The new Arthrex Arthroscopy Instrument Set was designed with the highest quality material properties to increase instrument durability, functionality, and ergonomics. From the new and improved chondral pick instruments and attachments to the vast array of curettes, osteotomes, elevators, and graspers, this set is sure to meet all surgeons' needs during an arthroscopic procedure.

Foot and Ankle

Trauma Lower Extremities

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A comprehensive overview of a product team’s portfolio.

Ein umfassender Überblick über das Portfolio eines Produktteams.

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Foot and Ankle: Next Generation in Foot and Ankle Technology 2023

A document containing information about Arthrex products and product lines.

Ein Dokument mit Informationen über Arthrex Produkte und Produktlinien.

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Arthrex Arthroscopy Instrument Set

Thomas G. Harris, MD (Pasadena, CA), demonstrates various instruments within the Arthroscopic Instrument System as well as the application of AlloSync™ Expand demineralized cortical fibers.

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Arthroscopic Instrument System

My name is Tom Harris from Pasadena, California. Happy to show you all the arthroscopy set. The new version of it provides a lot of different options for this. We'll start off by showing some of the sharp and blunt elevators. So this is a nice tool to not necessarily cut cartilage but just to elevate cartilage. You can also kind of tap the cartilage from the top down and just get a feel for how soft the cartilage is. And if there's a lesion underneath the cartilage itself. And there are four different ring sets in this set of different sizes and alignments. The small angled curette and because of that angle, makes it nice to just define our edges now and just get a little deeper into where that lesion is, you can see that it looks like it's relatively well contained. It doesn't seem to go into that lateral gutter. The set comes with cupped curettes both straight and curved. Here's an example of the curved large curette, and that we can come in through that same portal. And if we need to just kind of dig out a little bit more bone underneath, we can do that. Really sharp edges there, just to really get down to the subchondral area and past all that cartilage. And now you're getting into some more of the Subchondral area, and you can see there's a stable rim laterally. And the area here, you can start seeing some of that bone underneath that area that you want to penetrate with your microfracture. Another nice thing about the curettes or the ring curettes or the osteotomy. All the instruments have a nice knob that's been placed on them. So for tactile stimulation, tactile feedback that you can just put your finger there and know that the working end is directly 180 degrees from that. This is a nice tool and a nice addition to the set. This is a cupped curette as well, but it's a little bit smaller and there's different sizes of that. It's got an angle to it. If you need to get really in the back of the ankle joint, and then there's a straight side to it, and when you put it in the ankle it's really a nice size. So that again a little bit too straight. So we'll switch to the other side and go to the curved side. And then we can just get in the back if you need to. Really useful tool to have in the set And you can just kind of level this off a little more. We'll also just mention the double ended curettes, which can serve as a shovel or a rake. And you'll see if there's a really posterior or real anterior lesion they need to cut or push. This almost works like a rake or a shovel. Not as useful for this particular lesion, but if there's something more in the back or something more in the front, then you can use that. But you can see a newer tool here that has some nice applications to it as well. For ankle fusions, anytime you want to have osteotomy to prepare a joint for a fusion, there's three different osteotomies in here. There's a nice straight one. So if you were going to prepare the tibia for an ankle fusion, this would be a great a great tool in your warehouse. And the same thing here. This one's got a little bit more curve to it. This would work a little bit better on the talus because it's got a nice curve as we go through that area. So not necessarily germane to this particular lesion, but something that's nice to have for your ankle arthroscopic fusions. And then lastly, something that is pertinent to this case would be the tropics. And we have four different options here for us. For this case we've employed a 90 degree. It's always kind of kind of come in from the side here. And then you can see you've just got the nice color coded nature of it there. And then we'll go over the nice attachments to it. So instead of just pushing down with your hand, which we've done in the past, now we have a nice attachment that's going to fit onto this. So this is the attachment rod and the strike attachment which is a new addition to this arthroscopy set which makes it easier to impact. And it goes into there's a little hole right here that fits in there nicely. And then you push straight down and it locks onto there as well. So you've got a nice area to impact that's a little bit more close in terms of the direction of the impact. And so as we watch on the arthroscopic, you can see how that goes in there nicely and kind of buries it all the way to the edge of that gold area. And if we want to do a different angle you can see some of that fat removing is what we want to see. Maybe we'll go a little bit more right in the center portion of it there. Nice. Great. We have a nice lesion nice hole. And we'll go back with the shaver at that point. Nice options here for different angles. You can see that's the the 90 degree option there. There's both a 30 as well as a 60. Also another nice tool that's a welcome addition to the arthroscopy set is the Syndesmosis probe. And the Syndesmosis probe has both a two and a three millimeter metal ball on the tip. And it can just measure if there's any instability within the syndesmosis. So, as we put it in our particular case here, we look at the interosseous membrane. We can see in this particular case there's no obvious diastasis that can be accessed. There's also a whole list of different graspers that can be used in this new set. So here's an example of a posteriorly tilted curved grasper. And it's been really tested to get in the back of the ankle really nicely based on that angle curvature. And you can see it does really work well. We're already able to put this in the back of the tibia there. And then also included in this set here is the GPS targeting guide. And this can be helpful for those who like to drill these particular lesions if they're in a difficult area to access the microfracture. Also, they can be helpful to put your six, 7 or 7.0 screws in to help with an arthroscopic fusion to just line them up exactly where you want them to go. Another addition to this set is the new probe, and I'll show you inside the joint here why it's so nice. And that has really nice gradations of of measurements. The very tip of the probe is two millimeters. So if you need to measure the depth you can do that. But it's often hard to measure for some other probes you're just kind of guessing. And then this particular probe, you really do know you have two millimeter increments. And that really helps you determine the size of the osteochondral lesion you're dealing with, which is really, really helpful in terms of prognosis and how you're going to treat it. Another nice component to the ankle arthroscopy set is the cannula, which is new for bone graft. And the cannula is accompanied by a tamp. So this can be filled in with ArthroCell. Or today we're going to demonstrate a new AlloSync expand graft. We'll place it in this area. And then it can be pushed and placed into the joint, which is a nice option not necessarily for Osteochondral defect, but more for an arthroscopic effusion, or where you're trying to deliver a large amount of bone graft into a joint. The joint has already been dried. You can see that the graft is already starting to expand as it comes into any parts of the joint that were already wet. We can apply more fluid to watch it expand even more. So you can see it expanding there in real time really does fill up the whole joint nicely. And you can see those long fibers kind of expanding there as well. So in closing you can see this arthroscopy set is a really comprehensive set. It is an upgrade from what we have been using in the past. It has every option available for you. It's really been designed to obtain good access to both the posterior and the anterior aspect of the joint.

Imaging and Resection

Extremity Arthroscopy With the New Arthroscopic Instrument System and New ApolloRF® SJ50 probe

A visual representation of the tray and its components that includes product number, product description, product quantity, and a tray tracking form that administrative staff can use to manage trays for the hospital and/or surgery center.

Eine visuelle Darstellung des Siebs und seiner Komponenten mit Produktnummer, Produktbeschreibung, Produktmenge und einem Formular zur Nachverfolgung von Sieben, das das Verwaltungspersonal zur Verwaltung der Siebe für das Krankenhaus und/oder das Operationszentrum verwenden kann.

Sieblisten

Uma representação visual da bandeja e seus componentes que inclui o número, a descrição e a quantidade de cada produto, juntamente com um formulário de rastreamento que a equipe administrativa pode usar para gerenciar bandejas de hospitais e/ou centros cirúrgicos.

Listas - Conjunto de instrumentos

Una representación visual de la bandeja y sus componentes que incluye el número, la descripción y la cantidad de cada producto, junto con un formulario de seguimiento que el personal administrativo puede usar para administrar las bandejas del hospital y/o centro quirúrgico.

Listados - Set de instrumentos

Tray Lists

DEX Arthroscopy Instrument Set - AR-8656S

Arthrex presents an overview of the new comprehensive Arthroscopy Instrument System.

Product Overview: New Arthroscopy Instrument System

All right. Hi, everybody. My name is Zach. Day one of the product managers for the distal extremities team. And today I'm going to do a quick overview of the new Arthrex arthroscopy instrument system. This is a very comprehensive set. And as I pop the lid you'll see that everything is broken into tiers. So this top level of instruments are all the joint preparation instruments. And when you pick this first level up, you have a vast array of graspers, biters, punches, scissors and wrongdoers as well. And then you have a few various instruments specializing for your microfracture. And we've got the Syndesmotic probe in here as well, and a little biologics delivery tube. So the set also does house the current second generation GPS targeting system. But since that is not a new set, I'm not going to actually highlight the function of this set. Just see that it does fit. And if you don't want to stack the system in there, you have an auxiliary bin to stack various instruments that that surgeon might want to use during arthroscopy procedures with this top layer of instrumentation. Like I said, this is all basically joint prep instrumentation. And every instrument is color coordinated. So all of your control picks are black handled, your osteotomies are red handled. All of the various different curettes have a blue handle. Your ring Curettes have this silver handle. And then the various elevators that we have are in gold. And the thing I want to highlight first off are these microfracture picks, because we have a new specialized way of impacting the chondral picks. So as the instrument doesn't skive. So I'm going to show you guys how to put that together. So we have first this 30 degree Chondral pick. The surgeon if they if they want to they can impact the back of this pick with a mallet. But as we've seen historically with an instrument like this, since the, the control pick is at a 30 degree angle. When you when you hit this mallet, it tends to skive forward and not into the bone. So we've created a specialized instrument that's in the top tray right here. We have a new strike plate that attaches to the pick. And so I'm going to show you quickly how to build that. So here's your strike plate. And this is a little thread in feature. And you'll actually thread this into the strike plate first. Once that's threaded in you take the little nub here if you will. You can see this little raised portion. And there's also a hole in this strike plate right there. And that will mate into it. So you push it in with your thumb. And then I push the strike plate down and you can hear that tactile clip. And so now this is engaged and loaded to where if the surgeon wants to mallet here they can. But you can imagine that when we're mounting in line in this line which is in line with the tip of the awl. This instrument is going to skive less, so the surgeon will get the microfracture pick in place, and then the assistant will be holding this microfracture impact handle and tap it in place. And then when the surgeon is done using that instrument, the first thing they're going to do is you're just going to reverse the way that you put it on. So you're going to peel it back first, peel back, it disengages. And then if they want to keep this loaded and switch to say, their 90 degree pick because they've got another spot they want to go to, they're going to click it on at the top, push it down, you hear it click in. And now they're ready to go with their 90 degree attachment in the same fashion. Okay. On top of the 90 degree pick and the 30 degree pick we also have a 60 degree control pick. So you see all of these instruments have a gold plating. And so that that tin coating is verification that when you've buried that the gold plating in the bone, you've gone deep enough with that microfracture pick. The other instrument that we have for typically the the anterior portion of the talus is actually a straight pick. So you can see this this instrument is just completely straight. And obviously this instrument won't require a strike plate attachment. So the surgeon can just impact back here. And that's this is going to be really nice for the anterior curve of the Taylor dome where they're working in this space here. So shifting gears from the control picks to the Osteotomies. We've got three specialized instruments here. We have a curved osteotomy a straight narrow osteotomy and then a wider straight osteotomy. But one thing you'll notice with all of these instruments on top is that they all actually have this little nub feature, and that's really for the surgeon to quickly know. They have that tactile feedback to say, okay, this is the working end of the instrument. So regardless of the instrument that they're using, when this instrument is at 12:00 with their index finger, that's the way in which that instrument is designed to function. So if they're holding it in this plane in there, they don't feel that nub. They're like, okay, this this isn't the sharp or working end of the instrument. I want to have it the nub on my index finger. And that's my indicator of how I should be using this instrument. So you can see we have the small curved osteotome and then a similar diameter and a straight here. And then the larger osteotome will make quick work of the talus and the distal tibia when a surgeon might be performing an arthroscopic ankle fusion. Okay, so shifting gears to our curettes, the set has a vast array of cup curettes and ring curettes, but let's focus more specifically on these first three curettes as part of this set, as these are all brand new. So the first Curette, as you can see, can see, these are double ended curettes. And what's nice about these. So we have a double ended straight. And then we also have a double ended curve. But the the geometry of the instruments themselves, the heads of these instruments are exactly the same. So I'll just spend some time explaining the straight curette. So these instruments as you can see it's, it's shaped like a garden hoe. And so these instruments are going to be really helpful when a surgeon is trying to take a cartilage defect and make a nice rim around to make a really solid border around the cartilage. So you can see one of these instruments is curved downwards. And I'm going to flip it over. And the other side of it is curved upwards. So the thought process is, is with the down curved instrument that's going to work in the posterior aspect of a cartilage defect. And the surgeon is going to rake and pull this way. And that's going to make a nice rim. And they can kind of curve around as they need to. And then we're on the when they're on the anterior portion of the lesion, they're going to use the reversed curve. And they're going to do the same thing. They're going to cut into the cartilage and they're going to push away. And they can make a nice rim this way. So what it allows surgeons to do with the other complement of curettes and such is that they can make a nice rounded curved defect so they can insert BioCartilage or any other biologic material that they might use to fill that defect that they've created. And another simple instrument, but very nice to have is this small double ended cup curette. So this is going to be fine tuning with the smaller defects. But so one side is you can see is a three okay. So this is our three millimeter curved cup curette. And again it has this indicator. So the surgeon knows okay my index finger goes here. This is the working portion of the curette. But you've got a three millimeter curve on one side. And then you have a two millimeter straight on the other side. And this is for fine tuning smaller defects. Surgeons could even use this at the MTP joints or any of the joints around the midfoot, and then from from there. The next round of Curettes are are pretty self-explanatory. You have a large straight cupped curette that you can see here. You have a curved version of that as well, and then you have a straight with a down curve. So the instrument is straight, but the cure at itself is down curved. And that can help in the posterior aspect of the talus as well as this curved instrument. So those are all pretty self-explanatory, but do a really nice job in removing cartilage. So shifting gears to our silver handled ring curettes, we have a large ring curette. And one thing that's nice to know about this instrument specifically is our other ring curettes that are in the system are cutting on both sides. But because the head of this ring, curette is so large and so thick, only one side of it is cutting, so this will be especially helpful if the surgeon is working in a tight joint where they're debriding say the Taylor Dome. But this curette would still hit the the distal aspect of the tibia, and it won't cut the cartilage of the tibia. As they're using this instrument. We have the three versions of our ring Curettes. So we have simply just a straight curette here. This is cutting on both sides. A nice thing that we made change wise with the original arthroscopy set is that we beefed up the neck of these instruments, and we went to a more rigid version of stainless steel. These curettes aren't going to break or dull as quickly as the other instruments, so we've got a straight the next curette. It has a slight up curve, you see. It's a straight, but the tip of the curette is slightly curved and this is cutting on both sides still. And finally we have the down curve. So you can see indicator here. The caret is is curved down. And that's going to work well in the posterior aspect of the talus for example. Finally the last group of instruments are our gold handled elevators. And the really what I expect to be the workhorse of this set is our sharp 90 degree elevator. And I'll pull that out so you can see it. But this is very similar to the original paddle elevator that we had in the first generation arthroscopy set. But one thing that you'll notice when you start to use it is this the working tip has been made smaller, so it's much easier to introduce in through that arthroscopy portal. And it just makes the instrument much more functional. So this is the sharp version of this. So while I outlined the double ended curettes were used for making that anterior and posterior rims of the cartilage, this 90 degree all can All can be used to make the medial and lateral borders of the curette, since its cutting on both sides. The surgeon can simply come in and rake this way, and they can come to the other side and rake on the opposite side to make that nice rim of cartilage and a similar design to the sharp paddle elevator. This is our blunt paddle elevator. Same thing. We shorten the working length of the instrument so it's easier to introduce in your portals. And this is really just for initially when the surgeon is trying to assess how big of a flap lesion they might have off that cartilage, they can go in with this paddle and peel back until they see that stable margin and understand where really that that stable rim of cartilage is, as opposed to what they're going to need to remove. And finally, we have our Cobb elevator. And we're going to use this instrument actually in conjunction with our our biologics delivery cannula that's reusable in this set. So when we're using the Cobb elevator we really design this to be used after our little bone graft cannula. So this is just a simple cannulated cannula. And tamp so the surgeon can pop in. They can fill this cannula with their their DBM or other biologics type material. And they're going to simply tamp this in with their mallet and they'll impact on the back. And that will allow them to deliver the biologics into the arthroscopy environment. Once they've done that then they can go in, their fluid will be shut off, and they'll use the Cobb elevator, basically to fill in that defect with that bone graft that they've just introduced. So these three instruments we've really designed to go hand in hand with each other. So the last few things to highlight on the right side of this second tier is the Syndesmosis probe. So this is not a new instrument. Many of you are aware of this, but this is based on what Doctor Guyton published. He helped us design this probe. But you've got the two millimeter end and the three millimeter end of the probe that you're going you're going to insert between the tibia and fibula arthroscopically to determine the severity of the syndesmotic injury. So that is in the in this instrument set as well. And last but not least is our double ended probe. Pretty straightforward instrument. But you have a four millimeter probe on one side and a five millimeter probe on the other. And these are graduated with two millimeter increments. So as the surgeon is trying to assess, say, the size of the cartilage defect, they can go in and say, okay, it's a 14 by an 18 defect. And they can they can annotate that as part of their operative note. Last but not least, as part of this set are the new linear instrumentation that we've created. So these we've reduced the length of these instruments as opposed to the original set. So these are now ten centimeter working length which is going to be much more minimal to not only foot and ankle surgery, but really a lot of arthroscopy procedures in general. So we've got a vast array of graspers that are ratcheting and non-ratcheting. You see, this is just your standard straight grasper. So this is our alligator Grasper. And this is this is great for grabbing loose bodies and things like that. So and it is ratcheting so the surgeon can grab on to that loose body and not worry as they're pulling it out of the joint, that they're going to lose hold of that loose body for instance. Next is a straight down grasper. Again this is ratcheting. But this is really designed for that surgeon to get posterior in the Taylor Dome or around any other structure that they might need to bend around. If we have surgeons performing arthroscopic repairs, we've created two instruments to help them with suture management. So we have a standard looped grasper that surgeons can use to free up suture. We've also created a FiberTape retriever that functions much like the ring grasper. But of course this is designed specifically to remove things like LabralTape FiberTape SutureTape from the arthroscopy environment. So both of these instruments are in that set as well. Finally we have an arthroscopic scissor. And this is pretty straightforward. But this is just a shorter length standard arthroscopy scissor. And the last for standard instrumentation are just your various punches of different diameters. So this is your small punch. You have a large straight punch. So you can see this is larger basket punch. That's going to take a bigger bite of whatever you're trying to remove. And then we have a curved left and right punch. So pretty self-explanatory. But these are straight. And if a surgeon needs to get say posterior medial or posterior lateral and bite something, they can more easily do that. These three instruments I think are going to be great for the arthroscopy out there. But these are pituitary rangers and we've got them in a straight biter. We've got them in an up curve biter, as you can see. And then finally we have a down curve biter. So these will be great at removing osteophytes, say from the anterior portion of the talus or in any other situation where the surgeon wants something that's aggressively going to be able to remove bone and hold on to that bone as they're removing it from their portals. So in summary, as you can see, this is a very exhaustive set. It's it's robust. It really has everything a surgeon needs for an arthroscopy procedure and really not just for ankle arthroscopy. We've shown this to quite a few sports surgeons. And they they see that they could utilize this in their knee procedures, in elbow arthroscopy and even in shoulders. So this is a nice comprehensive set and we hope it helps our surgeons treat their patients better. Thank you very much.

ArthroBrostrom™ Repair Implant System

Ankle Arthroscopy Set (AR-8655S)

Alastair Younger, MD, (Vancouver, BC) demonstrates his technique for Arthroscopic MTP Fusion using the Arthrex® Synergy Video tower, Ankle Arthroscopy Instrumentation and the headless 4.0 mm Compression FT Screws.

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

Arthroscopic MTP Fusion Using Compression FT Screws

Hi, I'm Alastair Iyengar and I'm at the University of British Columbia. We're going today be doing an arthroscopic great toe fusion. So for the positioning for this patient with the first MTP fusion being on the left side, we have a beanbag here to lift her hip up a bit so that the toes are pointing up towards the ceiling, which will assist us in positioning of the implant. We've got her foot down to the bottom of the table to make sure that we can get access, because I'm going to work mostly from the bottom of the table, and we put the arthroscopy on the opposite side of the bed so that we can see it. We're also using a calf tourniquet for this case, although you can use calf or thigh and we have a nerve block. Our patient is a 56 year old lady and she's developed degenerative change in her the first MTP joint, its isolated deformity and her first ray is relatively straight. She has no other problems and no transfer metatarsalgia. She has destroyed the joint to the point where there's minimal range of motion. And so this basically these the only alternative. If we look from the lateral view here we can see a large dorsal osteophyte. And this will need to come out which we'll do through the scope. And we can then ream back the the dorsal osteophyte using a bur. We may need a pituitary ranger to take this out. And once we've got the joint debrided which we'll use two dorsal portals and possibly a medial portal, then we'll hold the foot neutral, the toe neutral, and then we'll put our screws across. And we'll use either 2 or 3 headless screws to immobilize the great toe in the neutral position. So the portals in this joint are going to be dorsal medial and dorsal lateral. The way I find them is by moving the joint and then feeling for the joint margin. So the joint line is roughly here, and my portal is going to be there and there, and then I'll do a small plant and medio portal, which will be just down on the medial side of the sesamoid. And that will allow us to get in. Obviously have to take this osteophyte out at the same time as we do the surgery. If I need to, I'll distract the joint and that will open it up and allow me to get in to the to the joint margin with a greater degree of freedom. So just nick through the skin, because we don't want to damage the nerve that's just underneath here, the dorsal medial dorsal lateral nerve. And I'll take a snap please. And I like to find the joint line with a snap first. And then once I'm into the joint, if we know we're going to do a fusion right away, it's often nice to then release the joint. So I'm into the joint there. I can feel it. I can then release the joint with an OsteoAuger with a with a curette. And what I'm going to do here is a large osteophyte on the dorsal side of a joint. I'm just going to release the capsule off the top of it and around it. So when we get our bur in, we can actually bear this out and remove this osteophyte. It's also nice to release the capsule down each side of the joint so that once we're in, we've got a reasonable amount of space to work with. So what I've done is release that this I do. If I know that on x ray that the joint is so destroyed that we're not going to be able to salvage it. This also allows me to find the other portal. Can I take the knife, please? So I can feel the curette poking on the opposite side. So I'm just going to make a small incision here. Same technique just through the skin. So we've got the joint exposed here now or visualized? I'm using a dorsal medial dorsal lateral portal. We're using the SynergyRF tower. And you can see we've got great resolution on the screen to see what's going on. When I look across the joint, we can see that there's marked degenerative change on both the metatarsal head and on the proximal phalanx. There's pretty much a small amount of cartilage left down in the plantar medial side. I got my three five shaver down into that area, and we'll use that to remove the residual cartilage. But there's only a little bit left on the dorsal side. And when we looked around to the lateral side we can also see that there's really very little cartilage left. So this really is only a fusion type of joint. And in some cases I might consider a debridement. But I usually need some cartilage remaining. And the other thing that's important for debridement is you need some residual motion. And in general there's not enough motion left. And I'm using a shaver here to remove the cartilage. But there's a number of different instruments we can use for this. The PoweRasp is nice to use in this environment. It's important. However, whatever instruments you use to make sure that you get all of the residual cartilage out. So I'm using A24 scope at the moment. It's nice because it's got a short and a short lever arm, and I can rest my hand on the edge of the skin and control the scope. And the larger scopes are quite nice. Like the two nine scope is nice because it gives a broader field of view, and if you can fit it into the joint, that's great. I don't use any traction, as you can see, and I prefer to leave the toe loose like this because it allows me to dorsiflex and plantar flex and work my work my way around the joint. And by dorsiflexing and plantar flexing, I can get different parts of the joint exposed. The current time I'm just doing a dorsal debridement, removing the synovium so I can actually see the dorsal osteophyte I got to take out, which I'm then going to remove with a bur. Although we could also use the the PoweRasp and by palpation we can make sure we get all of this out. The other way of referencing removing the dorsal osteophyte is to take two K-wires and put them down under power and use that to to reference it. And the final thing is to shave up to the point that you can actually see the metatarsal shaft, and then make sure that your osteophyte is removed down so that the metatarsal shaft is continuous with the dorsal side of the joint. The main thing is to get the soft tissue out of the way so you can get the exposure, Bearing in mind that there's also on the dorsal side of the joint, the extensor tendon. So be careful to remain within the capsule. And also make sure your shavings within the capsule to avoid damage to the dorsal cutaneous nerves. And I've got a number of curettes these I use a lot because they're first of all, they've got quite a sturdy base. Secondly, I can put my thumb on this little hole and know when I'm inside the joint exactly where the cut points and what I've used this for is to get into the joint, and then I've used it to mobilize the dorsal osteophyte. So I've now got all of them released on the shaft. I'm just literally putting the curette on the metatarsal shaft and then just working down the shaft to remove the dorsal osteophyte. And now I'm just going to use the grasper to take those fragments out. The current time, we're just cleaning out the dorsal side of the joint. When I'm doing a dorsal debridement, it's nice to hold the the toe into extension. You can see that Mike here has got the toe held up. That takes the tension off the dorsal capsule and allows us to develop that space so that we can get these fragments out. The current time I'm shaving up on the metatarsal shaft, I can see that area on the shaft. And then just going to work down the shaft and make sure that the osteophytes are clean back right down to the to the joint level. So we've finished our debridement. We've used a combination of the curettes, the burr, the shaver to breed the rest of the joint. And we've got a complete debridement of cartilage here and c across the joint and from the top side to the bottom side. We have no essentially no residual cartilage. And we've got reasonable penetration of the subchondral bone too. So at this point, I think we're basically done a debridement. So now that we've finished our debridement, we need to get fixation done. The metatarsal needs to be correctly aligned with the floor. So I got this flat plate here. And what I'm going to do is make sure I've corrected various valgus. I don't want the toe to be too much this way or it's going to crowd the second toe. So I'm going to make sure I bring it out and up. But I also want to make sure it doesn't pronate. So there's a temptation for the toe to pronate. So I'm going to deprotonate it and bring it out, and it needs to be about ten millimeters off the ground or about ten degrees Dorsiflex should I say so that it is. We've got a little gap here so that she can roll off, because if she's too flexed, she'll end up having a hyperextension deformity at the IP joint. She's too extended. On the other extreme, she'll end up rubbing her IP joint in the shoe. So we've got to make sure we've got correct varus valgus correct flexion extension. And also make sure that we got correct pronation supination. I'm just putting my first wire across the joint in the reduced position from proximal to distal. And that should hold us. Yeah I'll take a second one please. So that's got us in a neutral position. While it looks like there's a large residual osteophyte here, this is all skin. After we've removed our osteophyte from the dorsal side. There we go. The second one in from. So what we're using here is a full thread screw. And the reason I like this is because now that we've cleaned the joint, the strong bone is at the joint level. So if we look across the across the joint. We've cleaned off the cartilage and we've now got strong bone next to the joint surface sitting like this. If we take a full thread, screw and place it across that joint surface like this, we'll grab both sides of the joint so the main fixation will be full form the full thread screw. The next thing I'm going to try and do is make sure there's reasonable spread of those screws to make sure it's immobilized. Well. So I'm going to use probably three screws. And my angles are from distal to proximal. You can go from medial to lateral. You can also go proximal to distal. And so you can go just underneath the metatarsal head and down into the metatarsal shaft. And we can place either two side by side, one up or one down. And then put it around a screw going proximal to distal. So that's what we're going to do. Just take this take the. Take the. [00:11:48] Just take the one. With the conical screws. [00:12:00] Are you recording? Yes. Take a snap, please. With the conical screws. Are you recording? And I like to go distal to proximal because as I push on the screw, it tends to close the joint gap as opposed to open it. At least for the first screw. That's good. So we've got good compression of the joint surface and good correction of the valgus angle and this lady's toe. And it's going to sit just about right in the shoe. And so I'm going to take that wire out. So putting our second screw down from the medial side up, I try and make sure that the length of the screw is reasonably balanced across the joint. You don't want too little fixation on one side compared with the other, and if you can leave the base of the screw just on the edge of the cortex as it gives you better control of rotation. Equally, you want to make sure it's down far enough that the patient won't feel the end of the screw on the skin, so advance it just till you don't feel it anymore on the edge. So we've got two screws in. We're just going to put our third screw in this proximal to distal. And we've got the toe held in the correct position here with an appropriate degree of plantar flexion dorsiflexion being present. We're going to measure the the size here. I've just gone underneath the the base of the toe. So I'm just above the sesamoids on the medial side. And that's a good screw position. I can often times get two screws in here. And you may need screw sizes up to about 40 to do this. So take a 36 please. So we're going to close these wounds with nylon. We'll put a soft dressing on. She can be in a walker boot non-weight bearing for one week. After that we'll let her weight bear in the walker boot. And we'll gradually transition her after that point into a rigid soled shoe. Sutures out at two weeks and follow up at two weeks. Six weeks and three months.

The ArthroBrostrom® technique, developed by Peter G. Mangone, MD, (Asheville, NC) and Jorge Acevedo, MD, (Royal Palm Beach, FL) allows surgeons to perform an all-arthroscopic modified Brostrom repair utilizing BioComposite SutureTak® Anchors and Curved Micro SutureLassos™. Arthrex® has developed a convenient repair system for the ArthroBrostrom technique for added simplicity and reproducibility.

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

ArthroBrostrom®

Arthrex presents the ArthroBrostrom technique and implant system developed by Doctor Jorge Acevedo and Doctor Peter Mangone. The standard Anteromedial portal is used for visualization of the ArthroBrostrom procedure. After determining the safe zone from the distal tip of the fibula between the superior border of the perineal tendons and the intermediate branch of the superficial peroneal nerve, the exit points for the SutureLasso are mapped out. Debridement of the lateral gutter is performed using an arthroscopic shaver. The site of the first anchor is located one centimeter proximal to the distal tip of the fibula. The preloaded 3.0mm biocomposite SutureTak anchor is pre-drilled and inserted through the guide. A sharp tipped curved micro SutureLasso is inserted through the anterolateral portal and is brought out of the skin. A looped wire is passed through the SutureLasso and the lasso is then removed, leaving the looped wire in place. One of the suture limbs is passed out through the skin with the use of the wire loop. Care is taken to assure that the suture limbs are not crossed. The micro SutureLasso is passed again through the anterolateral portal as described previously. The process is repeated for the second suture limb. The second anchor is now placed one centimeter proximal to the first anchor. Alternatively, using the micro SutureLasso, an outside in technique can be performed to shuttle the two remaining suture limbs. A small incision is placed along Langer's line. Using a small arthroscopic probe or hemostat. The sutures are then pulled through this centrally placed incision. If distraction is being used, it is removed and the ankle is held in a slightly everted and neutral to slightly plantar flexed position, with the ankle held in the appropriate position. The suture limbs are tied tightly down. The ArthroBrostrom avoids the need for ancillary portals and traditional open incisions, while decreasing operative time and recovery time.

Peter G. Mangone, MD, (Asheville, NC) presents the ArthroBrostrom® technique utilizing the Arthrex ArthroBrostrom implant system for chronic lateral ankle instability. Dr. Mangone reviews the history of arthroscopic repair techniques for lateral ankle instability and compares his outcomes to standard open repair techniques. Finally, Dr. Mangone performs a cadaveric demonstration of the ArthroBrostrom technique while highlighting technique pearls to allow for a simple, reproducible and solid arthroscopic repair of the lateral ankle ligaments and extensor retinaculum.

A video of a live presentation reviewing Arthrex products or techniques.

Video einer Live-Präsentation, die Arthrex Produkte oder Techniken überprüft.

Präsentationsvideos

Vídeo de apresentação ao vivo analisando produtos ou técnicas da Arthrex.

Apresentação vídeos

Video de presentación en vivo que revisa los productos o técnicas de Arthrex.

Video presentaciones

Presentation Videos

ArthroBrostrom® Repair: Is It As Good as the Open Technique?

Steve Martin, MD, (Clemson, SC) presents current innovations for foot &amp; ankle sports surgeons treating athletes. He describes the surgical treatment for syndesmosis, ankle fracture, deltoid, lateral ankle and Achilles injuries using the Arthrex TightRope® Syndesmosis, Ankle Fracture System and InternalBrace™ Ligament Augmentation Repair.

Arthrex Foot & Ankle Innovation for Sports Surgeons

All right for topics. Go over them very quickly. First one is pronation, exploitation, ankle fractures in your athletes. And even for the guys that are going to the university centers, I encourage you not to pass these off to your trauma colleagues, and I'll show you why in the talk. My background is sports and trauma. It's not foot and ankle, but you'll have a better understanding of the ligaments injury than they do. They get stuck on the bone side of it. And so when you look at what's been done to this point at the level one trauma centers, and in practice over the last 20 years, we have not done a good job with our syndesmotic ankle fractures. We have about a 40% reduction rate. If you do an open reduction of the Syndesmosis. In this particular study, they decreased it down to 1,515% male reduction based upon post op cts. And so in those patients with mal reduction, syndesmosis functional outcomes are dramatically worse. And so we have to do a better job. One of the reasons that we are not doing a good job is the understanding of this anatomic plane of the syndesmosis. If you put a clamp on the syndesmosis and you're not exactly in that anatomic plane, you bring your CRM in and the syndesmosis is still a little bit wide. What do you do? We squeeze a little harder. Right. Well the clamps are already in the wrong position. So if you squeeze it harder, all you're doing is reducing it even further. You're inducing either internal or external rotation of the fibula in that incisura. And so I don't use a clamp anymore in my cases. If you're putting syndesmotic screws and you put those out of plane and you squeeze it all with them, you're now reducing the syndesmosis. And so the problem is, is that in orthopedics and I'm guilty of this over the last, you know, my practice is that we love to think in orthogonals. We love to think parallel and perpendicular. Well the problem and then we have this ankle mortise which is a box. So let's stick this 90 degree box and then let's make everything parallel and perpendicular. Well, all your injuries are rotational. So when you're thinking about the injury, don't think about the mortise and about the box. Think of a circle. That circle is unlocked and then it's progressively opened like a door on its hinge. So here's your anatomy of the Syndesmosis. You look on the left, there's your anterior inferior, big, broad fan shaped ligament that runs about 60 degree angle. You can have a Wagstaffe fracture that we see very commonly over there on the fibula, your caput fracture that you see on the tibial side when you go over to the posterior side of the ankle, same thing. It's very broad based. It has two bundles. It has a more superficial and a deep bundle. And that's important as I show you the injury mechanism. So if you think of it in terms of the biomechanical strength, that posterior is about 40% of the strength, anterior is about 35. And your interosseous membrane about 25%. Your injury mechanism in your athletes, especially the foot, is in pronation there planted and they're changing directions as that foot is in pronation. Then there's an external rotation force applied to it. Depending upon how much external rotation and how much abduction of the talus determines how high up the fracture is. And you'll see it again here. If you'll watch his left foot out of bounds as he plants. And this is the key. When you get a fracture, is the foot's planted in pronation there. Then he's rolled up on and then the big external rotation force. And so the foot is not able to disengage from the turf. And that's the difference between a high ankle sprain and your pronation. External rotation fracture is the inability to the foot to disengage from the turf. And if you'll see back on his x ray, you'll get that kind of reverse fracture line. So when you get an MRI what starts is the medial side. Your deep deltoid is torn. Then your anterior inferior is torn. Most of the time it can be off the tibia or the fibula or mid substance. Then you'll get your interosseous membrane and fibula fracture. And at that point the the fibula continues to externally rotate and it starts to peel the posterior off. And in 90% of the athletes that posterior is an incomplete avulsion. If you look at it arthroscopically. And I'll show you this guy's case, is that the deep bundle is torn right off the back of the tibia, but that more superficial higher up bundle is intact. And the reason that's important is I now have a hinge to work with, and all I have to do is internally rotate the fibula to get my reduction. And that's not about 10% of the time that will be completely avulsed. And I'll show you a case of that. So there is that peel back lesion like in the shoulder of that posterior inferior. And you can see the wavy waviness to that ligament is it's still partially intact, and all you have to do is internally rotate and you'll reestablish that posterior hinge. And so here you're looking from an anteromedial portal that's looking posterior laterally. These osteochondral fragments that are attached to the posterior syndesmosis are there 100% of the time. And so that you can see that that's the deep bundle, the posterior inferior syndesmosis. And in these young athletes I scope all of these. That's another reason for you guys to be doing it instead of the trauma guys. They don't like to have a scope in their hands. And I think the scope is very valuable. You're documenting Osteochondral injuries. You're pulling out osteochondral fractures very, very commonly that are going to be loose bodies. I do multiple stressing, both fluoroscopic and arthroscopically. You know, midstream in my repair to make sure I'm getting a stable, rotationally stable ankle. This in It's in the interest of time. So after he gets plated, the TightRope a very easy device to put in. I view this as an internal brace of my interosseous membrane. Remember, that was 25% of my syndesmosis. If you're going through the plate, here's the Arthrex lateral locking plate. You can go about 30 degrees off axis of the plate. And that's why I don't use a guide pin in that situation. I go straight with the drill. You just you pass your suture through. Pull your implant through to the other side. And I usually do bring CRM in and confirm that I've set that button on the other side. You can toggle your sutures to help do that. So here he's splitting the two to get the button to toggle. And then you pull back and you can lock it. And I confirm with CRM. As you're tensioning. I don't always use the little hemostat that you see here, but you want to sequentially tension one, then the other one and the other because the sutures will bunch up just a little bit. It never causes a problem. You just kind of work it down and then all the way down. And as you can see with this plate, the button does fit all the way down into the device, which is important, which I'll show you here in just a second. And so what I add to that is a repair of the anterior inferior syndesmosis. I'll either put if it's an avulsion, I'll put an anchor in and put a suture into it. What I'm doing now is an internal brace. You saw the internal brace and some of the other other talks. It's two SwiveLock, two FiberTape between it. There'll be an extra suture on one of the swivel locks that I'll do my repair with. So I'm repairing and internally bracing the anterior inferior. And then I'm getting complete rotational stability of the ankle. And on your athletes that's important. And so there's just a repair with a that's a SutureTak anchor. At ten weeks he was doing He was already back to our outdoor track. He runs a 100 meter. I don't take credit for his speed. When we look at the fracture set, it does all work together with the TightRope. It's built around the TightRope. You have that 35 degree cutout in the plate so that you can drill off axis in that anatomic plane that we talked about before. The scallop plates allow you to put a TightRope outside of the plate as well. If you want to get the more rotational control by putting your two TightRope at a 30 degree axis. You have all your plate options both laterally and medially. And so you basically you have one fracture set. Then you have your TightRope, you have some anchors InternalBrace, and you have everything that you need to get rotational stability of your ankle fractures. The problem when the button doesn't fit into the device is that you can get friction against the plate with your suture, and actually have a suture failure that probably indicates that you didn't have didn't have rotational stability as well. And this is a case just from a couple of weeks ago. This was actually a motorcycle accident. And he had a huge medial abrasion, full thickness, and didn't want to do any medial surgery at all, didn't want to repair his deep deltoid, didn't want to do anything on the medial side. So I actually put him lateral decubitus, draped all that out, did a quick scope of the anterior, a single anterolateral portal just to make sure my hinge was intact. There is his internal brace so he has no other fixation of his syndesmosis other than an internal brace. And then on the video. So here's the fracture here plate. Here's superficial peroneal nerve. It's actually starts outside of the fascia. So it's a little bit of a variant comes down and about 4 to 5cm above the tip of the lateralis which is right there. It splits into three major two major branches intermediate and dorsal medial branch right there. Army. Navy. Here is our repair of an internal brace of our anterior inferior. There's the ligament. Here's the internal brace. Just slight. One hemostat underneath. Tension running diagonally at the 60 degree angle of the normal anatomic anterior inferior syndesmosis. You can see now when we externally rotate. No motion at the syndesmosis. And when we look at our reduction, you can actually see your lateral talus. And you can anatomically look that your reduction is anatomic. You can do an anterior posterior shuck test which shows you the stability of the syndesmosis. So here's the last case on the ankle side. This is a soccer player. Now he's lost his posterior hinge. A little more difficult situation. And you have to spend a little more time making sure your syndesmosis is right and reestablishing the hinge and I do it. This is from a little over a year ago, and I actually do more of the internal bracing now. But he gets his scope. We confirm the injury, we do the stress testing, we fix his fibula, do an open reduction and repair of the syndesmosis and repair the anterior inferior couple trans osseous TightRope to do the interosseous membrane and the posterior hinge. And actually, this is an internal brace of the deep deltoid. And I have a little bit different technique on that now, but you're looking at repair or internal bracing of all the elements of the injury, starting all the way over to the medial side and both your anterior and posterior syndesmosis and your osseous membrane. So you're working on all the elements of the ligaments injury. And so here he is at ten weeks. He's full weight bearing. He's walking to class with no brace. He's got more than 12 degrees of dorsiflexion. He's doing in-line jogging and he wants to play soccer. I didn't clear him because he wasn't one of our collegiate athletes and he hadn't rehabbed adequately, but he was he was doing well. And so this concept of an internal brace, as we apply it around the foot and ankle with ArthroBrostrom repairs, with our anterior inferior syndesmosis, our deltoid and our spring ligament is that is that we add the internal brace, which is a very simple device, two swivel locks with FiberTape and I am protecting the repair. I'm not substituting for the repair. I'm not substituting for the biology. The biology is still there. I'm protecting it from the extremes of stress strain to allow the biology to heal properly. And so when you look at ArthroBrostrom repair, and this kind of gives you the concept of an internal brace, ArthroBrostrom repair is done exactly the same as you would before two anchors on the fibular side after you've pulled up your anterior talofibular ligament. Swivelock. In between the two anchors. Loaded with the FiberTape was a 3.5 SwiveLock, and right off your tubercle on your talus. You say you do your standard ArthroBrostrom, and then in this case, a 4.75 SwiveLock and that becomes your glide modification of ArthroBrostrom. And by doing that, that very simple addition to the technique. Here's a study by Clanton American Journal of Sports Medicine just this year. Look at the improvement in your failure. Newton's with the standard rostrum with anchors versus your native atfl versus ArthroBrostrom with anchors and internal brace. And so that allows that patient to earlier rehab earlier, get more aggressive with what they want to do and protect the repair. And so the key though is the biology still needs strain. If you want that ligament or tendon to heal properly. Wolff's law still has to apply. So the internal brace is not replacing it. And so the tension that you put on and there's some technical ways to do that is important. You're not over tightening. It's just like the mpfl that Pat was talking about is that I'm just putting it to the point that it's tight but not over constrained, and that's important. And last, just talking about the percutaneous Achilles tendon repair system or the SpeedBridge. When you look at the Achilles tendon and there's been multiple meta analysis of this and this most recent one in our journal in 2012, they looked at ten studies that qualified if they were treated non-operatively with functional early functional rehabilitation. They had basically equal results, including rerupture versus surgery. Surgery carried a higher risk obviously from wound complications standpoint. If they didn't have functional rehab then the the Nonoperative group did not do as well. And so what if I can give you a technique which eliminates the wound complications, allows the functional recovery in a more accelerated fashion, restores the length accurately. We're going to have a better result. The problem is we haven't had a way of doing that consistently because of the wound complications. The posterior ankle, the skin doesn't have a lot of pliability. Swelling works against you. Big long incision. It's relatively hypovascular. So if we can do it, minimally invasive if we've got a younger, more active population. A technique that restores length limits wound complications, allows rehab, and lowers the rerupture rate. And that's what the parse device does. So this is a Gordon McKay which you've seen previously with the Achilles tendon. Speedbridge. This is sped up. So I definitely he may operate this fast I don't. But what I'm showing you basically is the ease of the device. And so you start with a small transverse incision. You split your pair of tenon. The device slides inside the pair of tenon so that these sutures are all inside that pair of tenon. Two small incisions down on the calcaneus. You're putting two swivel locks in so you drill and tap. So this is no different than you're doing rotator cuff surgery, in essence. It's a curved banana lasso. You're going up through that through that distal piece. So I'm not passing any other suture. They're all going down through the distal tendon. Up through. And you confirm that you can feel it as it passes. And so there's not this big conglomerate suture not right at the right at the repair. So there's no knots in there. So from a vascular healing standpoint your tension. You see he passed point a little bit to get the appropriate tension. And then you put your two swivel locks in. So all you're attempting to do is restore length with stable fixation. Then you can close your pair of tenon. I think it would. It's helpful to add your platelet rich plasma at that point for your healing. As soon as you close the tenon, then you're injecting within the tendon sheath. So all that, all those sutures are within the within the tendon sheath. There's no knots, and you allow adequate healing. So when you're looking at tensioning, this is out of one of the Academy's devices. I do prep the other leg there in prone, prep the other leg, put the knee at 90 degrees and marry the resting tension of the other ankle. As you're putting this the first SwiveLock in. And this is one of his cases. And we can talk about level one evidence all you want to. But if you see cases like this, it makes you at least think of maybe we're on to something here. This is one of the athletes that was a bobsledder. Here he is in the left slot, eight weeks after repair with the technique that you just saw. Pretty stout fellow. Eight weeks. And here he is at 15 weeks in the Olympic trials for the bobsled. [00:18:54] What? What do. You want? So I think your common theme with all of these four topics really is this ability to protect my repair. So with the pronation, rotation, ankle fractures, immediate rotational stability of the loaded ankle, the TightRope plus the internal brace, the anterior inferior. And it's eliminated my need for any syndesmotic screws. I haven't used a screw in over seven years except for the diabetic peripheral neuropathy situation. The all inclusive ankle fracture set, which marries to the TightRope, and the internal brace and the internal brace technique for me, for the ArthroBrostrom, for the spring ligament with the posterior tib tendon reconstruction. And lastly, that Achilles tendon SpeedBridge with the pars device. Thank you.

Jorge Acevedo, MD, (Royal Palm Beach, FL) presents the Arthroscopic Brostrom Technique utilizing the BioComposite SutureTak® and Curved Micro SutureLasso™. It allows the surgeon to treat intra-articular pathology and repair the lateral ankle instability simultaneously with minimal incisions.

I'm Doctor Jorge Acevedo and I will be presenting the ArthroBrostrom technique. Initially, the landmarks are outlined, including the superficial peroneal nerve, inferior extensor retinaculum. A standard anteromedial portal is performed, and the joint is visualized with a standard 21 point inspection. The standard anterolateral portal is then performed using an inside out technique. This is performed with care to avoid injury to the superficial peroneal nerve. It is important to make the portal in a location where the lateral gutter is easily accessed. Initially, the arthroscopic shaver is used to carefully debride the lateral gutter. This is a crucial step in order to gain appropriate visualization, and usually requires a minimum of five minutes. The drill guide is first inserted and placed just above the inferior tip of the fibula, approximately one centimeter above the distal tip. It is important to hold this cannula perpendicular to the fibula. The guidewire is then placed typically through the cannulated, obturator and drill guide. It is helpful to palpate the posterior fibula while drilling the guidewire in order to determine correct trajectory. Once the wire is inserted, the cannulated drill is placed over the guidewire in order to achieve drilling to the hard stop. The drill is then removed while holding the cannula in place. The anchor is placed through the cannula. And impacted to the laser line on the proximal handle. This can also be visualized arthroscopically to assure that the laser line is seated up to the bone. The anchor driver is removed with a twisting motion. At this stage, it is important to determine which suture is in the more proximal and or superior end versus the more distal end or inferior end, and assure that they are not crossed. When using the inside out technique, the SutureLasso is visualized entering the joint between the sutures and the lateral ridge of the talus. The surgeon's thumb is maintained on the gentle curve of the lasso, so that the lasso can be oriented to easily pierce the inferior extensor retinaculum and capsule. The lasso is felt just above the perineal tendons and allowed to penetrate the skin. The wire loop is left in place while pulling the SutureLasso out of the portal. The inferior suture is passed first using the wire loop. The sutures are clearly visualized and the SutureLasso is again passed through the anterolateral portal. And pierced a centimeter anterior to the first pass. The wire loop is again passed through the SutureLasso and the SutureLasso is then removed. The second limb is subsequently shuttled using the wire loop. While this is occurring, your assistant can hold the more inferior limb so that it that it is not accidentally pulled through. Alternatively, the outside end technique can be used. It is useful, however, to have both techniques in your repertoire in order to better access different anatomy. The second anchor cannula is then placed approximately one centimeter proximal to. The first anchor location is approximately right below the level of the articular surface of the joint. In a similar fashion as was done previously, the guidewire is drilled through the cannula during the drilling process. You want to make sure that the cannula is angled out or laterally and not medially into the joint. The guidewire is then over drilled to the hard stop as shown previously. The anchor is then placed through the cannula up to the laser line. The second suture is labeled as a TigerWire suture. To differentiate from the first set of sutures, it is important not to pass the SutureLasso horizontally, because this will engage only the subcutaneous Cutaneous tissue, but instead enter the skin perpendicularly to grab the inferior extensor retinaculum and the atfl and enter the joint as shown. The next step is to have your assistant pass the wire loop so that he can then grab the wire with the suture grasper. Prior to pulling the sutures through, an incision is then made approximately 3 to 4mm in length along Langer's lines. This prevents cutting the suture while making the incision. The inferior limb of the second anchor can then be passed using the wire loop. Once again. This is visualized arthroscopically to make sure that the limbs are not crossed. The second pass is made again perpendicular to the skin and away from the nerve. Again, the wire is pass and grasped within the joint and pulled out of the portal site. The second suture is then passed with the wire loop. At this point one can simulate the suture tying in order to gauge the amount of tissue imbrication, the sutures are passed through the small incision subcutaneously. The ankle is held in neutral and slight eversion, either a slight or not as used in the most inferior set of sutures, or a regular surgeon's knot can be used to tie the sutures. Sometimes it will have a puckering effect of the skin, which can be easily released with a hemostat. The repair can be visualized arthroscopically if the surgeon desires to augment the procedure. The sutures can be tunneled subcutaneously over the lateral border of the fibula. A separate secondary incision can be made in order to pass both sets of sutures proximally. A PushLock anchor can then be placed into the lateral fibula, creating a second row and a SutureBridge situation.

James McWilliam, MD, (New York, NY) talks about arthroscopic techniques for Foot &amp; Ankle. He also discusses the Ankle Arthroscopy Set of instruments that was designed to offer a comprehensive solution for small joint arthroscopy that would alleviate the need to utilize awkward instruments from larger joint sets. This comprehensive set of instruments includes ring-handled graspers and punches, curettes, osteotomes, elevators and Chondro Picks to satisfy all small joint arthroscopy instrument needs.

Arthroscopic Techniques for the Foot and Ankle

Cup Curette, Double Ended, 2 mm / 3 mm

Ring Curette, Small, Reverse Angle

Ringkürette, rückwärts gewinkelt, small

Rongeur, Up Punch, 4.0 mm x 100 mm Straight Shaft

Rongeur, Straight Punch, 4.0 mm x 100 mm Straight Shaft

Rongeur, Down Punch, 4.0 mm x 100 mm Straight Shaft

Punch, Large Straight Tip, Ø2.75 mm x 100 mm, Straight Shaft

Punch, Large Straight Tip, Ø2.75mm x 100mm Straight Shaft

PUNCAO PONTA RETA GRANDE EIXO RETO DE 2.75 MM X 100 MM

Punch, Standard 45° Left Angled Tip, Ø2.75 mm x 100 mm Straight Shaft

Punch, Standard 45° Left Angled Tip,Ø2.75mm x 100mm Straight Shaft

PUNCAO PONTA ANGULAR ESQUERDA PADRAO DE 45 EIXO RETO DE 2.75 MM X 100 MM

Punch, Standard 45° Right Angled Tip, Ø2.75 mm x 100 mm Straight Shaft

Punch, Standard 45° Right Angled Tip,Ø2.75mm x 100mm Straight Shaft

PUNCAO PONTA ANGULAR RETA PADRAO DE 45 EIXO RETO 2.75 MM X 100 MM

Punch, Slender Straight Tip, Ø2.75 mm x 100 mm Straight Shaft

Punch, Slender Straight Tip, Ø2.75mm x 100mm Straight Shaft

PUNCAO PONTA RETA DELGADA EIXO RETO DE 2.75 MM X 100 MM

Grasper, Pointed Straight Tip, Ø2.75 mm x 100 mm 25° Down Curved Shaft with SR Handle

Grasper, Pointed Straight Tip, Ø2.75mm x 100mm 25°Down Curved Shaft, SR Handle

GARRA PONTA RETA PONTIAGUDA 2.75 MM X 100 MM 25 EIXO CURVO PARA BAIXO, ALCA SR

GRSPR,PNTD 2.75 X 100, 25°DN CRV, SR HND

Grasper, Pointed Straight Tip, Ø2.75 mm x 100 mm Straight Shaft with SR Handle

Grasper, Pointed Straight Tip,Ø2.75mm x 100mm Straight Shaft

PINCA PONTA RETA PONTIAGUDA EIXO RETO DE 2.75 MM X 100 MM

Grasper, Alligator Hook Tip, Ø2.75 mm x 100 mm Straight Shaft with SR Handle

Grasper, Alligator Hook Tip, Ø2.75mm x 100mmStraight Shaft

PINCA PONTA DE GANCHO ALLIGATOR EIXO RETO DE 2.75 MM X 100 MM

Mini Suture Retriever, Ø2.75 mm x 100 mm Straight

Mini Suture Retriever, Ø2.75mm x 100mm Straight

RECUPERADOR DE MINI SUTURA 2.75 MM X 100 MM RETO

Scissor, Serrated Tooth Straight Tip, Ø2.75 mm x 100 mm Straight Shaft

Scissor, Serrated Tooth Straight Tip, Ø2.75mm x 100mm Straight Shaft

TESOURA PONTA RETA DE DENTE SERRILHADO EIXO RETO DE 2.75MM X 100MM

Micro FiberTape Retriever, Ø2.75 mm x 100 mm, with SR Handle

Micro FiberTape Retriever, Ø2.75mm x 100mm, SR Handle

MICRO FIBERTAPE RETRIEVER 2.75MM X 100MM CABO SR

Instrumentencontainer, für Sprunggelenksarthroskopie

Ankle Arthroscopy Instrument System

Instrumentenset, für Sprunggelenksarthroskopie

Ankle Arthroscopy Set

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