Rodilla

Sutura FiberSnare®

La nueva sutura FiberSnare con lazo más grande se ha diseñado específicamente para brindar comodidad y facilidad de uso al mover suturas durante los procedimientos de reconstrucción y reparación de ligamentos. La sutura FiberSnare tiene una longitud total de 26” y su construcción consta de una sutura FiberWire® n.° 2 con un lazo de 2” en un extremo, mientras que el extremo opuesto tiene una rigidez de 12 pulgadas.&nbsp;
Las suturas FiberSnare se pueden utilizar tanto para técnicas de perforación retrógrada (de afuera hacia adentro) como anterógrada (de adentro hacia afuera) como sutura de traslado. Los nuevos patrones de color exclusivos (sutura a rayas negra/blanca y blanca/azul) también permiten una identificación y manejo más sencillos de las suturas.

Knee

Michael J. Alaia, MD (New York, NY), demonstrates a BTB ACL reconstruction with the InternalBrace™ technique using FastThread™ screws and the FiberSnare® guidewire for independent fixation.
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.

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video

Human

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

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Surgical Technique Videos

BTB ACL Reconstruction: InternalBrace™ Technique, FastThread™ Screws, and FiberSnare® Guidewire

This animation demonstrates the technique for using the FiberSnare® nitinol guidewire to create independent fixation of FiberTape® sutures when performing BTB ACL reconstruction with the InternalBrace™ technique.&nbsp;
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.

BTB ACL Reconstruction Using the InternalBrace™ Technique and FiberSnare® Nitinol Guidewire

Following completion of tunnel drilling, a fiber snare shuttle suture is placed to facilitate graft passage, identify the white tightrope tensioning sutures and the blue tightrope passing sutures, and load all four ends into the loop of the fiber. Snare shuttle suture using the fiber snare suture, shuttle the tightrope tube implant through the joint and out of the femur. Confirm the button is flipped on the lateral femoral cortex by pulling distally on the fiber tape. Sutures for the internal brace technique. Prior to introducing the graph to the tibial tunnel, retrieve the fiber tape sutures through the passport button cannula. Advance the graft by pulling the tensioning strands one at a time, alternating approximately two centimeters on each side. When the femoral bone block is visible in the joint, align the bone block with the femoral tunnel using a grasper. Once the femoral bone block is flush with the lateral wall of the notch, pull firmly back on the graft to check fixation. Introduce the fiber snare. Nitinol, guidewire up the tibial tunnel between the tibial bone block and tunnel wall until it is visible in the joint. Retrieve the fiber snare shuttle suture out of the passport button cannula. Prepare the tibial tunnel using the appropriately sized fast thread interference screw tab by inserting to a depth that approximates the screw length implant the appropriately sized fast thread interference screw over the guidewire. Outside the passport button cannula. Place the round ends of the fiber tape suture for the internal brace technique into the loop of the fiber. Snare shuttle suture. Remove the nitinol guidewire from the tibial tunnel and gently pull the attached fiber. Snare suture distally in line with the tunnel by hand to shuttle the round ends of the fiber. Tape sutures through the cancellation of the fast thread interference screw. Once both limbs of fiber tape have been retrieved, remove slack by pulling them one at a time as to avoid pulling the round, a flat transition of both limbs through the screw simultaneously. It's recommended to use the secondary fixation implant system for fixation for the fiber tape. Sutures for the internal brace technique using the spade tip drill, followed by the 5.2mm tap, and with the knee in full extension. Place the graft, sutures and internal brace fiber. Tape sutures into the eyelet and screw the swivel lock. Anchor into the pilot hole. Remove the driver and retention suture from the anchor. After the knee is cycled several times with the knee in full extension, the tightrope tube B2B implant can be retensioned to remove any slack in the construct. Cut the tensioning tails flush to complete the construct.

application/pdf

A step-by-step demonstration of how a product would (or could) be used in a surgical technique.

Eine schrittweise Demonstration, wie ein Produkt in einer Operationsanleitung verwendet werden würde (oder könnte).

Operationsanleitungen

Demonstração passo a passo de como um produto seria utilizado em uma técnica cirúrgica.

Guias de técnicas cirúrgicas

Demostración paso a paso de cómo se utilizaría un producto en una técnica quirúrgica.

Guías de técnicas quirúrgicas

Surgical Technique Guides

James M. Paci, MD, (Long Island, NY), demonstrates a technique using the FiberSnare® nitinol guidewire to independently route FiberTape® sutures for the InternalBrace™ technique through the cannulation of a tibial FastThread™ interference screw during a BTB ACL reconstruction.&nbsp;
 
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.&nbsp;

Independent FiberTape® Suture Routing for ACL Reconstruction Using the InternalBrace™ Technique

This is Doctor James Pacey from Long Island, New York. So we'll be utilizing the arthrex internal brace. Guidewire, suture passer. The internal brace, guidewire suture passer will be used to shuttle the internal brace fiber tape sutures through the cancellation of the tibial interference screw in order to be able to independently tension the internal brace separate from the graft fixation with the screw. We have a left knee that has been prepared, tibial and femoral sockets have been drilled and our shuttle stitches in place. At this point, we'll proceed with graft passage, so we've lengthened the tightrope in order to be able to visualize the button flip from internal to the joint, which we'll see shortly. And the tightrope and passing sutures have been passed through our fiber snare in order to pass and shuttle the sutures through both tibial and femoral tunnels. This is a purl to confirm button deployment and placement on the lateral femoral cortex, making sure that the button is all the way up and with tension back tension, there's no motion. And then we're going to keep the camera immediately now. So we grab our internal brace sutures and shuttle those out of our lateral portal. We can now bring our graft in slightly to take some slack out. So here we have the internal brace guidewire suture passer. So the product is composed of a 1.1mm guidewire, which is used to guide the interference screw into place. At the tip of the guidewire. You see the attachment to the fiber snare suture allows us to shuttle the suture and the internal brace fiber tapes through the core of the interference screw, enabling us to independently tension the internal brace from the ACL graft. We're going to introduce the guidewire passer. I like my guidewire posterior to my tibial bone block. So I'm going to focus on staying behind the tightrope. We're going to shuttle the suture portion out the lateral portal with our fiber tape sutures. With the guidewire in place, we can now begin to advance our ACL into the tibial and then femoral sockets. You want to grab a kingfisher to guide the femoral bone block into place. So now our graft is in place and our passing stitch is in place. So now we can come out of the joint. We can check our extension. We can show that our graft is not going to impinge. So next we'll tension our graft and place our tibial interference. Screw one technical point here. You can see that we've marked our femoral bone block. We bring it flush with the condyle but don't fully pull down the tightrope at this point, in order to be able to retension the graft and final tension, the graft on the femoral side. So now we're going to focus on our tibial fixation, which will be our tibial interference screw. I do like to tap for the tibial side. So usually we'll, we'll hold a draw here with full tension on our sutures and get started on the tap and then tap up to make sure that our interference screw will start without an issue. So now we've got a line to line. We've got a ten tunnel and a ten screw. So with full tension on the graft, we'll then advance our tibial interference screw. We want to make sure that we don't advance that tip too far. And we can check that in our tunnel. I've marked the tip of the bone block here blue. And you can see that we can advance that screw slightly more to fully capture. So that's a good check. On occasion, when the screw compresses, the driver gets tight. The new slap driver allows you to then unlock and use a slap hammer mechanism to remove the screwdriver. We can now take the camera and make sure that we fully seated our tibial interference screw. Again, we're just about line to line to the tip of the block, so I know I have good fixation there. So now we're fixed on the tibial side. We'll come back in to the joint. And now we can shuttle our internal brace sutures. See our graph nicely in place there. Our passing stitch and our internal brace sutures. So we now have the round suture on the end of the fiber tape sutures that we want to shuttle through first. So we'll take the round ends through our snare mechanism. You can watch that shuttle down and through. And there is our independent internal brace sutures lying next to our ACL graft. And we'll move the camera over laterally to get a more conventional view of our graft and internal brace. And we can see then from distally, the internal brace sutures passed through the center portion of the tibial interference screw. We still have not bought our final tension on our graft as we have not tied off our femoral tightrope. So now we're preparing for placement of the internal brace swivel lock using the ACL Backup Fixation Kit, which has the drill, the 5.2 tap, and the Biocomposite swivel lock for securing the internal brace. Drill a socket just distal to our tibial tunnel, then tap for the swivel lock using the five two tap. We'll then bring the knee into full extension tension our internal brace sutures to make sure there's no slack. So our swivel lock is now fully seated, securing our internal brace. Tap the body of the internal brace swivel lock out and we're nice and solid. So at this point we have set our internal brace in full extension, our tibial interference screw and tibial fixation is in place, but we have not final tensioned the femoral tightrope. You can see our internal brace has good tension on it. Our ACL graft has slight laxity, but we've left some slack in the system and ability to retention on the femoral side. So if we can now retension our femoral side. You'll see just a little bit more creep in that graft to get full tension on the ACL. And now you can see the difference in the tension on the ACL and the internal brace. And now we can come into full extension. And we show that we have no notch impingement. Completing our patellar tendon ACL reconstruction with internal brace through the cancellation of the tibial interference screw with independent tension.

Ashley Ali, MD (St. Louis, MO), demonstrates a biologically augmented ACL preservation technique using the AlloSync™ button as an interpositional scaffold in combination with the ACL Repair TightRope® implant, FiberRing™ sutures, and FiberTape® suture for the InternalBrace™ technique.
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-tobone fixation.

BioACL™ Repair Using ACL Repair TightRope® Implant, FiberRing™ Sutures, and InternalBrace™ Technique

Hello, I'm Doctor Ashley Ali, and I'll be demonstrating to you ACL repair with biologic augmentation with the AlloSync button. So the products we're using today would be the FlipCutter three FiberSnare knee Scorpion FiberRing ACL repair TightRope AlloSync button with BMC 2.4mm drill bit Cannulated, and the ACL Backup Fixation Kit with the 4.75 SwiveLock. So now we're here in the left knee. Here's a femoral cited ACL avulsion tear. You can see it's torn. The remainder of the ACL stump is intact and good quality tibial portion is attached. So this is a pure femoral sided avulsion which looks amenable to repair at this point. Once I confirm that the ACL is amenable to repair, I will take the scope back out and go forward with harvesting proximal tibial bone marrow aspirate. Okay. So here we have our femoral guide in our lateral portal. I'm going to place my femoral guide right in the center of the ACL footprint. I like to make this incision big enough so that I can pull the button all the way out. And I can really make sure that button is sitting down on the cortex. Now we have our FlipCutter into our femoral footprint of our ACL right in the center. And we're going to withdraw the femoral guide from the lateral portal. We're going to mount it in the outer sleeve. Next up we're going to withdraw the FlipCutter and we'll place in the FiberSnare. Make sure to hold that in. The water pressure can sometimes push the FiberSnare out. Perfect. Take a CrabClaw or any sort of grasper. Grab that suture out of the lateral portal, and then we'll dock that with a hemostat That you're. Then I'm going to switch portals into my lateral portal just for demonstration purposes. You can see that we have a pretty significant anterior drawer here. Next step we're going to place our fiber rings. I typically use the 35 millimeter fiber ring. So when we use this 35 millimeter fiber ring it allows for enough length to then pass through that AlloSync button. So after this bite, I would say this is probably capturing my Anteromedial bundle. I'd like to make a little bit of a deeper bite for my next throw to at least capture that posterolateral bundle. And then next we have two options to make an accessory portal to dock our fiber rings, we can either go trans patellar tendon or an accessory medial portal in this knee, specifically due to the anatomy, I would probably go just trans patellar tendon, making sure I don't put that through the passport. So I use my mini KingFisher to then retrieve my fiber rings through my trans patellar tendon portal. Here's our second pass with our knee Scorpion and our fiber rings. Again, I'm just going to go a little deeper here, trying to get a little bit more of the posterolateral bundle, a little more substance. We're going to leave that suture then in our passport. Next step is to connect our ACL repair TightRope to our fiber rings. So we'll cut the swedge. And then we'll take our ACL repair TightRope card unwind number one. And then we will connect this to our fiber rings, which we've already passed through the ACL. So there we've shuttled it through the first fiber ring. So next up, I'm going to keep tension on this TightRope while I'm retrieving my second fiber ring. And we'll do the same step over again. We'll cut this wedge shuttle that same limb through the second fiber ring. And then now we're shuttling our TightRope through. And then we'll cut the shuttle stitch. Next up, we'll complete the rest of the TightRope. We'll unwind number two and pass it through the loop that we've already shuttled through. So step two, we're going to take the second limb and pass it through the other loop of the TightRope. And then we will complete our TightRope by shuttling it through. Number three. We'll pinch this and then take the rest of these sutures off like that. Okay. Now we're going to open up the card and then retrieve the retrieve the sutures out. So you can see these limbs are a little offset. We're going to just tension the shorter of the two so that those limbs are then equal. The AlloSync button introduces additional biology to an ACL repair by adding human allograft bone matrix along with autologous concentrated cells. The AlloSync button is a demineralized cancellous disc that is compressible like a sponge. The AlloSync button can be hydrated using bone marrow concentrate, which is processed with Angel system. The AlloSync button provides a scaffold for cellular attachment and proliferation during testing. After one hour of arthroscopic simulation, viable cells continued to adhere to the AlloSync button. So at this point, we've already soaked our AlloSync button for five minutes in the BMC. So we're going to assess the AlloSync button to see if it has the amount of Sponginess that we are looking for. And that looks perfect. All right. Next we're going to use the guide sleeve for the 2.4mm pin to create a hole in the center of the AlloSync button. We'll melt it down and then just twist it a little bit. All right. Now that we've made the hole in the center of the AlloSync button, we can then shuttle it onto our ACL TightRope. We're going to take our suture threader from our TightRope and thread that through the center of our AlloSync button. We're going to take our blue lead sutures and our tensioning sutures from our TightRope, and shuttle them through the center of the AlloSync button. We're going to then slide AlloSync button over our TightRope button. So as you can see, this button no longer has that red color as it previously did. Despite that, we do have a study here which demonstrates there still is cellular adhesion. Even after one hour of arthroscopic stimulation. And now we retrieved our femoral shuttle stitch. And we've removed the passport. We're going to then shuttle our TightRope through. Our femoral tunnel. So now I'm just going to assist the passage through. The medial portal with a KingFisher. And we're going to pass our button all the way through. And then the next step is to go ahead and make sure that this AlloSync button is in the right orientation. Yeah, I like that. I like to make it real flat against the femoral wall. Just like that. Perfect. That's exactly where we want it to go. So there's our button sitting right there against our femur interposed between our ACL. We're going to make sure our button is down in the femoral cortex. And we're going to tighten our TightRope to make sure our ACL is nicely tensioned to the lateral femoral condyle. So when I'm doing this tightening I'll put the knee I'll put the knee in about 30 degrees of flexion. Posterior draw force. All right. Next up we're going to drill our tibial tunnel aiming for the center of the ACL footprint again. This is our cannulated 2.4mm drill bit. We'll remove the central cannulation. We're going to place our nitinol wire through our 2.4mm drill bit. Zip line down those. Make sure I don't have a tissue bridge. Okay. Always make sure we pull the drill bit out first before we pull the nitinol wire. Just to make sure we don't cut the end of the night null wire. Perfect. We're going to then exchange this for a little stronger shuttling suture, which is a FiberSnare. Pass the ends of our sutures through the FiberSnare loop. Pull the internal brace down. Make sure both limbs are taut. Looks great. I like that. Fold. Stitch. Thank you. So now we've fixed our internal brace distally on the tibia with our ACL backup kit. And we're going to do our final tensioning at 30 degrees of flexion with a posterior draw force. So here's our anterior draw. I'm glad to see the internal brace has a little less tension than our native ACL. Just so we don't stress shield. So our final view of our ACL repair with AlloSync button.

A document containing information about Arthrex products and product lines.

Ein Dokument mit Informationen über Arthrex Produkte und Produktlinien.

Broschüren

Documento contendo informações sobre produtos e linhas de produtos da Arthrex.

Brochuras

Documento que contiene información sobre los productos y líneas de productos de Arthrex.

Folletos

Brochures

FiberSnare® Suture

This animation demonstrates the ACL GraftLink® technique using FiberTape® suture for the InternalBrace™ technique.&nbsp;
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.&nbsp;

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

Operationstechnik-Animationen

Visão geral incluindo as etapas relevantes de uma técnica cirúrgica Arthrex. Essas animações sempre incluem uma narração explicando o processo.

Animações de técnicas cirúrgicas

Descripción general que incluye los pasos relevantes de una técnica quirúrgica de Arthrex. Estas animaciones siempre incluyen una voz en off que explica el proceso.

Animaciones de técnicas quirúrgicas

Surgical Technique Animations

GraftLink® Technique Using FiberTape® Suture for the InternalBrace™ Technique 

Graftlink ACL reconstruction using a TightRope two implant and the internal brace technique. The GraftLink construct includes a TightRope two implant that is preloaded with FiberTape suture for the internal brace technique, and features new flat tape loops and tensioning strands for improved strength and handling, and a broader suture graft interface. The TightRope two implant uses an improved button design, incorporating a proprietary knotless fifth locking point that increases strength and resists cyclic displacement. Place the ACL femoral guide over the ACL femoral footprint. Arthroscopically. Adjust the angle of the guide to the desired position and tunnel trajectory, and then lock into place. Push the ratcheting drill sleeve down to bone. Advance a FlipCutter three drill pin through the ACL femoral footprint. Tap the tapered portion of the stepped drill sleeve into the femur seven millimeter or until resistance is felt when reaching the femoral cortex. Using the wheel, deploy the FlipCutter three. Drill to the appropriate size and retrograde. Drill back to the sleeve to create a socket. Remove the FlipCutter three. Drill and pass a blue and white FiberSnare suture through the drill sleeve. Retrieve it from the lateral portal and dock it for later graft passage. Remove the stepped drill sleeve. Place the ACL tibial guide over the ACL tibial footprint arthroscopically. Adjust the angle of the guide to the desired tunnel position and tunnel trajectory, and then lock into place. Push the ratcheting drill sleeve down to bone. Advance the FlipCutter three. Drill through the ACL tibial footprint. Tap the tapered portion of the stepped drill sleeve into the tibia seven millimeters or until resistance is felt when reaching the tibial cortex. Using the wheel, deploy the FlipCutter three. Drill to the appropriate size and retrograde. Drill back to the sleeve to create a socket. Remove the FlipCutter three. Drill and pass a black and white FiberSnare suture through the drill sleeve. Retrieve both of the FiberSnare sutures from the medial portal, and remove the stepped drill sleeve with the blue and white FiberSnare suture. Pass the femoral side of the GraftLink. Construct into the femoral socket until the button flips on the femoral cortex. Use the tensioning sutures of the TightRope two implant to advance the GraftLink. Construct into the femoral socket with the black and white FiberSnare suture. Pass the FiberTape suture for the internal brace technique and the abs. Tightrope two. Implant into the tibia with the knee in extension, use an 11mm, three hole concave button for tibial fixation of the GraftLink construct with the FiberTape sutures for the internal brace technique loaded through the larger oblong hole before tensioning the GraftLink construct. Anchor the FiberTape sutures for the internal brace technique using an ACL backup fixation kit. Using the spade tip drill followed by the 5.2mm tap, place the FiberTape suture for the internal brace technique into the eyelet and screw the 4.75mm SwiveLock anchor into the drilled hole. Take the knee through range of motion and then perform final tensioning on the GraftLink construct.

#2 FiberSnare suture, 26" length with 2” closed loop (White/Blue)

#2 FiberSnare with #2 FiberWire Braided Polyblend Suture, White/Bluewith Closed Loop, 26 inches, One End Stiffened, 12 inches

#2 FiberSnare suture, 26" length with 2” closed loop (Black/White)

#2 FiberSnare with #2 FiberWire Braided Polyblend Suture, Black/Whitewith Closed Loop, 26 inches, One End Stiffened, 12 inches

Sutura FiberSnare^®

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Animaciones de técnicas quirúrgicas (1)

GraftLink® Technique Using FiberTape® Suture for the InternalBrace™ Technique

Folletos (1)

FiberSnare® Suture

Guías de técnicas quirúrgicas (1)

BTB ACL Reconstruction Using the InternalBrace™ Technique and FiberSnare® Nitinol Guidewire

Videos de técnicas quirúrgicas (4)

BTB ACL Reconstruction: InternalBrace™ Technique, FastThread™ Screws, and FiberSnare® Guidewire

BTB ACL Reconstruction Using the InternalBrace™ Technique and FiberSnare® Nitinol Guidewire

Independent FiberTape® Suture Routing for ACL Reconstruction Using the InternalBrace™ Technique

BioACL™ Repair Using ACL Repair TightRope® Implant, FiberRing™ Sutures, and InternalBrace™ Technique

SutureTape Line Extension (2)

AR-7209SNL

AR-7209SNT