move their ankle into a dorsiflexed position so you can truly see that there is no impingement there any longer. And more importantly, they feel that. And I think that's the buy in from patients we've published on this to show that patients really do like this procedure and that they understand what's going on, and then they can titrate their activities post-surgically based on what they've seen at the time in a realistic fashion. So I think it's very, very helpful in that way.

This animation highlights various features and clinical applications of the ApolloRF® SJ50 probe, the first probe for foot and ankle arthroscopy with optimized fluid management for debris and bubble control.

ApolloRF® SJ50 Probe

Carl T. Hasselman, MD (Pittsburgh, PA), demonstrates the effectiveness of the ApolloRF® SJ50 probe in various ankle procedures. Dr. Hasselman highlights the probe’s benefits, including low default settings, optimized aspiration, and 50° curvature.

ApolloRF® SJ50 Probe in Ankle Arthroscopy

Hi, I'm Doctor Carl Hausmann. I'm from the University of Pittsburgh in Pittsburgh, Pennsylvania. What we're going to do is we're going to go over ankle arthroscopy with the use of the Arthrex S-50 Apollo probe. So I put my curve, the tip of my probe, 90 degrees into the joint. And then I lift my hand and it just goes in very quickly and easily. And that keeps you from struggling with the probe. Because once the probe is in, it will do the work for you. It also has hand control. So you'll have blue, which is just like on most instruments. It's going to be your coagulation and you're going to have yellow which will be kind of your cut and rapid cut. It comes with factory settings. I can tell you right now, 98% of the time the factory settings are more than enough to accomplish everything I need to do. But the nice thing is, is you can actually increase or decrease the intensities from the factory setting on the probes. With this probe at the factory setting, it really takes a matter of a second, and you can get a lot of this tissue out of the way. The neat thing about this is you'll notice it has the suction, so that if I do get an air bubble or two, it quite quickly alleviates them. And that's what I like about this probe more than the others. And so the nice thing is this thing is keeping the area cool while I'm doing my ablation of that area. Most probes, as they're straight when they come in, that's what you're going to get. So you're going to actually have to take your hand and bend your probe. And most of the probes are too stiff. So you end up using a pair of pliers or something to bend it. Then you ruin the sheath on the probe. You end up throwing them away. This probe has that hook so you literally can come in. And then when you rotate it, actually look at that. It matches the shape of the talus. So it is designed to let you go back all the way to the back of the ankle. And you can see I am literally basically almost at Subtalar joint. I'm so far back in the ankle. In fact, there's the posterior tibiofibular ligament. And you can see this probe can get all the way down to the posterior part of the ankle. So if you're trying to get an Ars trigonum out arthroscopically, I am literally right where the eyes would sit. So you could actually do your complete synovectomy with this probe and you can get all the way back. The other beauty is that two things of this probe, it actually has a 360 degree cutting edge on it, which is quite nice because you can actually use the edges just as much as the surface to do ablation. So one of the things you can watch is if for some reason you wanted to take down one of the ligaments in the back, I can literally put it in there and I can actually just hit and you can see that it's starting to actually cut using the edge of the probe. And you can see how I'm already starting. I'll go in close. You can see how the edge is literally cutting the ligament for me. But at the same time, if I didn't want to cut the ligament, say it was just hypertrophied and thick and frayed. I can also use my COAG. And if you watch when I see these frayed edges, I can literally just use my COAG and it will just get rid of the frayed edges. So it's basically getting rid of those frayed edges without really damaging the fibers, because you can see the see the fibers are still not hurting or not being damaged. They're staying perfectly nice. Now, for example, in arthritis, a lot of times we all see this shag carpet appearance and you want to get rid of this, but you can literally take this probe, putting it on COAG and just kind of come in and clean those areas up and see how I can just nicely get rid of that shag carpeting by kind of just mowing along it. But if you look down at the cartilage, you'll notice that I really haven't damaged the cartilage in any way. My probe is now between the anterior capsule of the ankle and the anterior edge of the tibia. And very commonly, we want to get rid of all the synovitis if we're doing an anterior colectomy. And so the beauty of this probe is you can actually get right up in that area. And then with my probe on cut, I can literally clean this whole area up. The one thing I have found is that a lot of times I'll give it a second breath after about 5 or 6 seconds, I'll like take a one second just to let the aspiration get rid of any warm fluid. And that way I can keep the whole joint space nice and Nice and cool. So I'm at the anteromedial gutter of the ankle. There's going to be some fibers of the anterior deltoid that I can clean out. But you can see, I can rapidly clean out all of the tissue in the anteromedial ankle. And the other nice thing about the probe is when I'm in here with this probe is because it's hooked. One of the other things I can actually use is use the hook to my benefit. So I can actually come in, and I can hook that tissue and pull it away from the cartilage surface. And once I have it pulled away from the cartilage surface, then I can hit my cut and I can actually cut the tissue. And that way I'm really staying away from my articular area so the hook actually can use it as an advantage, just like a nerve hook to get rid of this tissue. If you're getting nervous that you're getting a little too close. Now, what I could do is if I wanted to get rid of this, I could literally use my probe because of that hook, and I could breed all the tissue around it quite quickly. The nice thing is, I can respect that cutting of the 360 cutting. You'll notice how I'm literally taking off this tissue right around it, and not a single bit of damage to the lateral wall or the medial wall of the talus. And so I can ablate this. And I can also use the hook action to pull it away in a blade. And you can actually see how I've completely loosened this. So the neat thing is, is I've done a complete using the Sf50 probe. And now I'm just going to use one of the Arthrex Graspers. And I can come in and literally grab that piece. And the thing is I can pull it out. And now there's just a small piece left. And I'm not going to belabor the point, but you can see how easily I did that. But the really neat thing is with that probe is I just put this in and I'll pull the tissue back and we'll look. You do not see any damage. We did a complete synovectomy and Dyneema of the medial gutter. And there's not a single burn mark, not a scuff mark, not a single mark on that talus showing you that the probe didn't hurt the articular cartilage in any way, shape or form. And that's really neat about this because you literally just took out all that synovitis, and there's just a small piece of that medial malleolus left. This person has a cartilage lesion and it's an anterior lateral OCD, which is not uncommon. So a lot of times after we've done our microfracture, a lot of times we'll have those edges. This is the other place the ss50. So now you've microfracture you're quite happy. But you'll notice one of the things that we have left now is we have this rough edges right in here, and we worry about those breaking off. A lot of times people will put a shaver in, but this is actually one of my favorite tricks, is you can actually bring the ss50 in. And with the COAG just slowly, gently hit these areas and it actually kind of just takes off any of the rough edges. So just using the probe and little blasts, I can clean up any of those rough edges. But I'm not hurting the cartilage. Some of the key tricks to remember one. When you're inserting it, always insert the probe so probe so that the tip goes in first at a 90 degree. So you notice how my hand is held. So I'm going in first. Then I rotate my hand. Don't try to go straight in. It's not going to work because unless you want to make huge incisions it's not going to work. You want to keep your incision small, put the probe in, get into just the edge of the capsule, then rotate your hand. It comes in quite quickly. Number two respect the curve. Remember, when you're going back into the back of the ankle, you have to keep it turned at a 90 degree only as it goes past the talus. Then I rotate it and it respects it. And so now I can go into the back of the ankle and I'm in the back of the ankle. I can do all my work. And that actually is the safety probe and a lot of things I like about it. Again, I have that COAG function works great for osteochondral lesions, and you'll ablate it within a matter of seconds. And it's beautiful. It saves you a lot of time. And that's kind of the reasons, all the reasons that I like this probe because it has all the functions you could possibly need.

application/pdf

ApolloRF® SJ50 Probe for the Ankle

Imaging & Resection: New Product & Technique Highlights

The Apollo&lt;sup&gt;RF&lt;/sup&gt; SJ50 probe is the first optimized aspirating probe designed for foot, ankle and elbow arthroscopy.

Child (D)

Ablación por radiofrecuencia

Secondary (C)