Finished Product

AR-7900

Knee

Procedure

El set protector de sutura para menisco provee un sistema seguro y versátil para realizar la sutura de meniscos dentro/fuera o bien ""All-Inside"". La cánula curva, maleable, de un solo uso y el mango plástico integrado tienen una aguja de Nitinol y un empujador de aguja para mayor conveniencia. La herramienta para flexionar cánulas facilita la flexión simple y a medida para adaptarse a cualquier variación anatómica. 
 
La aguja para suturas de Nitinol permanece recta después de salir de la cánula curva para mayor control de la colocación de la aguja a fin de evitar las estructuras neurovasculares. El captador de agujas facilita dos opciones para guiar agujas de manera segura fuera de las estructuras neurovasculares. El mango cóncavo, curvo puede insertarse a través de una pequeña artrotomía como un retractor o puede servir como deflector de agujas cuando se realiza un procedimiento clásico con una apertura mínima dentro/fuera. El tubo captador de agujas se inserta a través de una cánula colocada en un portal posterior para captar agujas intraarticularmente dentro del receso posterior después de salir del menisco, cuando se realizan procedimientos de sutura de meniscos ""lAl-Inside"".

Aaron Krych, MD, (Rochester, MN) discusses the importance of re-establishing anatomical function of a damaged meniscus using the new ZoneNavigator™ system for inside-out meniscal repair. He also discusses using the Knee Scorpion™ suture passer for meniscal root repair and the meniscal root drill guide for transportal and transtibial root repair.

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Meniscus Root Repair and Inside-Out Repair Techniques

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ZoneNavigator™ System Surgical Technique ZoneNavigator™ System The ZoneNavigator system allows precise placement and passing of horizontal and vertical suture constructs for inside-out meniscus repairs. The multiple-cannula system is interchangeable and optimized for specific suture placement in the posterior, middle, and anterior zones of the meniscus. Anterior Cannula The anterior cannula is optimal for inside-out meniscus repair, from the anterior horn to the middle zone of the meniscus. Introduce the cannula through the contralateral portal for extreme anterior meniscus repair. Middle / Posterior Cannula Specific left (a) and right (b) cannulas target the posterior and middle zones of the meniscus. (a) (b) Mini SutureTape With Meniscal Repair Needles: The 0.7 mm Stainless Steel needles with Mini SutureTape are specifically designed for use with the ZoneNavigator system. The 0.9 mm-wide SutureTape disperses forces over a greater area compared to smaller round suture. Ergonomic Handle Control suture placement and needle advancement in 1 cm increments with the ergonomically designed handle. This allows the surgeon to hold the arthroscope with one hand and insert sutures with their other hand. 01 I ZoneNavigator™ System Surgical Technique 1 Select the appropriate cannula relative to the tear location. Attach the cannula to the handle and introduce it into the joint. The posterior/middle cannula is designed to enter the joint from the contralateral portal, allowing direct visualization from the ipsilateral portal with the arthroscope. 3 Advance the needle slightly by depressing the button and advancing it forward. Note: Exposing the tip of the needle can aid with precise placement of the stitch. Continue to advance the needle under direct visualization until the needle can safely be retrieved from the posterior accessory incision. 2 The needle catcher facilitates 2 options for guiding needles safely away from neurovascular structures. The concave, curved retractor may be inserted through a small accessory incision as a retractor or it can serve as a needle deflector when a classic miniopen inside-out procedure is performed. Insert the ZoneNavigator™ cannula into the joint and feed the first meniscus repair needle through the end of the handle. 4 Move the cannula to the next position on the meniscus. Load the second meniscus repair needle into the handle and advance similarly to the first needle. Note: Maintain slight tension on the previously passed suture to facilitate easy passage through the cannula. Complete the repair by tying the sutures over the capsule. ZoneNavigator™ System I 02 Ordering Information ZoneNavigator™ System Product Description Item Number ZoneNavigator System Handle AR-7900 ZoneNavigator System Anterior Cannula AR-7905 ZoneNavigator System Middle Cannula, left posterior AR-7910L ZoneNavigator System Middle Cannula, right posterior AR-7910R Needle Catcher AR-6660 Suture Product Description Item Number 2-0 Mini SutureTape Meniscus Repair Needles, qty. 2 AR-7523 2-0 FiberWire® Suture Meniscus Repair Needles, small, qty. 2 AR-7223SM Products may not be available in all markets because product availability is subject to the regulatory approvals and medical practices in individual markets. Please contact Arthrex if you have questions about the availability of products in your area. This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience, and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level and/or outcomes. View U.S. patent information at www.arthrex.com/corporate/virtual-patent-marking arthrex.com © 2021 Arthrex, Inc. All rights reserved. LT1-000005-en-US_D

ZoneNavigator™ System

Walter R. Lowe, MD, (Houston, TX) demonstrates an inside-out meniscus repair, including placement of a posterolateral needle catcher, using the ZoneNavigator™ system.

ZoneNavigator™ System Posterolateral Exposure for Inside-Out Meniscus Repair

Drew Osika Product Manager, Knee & Hip Arthroscopy ZoneNavigator™ Inside-Out Meniscal Repair System Arthrex, the leader in orthopedics sports medicine, introduces the ZoneNavigator system as the newest addition to meniscus repair. Features and Benefits The ZoneNavigator system revolutionizes the gold standard of meniscus repair, offering your surgeon customers precision control and ergonomics for inside-out meniscus repair. Increasing publications in medical journals stress the importance of repairing the meniscus rather than performing a meniscectomy. An increasing amount of procedures are performed using inside-out meniscal repair as an adjunct to all-inside meniscal repair. Three cannulas are offered with the system. A specific cannula for posterior and middle zones of the meniscus is offered in a left and right orientation. A third cannula is designed for anterior meniscus inside- out repair. DATE: 03/18/19 NUMBER: KH1-000011-en-US Anterior Cannula Left Middle/ Posterior Cannula Right Middle/ Posterior Cannula Drew Osika Product Manager, Knee & Hip Arthroscopy The ergonomic handle reduces the number of assistants required for an inside-out meniscus repair. Other systems require the surgeon to hold the arthroscope and the cannula while relying on an assistant to advance the needles and another assistant to hold a retractor in the posterior portal to retrieve the needles. The ZoneNavigator™ system gives your surgeon the control they prefer for this challenging procedure. Once the needle is loaded through the back of the handle the surgeon can place the cannula precisely at the desired location of the meniscus and, with one hand, advance the needle in a controlled manner, a maximum of one centimeter at a time. The button also allows the surgeon to retract the needle in an ergonomically safe technique. The recently launched 0.9 mm wide SutureTape with meniscal repair needles compliment the ZoneNavigator system. The 1.1 mm needles are sharp and can easily penetrate the meniscus while the 0.9 mm wide SutureTape provides a wider footprint to disperse compressive forces. Ordering Information & Pricing: Part Number Description Stocking Price/LSP AR-7900 ZoneNavigator System Handle $250/$358 AR-7905 ZoneNavigator System Anterior Cannula $150/$215 AR-7910L ZoneNavigator System Middle/Posterior Zone Cannula, Left $150/$215 AR-7910R ZoneNavigator System Middle/Posterior Zone Cannula, Right $150/$215 AR-7523 0.9 mm Mini SutureTape with Meniscal Repair Needles $115/$165 AR-7223SM 2-0 FiberWire® Meniscus Repair Needles, small $72/$103 AR-6660 Needle Catcher/Tissue Retractor $393/$563 Sales Tools: Surgical Technique Guide The ZoneNavigator system allows precise placement and passing of horizontal and vertical suture constructs for inside-out meniscus repairs. The multiple-cannula system is interchangeable and optimized for specific suture placement in the posterior, middle, and anterior zones of the meniscus. Drew Osika Product Manager, Knee & Hip Arthroscopy Posterior Horn to Anterior Horn with ZoneNagivator Michael J. Stuart, MD, (Rochester, MN) demonstrates the ergonomics of the ZoneNavigator™ system and explains the benefits of the anatomic cannula for inside-out meniscal repair. Lateral Meniscus Repair with Zone Navigator Michael J. Stuart, MD, (Rochester, MN) displays the various cannulas available for the ZoneNavigator™ system and performs a cadaveric inside-out lateral meniscus repair using 2-0 SutureTape and the ZoneNavigator system. Circumferential Stitch to Reduce a Horizontal Cleavage Meniscal Tear with Zone Navigator Michael J. Stuart, MD, (Rochester, MN) demonstrates an inside-out circumferential stich configuration using the ZoneNavigator™ system to reduce a horizontal cleavage tear of a lateral meniscus. Anatomic Radial Meniscus Tear Reduction with Zone Navigator Aaron Krych, MD, (Rochester, MD) demonstrates the ZoneNavigator™ system by placing a cruciform suture configuration using the inside- out technique to reduce an anterior radial medial meniscus tear.

ZoneNavigator™ Inside-Out Meniscal Repair System

Biomechanical Testing of Vertical Meniscal Tear Repair Using 0.9 mm SutureTape Sutures Arthrex Orthopedic Research Objective Meniscal tears can lead to significant pain, degenerative changes, and joint instability requiring surgical treatment.1,2 Vertical tears can be repaired using allsuture meniscus repair techniques. SutureTape (ST) is a flat-braided suture that is stronger than standard FiberWire (FW) suture and more resistant to tissue pullthrough.3 The purpose of this testing was to biomechanically compare a novel circumferential repair of vertical peripheral meniscal tears using the Knee Scorpion system with (1) #2-0 FiberWire and (2) 0.9 mm (#2-0) Mini SutureTape. Our hypothesis was that repairs using ST would show superior biomechanical stability with regards to elongation and ultimate load. and is consistent with previously published testing protocols.4 Load-displacement data was recorded at 500 Hz and used to evaluate the dynamic and total elongation as well as the stiffness and ultimate failure load. The total elongation was defined as the plastic elongation that occurred between setting the displacement to 0 and completion of the last cycle. The total elongation hence included the initial displacement until the 50 N load was reached for the first time. In contrast, the dynamic elongation reflects only the plastic elongation during cyclic loading, occurring between the first and last cycle. Stiffness was measured within a linear portion of the load-displacement curve. Statistical analysis was performed with JMP V. 15 using an unpaired t-test. The significance level was set at p < 0.05. Materials & Methods In 16 porcine menisci, a vertical cut 3 mm from the periphery of each meniscus was created with a scalpel. The cut was then repaired using the Knee Scorpion by a single stitch from inferior to superior (see Figure 1 B). This circumferential stitch repair was performed with (1) #2-0 FiberWire and (2) 0.9 mm (#2-0) Mini SutureTape (n = 8 in each group). Once the repair was completed, the initial vertical cut was extended into the anterior and posterior meniscal horns, resulting in a complete separation of the meniscus into 2 segments only interlinked by the repair. The repaired meniscus was then placed into the tensile testing machine (E10000, Instron) with each segment fixated by 2 metal clamps (see Figure 1 A). At a preload of 5 N, the machine’s displacement was set to 0. Subsequently, cyclic loading between 5 and 50 N for 200 cycles at 1 Hz was performed prior to a pull to failure at 5 mm / min. This testing protocol reflects load patterns on the meniscus during early post-operative rehabilitation exercises and activities of daily living Figure 1. A: Biomechanical Testing Setup. B: Schematic Drawing of Circumferential Repair Technique. Suture Ends Were Knotted With 4 Half Hitches. Results The results are listed in Table 1. No significant difference was found regarding the dynamic elongation after both 100 and 200 cycles (p = 0.421 and p = 0.210). Stiffness during pull to failure was comparable for both testing groups (p = 0.142), whereas the repairs using ST revealed a significantly higher ultimate load (p = 0.0003; see Figure 2). Also measured but not listed in Table 1 is a significantly higher total elongation after 100 and 200 cycles for repairs using FW (p = 0.024 and p = 0.017). Figure 2. Ultimate Failure Load (N) of Meniscal Repair Suture Constructs Discussion & Conclusions The flat-braided 0.9 mm SutureTape demonstrates a significantly higher ultimate failure load for meniscal repairs. Moreover, comparable dynamic elongation with higher total elongation indicates that the usage of ST for meniscus repairs might prevent initial cutting. Tables and Figures Table 1. Biomechanical Testing Results and p Values After Unpaired t-Test Dynamic Elongation [mm] 100 Cycles 200 Cycles Stiffness [N / mm] Ultimate Load [N] FiberWire 2.14 ± 0.53 3.10 ± 0.69 22.7 ± 5.4 111.5 ± 24.5 SutureTape 1.83 ± 0.90 2.55 ± 0.95 30.8 ± 13.2 162.8 ± 14.9 p Value 0.512 0.265 0.142 0.0003 Group References 1. Snoeker et al., “A clinical prediction rule for meniscal tears in primary care: development and internal validation using a multicenter study”. British Journal of General Practice 2015, 65(637):e523-e529. 2. Moatshe et al., “Comparable Outcomes After Bucket-Handle Meniscal Repair and Vertical Meniscal Repair Can Be Achieved at a Minimum 2 Years’ Follow-up”. The American Journal of Sports Medicine 2017, 45(13):3104-3110. arthrex.com © Arthrex GmbH, 2021. All rights reserved. LA2-000137-en-US_A 3. Arthrex, Inc. LA1-00038-EN_B. Naples, FL: 2017. 4. Barber et al., “Biomechanical Testing of Suture-Based Meniscal Repair Devices Containing Ultrahigh-Molecular-Weight Polyethylene Suture: Update 2011”, Arthroscopy: The Journal of Arthroscopic and Related Surgery 2012, 28(6):827-834.

Biomechanical Testing of Vertical Meniscal  Tear Repair Using 0.9 mm SutureTape Sutures

Reparación de menisco dentro/fuera

Child (D)

Orthobiologics

Soft-tissue meniscal allograft transplantation techniques continue to evolve with the advancement of fixation devices. Using common meniscal repair devices allows for greater flexibility while ensuring anatomic graft placement. Soft–tissue-only meniscal allograft surgical techniques and clinical outcomes are well documented and have good clinical efficacy.1-4
References
1. Kim SH, Lipinski L, Pujol N. Meniscal allograft transplantation with soft-tissue fixation including the anterior intermeniscal ligament. Arthrosc Tech. 2019;9(1):e137-e142. doi:10.1016/j.eats.2019.09.015
2. Spalding T, Parkinson B, Smith NA, Verdonk P. Arthroscopic meniscal allograft transplantation with soft-tissue fixation through bone tunnels. Arthrosc Tech. 2015;4(5):e559-e563. doi:10.1016/j.eats.2015.06.001
3. Elattar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P. Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc. 2011;19(2):147-157. doi:10.1007/s00167-010-1351-6
4. Myers P, Tudor F. Meniscal allograft transplantation: how should we be doing it? A systematic review. Arthroscopy. 2015;31(5):911-925. doi:10.1016/j.arthro.2014.11.020

James L. Carey, MD, MPH (Philadelphia, PA), demonstrates a soft−tissue-only meniscal allograft transplantation and provides a full overview of the technique, from preparation of the recipient site and allograft through various fixation options for securing the graft.

Soft-Tissue Meniscal Allograft Transplantation Technique

Técnica de trasplante de aloinjerto de tejido blando para menisco

Product

El sistema ZoneNavigator revoluciona la reparación meniscal de adentro hacia afuera con control de colocación de la aguja con una sola mano. Se hace avanzar y se retira el SutureTape 2-0 con aguja de reparación meniscal en incrementos de 1 cm usando el mango ergonómico. Las cánulas se fijan al mango para abordar eficazmente zonas específicas del menisco.
Use el captador de agujas para guiarlas fuera de las estructuras neurovasculares. El retractor curvo y cóncavo retrae el tejido de manera eficaz y guía las agujas para una recuperación sencilla.

Michael J. Stuart, MD, (Rochester, MN) demonstrates an inside-out circumferential stitch configuration using the ZoneNavigator™ system to reduce a horizontal cleavage tear of the lateral meniscus.

ZoneNavigator™ System Inside-Out Circumferential Stitch Configuration to Reduce a Horizontal Cleavage Meniscal Tear

Aaron Krych, MD, (Rochester, MN) demonstrates the ZoneNavigator™ system by placing a cruciform suture configuration using the inside-out technique to reduce an anterior radial medial meniscus tear.

ZoneNavigator™ System Anatomic Radial Meniscus Tear Reduction

Michael J. Stuart, MD (Rochester, MN), discusses using the ZoneNavigator™ system to address various meniscal tear patterns during inside-out meniscal repair.

ZoneNavigator System Handle

AR-7900

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