Cortical button fixation is a simple, reproducible, and biomechanically strong method that allows surgeons to reliably seat the tendon against the cortex of the bone socket, maximizing the surface area for tendon-to-bone healing.1 For tendon or ligament transfers, the Tenodesis Graft Sizing Kit can be used to determine which implant system to open. Using Arthrex's Tension Slide Technique, surgeons can tension the tendon into the tunnel and then add a BioComposite Tenodesis screw for aperture fixation to complete the construct. Cortical button fixation can be used for FDL tendon transfers, FHL tendon transfers, anterior tibialis tendon transfers, and posterior tibialis tendon transfers.
References
1. Arthrex, Inc. Data on file (APT-04032). Naples, FL; 2019.

Foot and Ankle

Product

The FDL Implant System is used for posterior tibial tendon dysfunction. Arthrex has developed the Tenodesis Tension-Slide Technique for FDL tendon transfer. The flexor digitorum longus tendon is traced to the master knot of Henry and harvested. It is then transferred to the navicular and stabilized with the DX button on the dorsal cortex as well as with a Tenodesis screw for aperture fixation. This procedure can be done in conjunction with the InternalBrace™ spring ligament augmentation.

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Flatfoot Repair With the InternalBrace™ Ligament Augmentation Procedure

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Flexor Digitorum Longus Tendon Transfer With DX Button and Tension-Slide Technique

The FDL Implant System comes in two size offerings of 4.75 mm × 15 mm and 5.5 mm × 15 mm with everything included for an FDL tendon transfer in association with the tension-slide technique. The addition of the Spring Ligament InternalBrace™ procedure completes this simple and reproducible method of fixation that reliably seats the tendon against the cortex of the bone socket, maximizing the surface area for tendon-to-bone healing as well as augmenting the repair of the superior and inferior band of the spring ligament complex.
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.

FDL Tendon Transfer Using Tension-Slide Technique and InternalBrace™ Spring Ligament Augmentation

FDL Implant System

Child (D)

The FHL Implant System is used for reinforcement of an Achilles repair. Arthrex has developed the Tenodesis Tension-Slide Technique for FHL tendon transfer. The flexor hallucis longus tendon is traced to the calcaneus and harvested. It is then transferred to the posterior calcaneus and stabilized with the DX button on the plantar cortex, as well as a Tenodesis screw for aperture fixation.

Joshua Nadaud, MD, (St. Louis, MO) presents his technique for Arthroscopic Flexor Hallucis Longus Tendon Transfer utilizing the Arthrex® Tenodesis Screw™ System.

Arthroscopic FHL Tendon Transfer

Joshua Metzl, MD, (Denver, CO) demonstrates his technique for an Insertional Achilles Tendon Rupture Repair utilizing Bio-Tenodesis™ set for a Flexor Hallucis Longus (FHL) tendon transfer and Achilles SpeedBridge™ implant system for reattachment of the distal Achilles tendon. The Achilles SpeedBridge is a knotless four anchor construct that creates a large hourglass pattern of FiberTape® suture securing the distal Achilles tendon to the calcaneus.

Insertional Achilles Rupture Repair With Achilles SpeedBridge™ Repair System and FHL Tendon Transfer

A Flexor Hallucis Longus Tendon transfer is used to aid in chronic Achilles tendonopathy. An FHL transfer is performed to augment an Achilles reconstruction utilizing Arthrex Tenodesis Screw™ technology. The tendon is excised either medially or laterally and transferred into a bone tunnel in the calcaneus bone. Final fixation is achieved with a screw from the Bio-Tenodesis™ Screw System.

Flexor Hallucis Longus (FHL) Tendon Transfer

Flexor Hallucis Longus Tendon Transfer With DX Button and Tension-Slide Technique

Anterior Tibialis Tendon Transfer Using DX Button and Tension-Slide Technique

The FHL Implant System comes in two size offerings of 6.25 mm × 15 mm and 7 mm × 23 mm with everything included for an FHL tendon transfer in association with the Tension-Slide Technique. This simple, reproducible, and biomechanically strong method of fixation1 reliably seats the tendon against cortex of the bone socket, maximizing the surface area for tendon-to-bone healing. The BioComposite Tenodesis screw adds strength to the final construct with an aperture interference fit and provides a scaffold for bony ingrowth.
Reference
1. Arthrex, Inc. Data on file (APT-04032). Naples, FL; 2019.

FHL Tendon Transfer Using the DX Button and Tension-Slide Technique

Thomas O. Clanton, MD (Vail, CO), demonstrates an FHL tendon transfer using the Arthrex FHL Implant System with Tension-Slide Technique and Achilles SpeedBridge™ repair.

FHL Implant System With Tension-Slide Technique

Thomas O. Clanton, MD (Vail, CO), describes the surgical treatment of a patient with chronic insertional Achilles tendinopathy using the FHL Implant System with the Tension-Slide Technique.

Chronic Insertional Achilles Tendinopathy - FHL Tendon Transfer Using the Tension-Slide Technique

David I. Pedowitz, MD (Philadelphia, PA), demonstrates a tibialis anterior reconstruction using the Tension-Slide Technique with the newly released Tension-Slide Tenodesis System.

Cortical Button Fixation

FDL Implant System

FHL Implant System