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.

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.

Kataloge

Visão geral e abrangente do portfólio de produtos de cada segmento.

Catálogos

Descripción general y completa sobre la cartera de productos de cada segmento. 

Catalogs

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

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.

video

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

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

Flexor digitorum longus tendon transfer using the DH button and tension slide technique with spring ligament. Internalbrace ligament augmentation. Make a 5cm to 6cm incision from the posterior aspect of the medial malleolus to just below the palpable navicular tuberosity. Use a combination of blunt and sharp dissection to identify the posterior tibial tendon sheath just distal to the medial malleolus. Open the sheath. Expose and debride, or excise the posterior tibial tendon. Insert the 1.35mm K-wires in the sustentaculum tali at 15 degrees palatally and slightly posterior, avoiding the subtalar joint. Shaverdrill with a 2.7mm cannulated drill. Then use the 3.5mm. Tap down to the laser line. Insert a 3.5mm SwiveLock anchor loaded with collagen coated FiberTape suture. Hold the paddle and turn the paddle clockwise until the black line is slightly countersunk. Then move the FiberTape SutureTak to the side. Identify the FDL tendon and open the sheath and dissect into the plantar medial foot. Making sure there is enough length for insertion into the navicular. Then cut the FDL tendon at that point. Place a traction stitch through the tendon using a number two FiberWire or number two. Fiberloop suture. Size the tendon through the tenodesis graft sizer based on the tendon diameter. Open either the 4.75mm or 5.5mm FDL implant system. At the most plantar point of insertion of the posterior tibial tendon on the plantar medial navicular tuberosity. Drill the 3.2mm spade tip pin bicortical across the body of the navicular from plantar to dorsal. Note it is recommended to use fluoroscopy to confirm spade tip pin is centered and just breaches the dorsal cortex with the foot in maximum plantar flexion and inversion. Pull the traction stitch so the FDL is tensioned appropriately at the interface of the bone and drill pen. Use a marking pen and mark the entry point of the tendon. Then make a second mark 15mm distal to the entry point. Use an Allis clamp to secure the end of the tendon. Speedwhip stitch with the FiberLoop SutureTape and lock the construct by making the final pass proximal to the previous pass and having the needle exit through distal tip of tendon. Remove the traction stitch and any excess tendon past the second mark. Use the reamer in the implant system based on the size of the tendon. Drill 20mm or just up to the dorsal cortex, but do not breach the cortex. Remove the spade. Tip. Drill pin. Irrigate to remove bone debris. It is important for surgeons to do a primary repair or imbrication of the spring ligament before the spring ligament. Internalbrace ligament augmentation is Is completed at this point. Take one lib of the FiberTape from the SwiveLock and pass it dorsal to planter using the nitinol wire. Passer and repeat with the other FiberTape limb planter to dorsal confirm concentric reduction of the talonavicular joint. Thread one suture limb from the tendon. Whip stitch through one side of the eight millimeter DX button and back through the opposite side with a straight needle. Thread the other suture limb in the same manner, starting on the opposite side. Make sure the suture limbs are not tangled, pulling each limb to ensure the button slides freely. Hold tension on the suture limbs and insert the tip of the button inserter into the button. Now hold tension on the sutures and insert the button through the navicular under fluoroscopy, ensuring it is deployed through both cortices. Pull lever back on the inserter handle to release the button. Note leave the button inserter in the hole when pulling tension back on button. Pull on the free ends to seat the button against the against the dorsal navicular cortex. Confirm with fluoroscopy that the button is in appropriate position resting against cortical bone. Remove the button. Inserter. Grasp each suture limb and slowly apply axial tension on each suture limb to dock the tendon into the bone tunnel. Once the tendon is fully seated, use the free needle and pass one suture limb through the tendon and tie 3 to 4 knots to complete the construct. Hold one limb of the FiberTape under tension from dorsal to planter, and the second limb under tension from planter to dorsal. Then insert the tenodesis screw next to the tendon and FiberTape sutures, securing it so it is flush with the cortex. Cut the excess suture and fixation is complete.

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

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

Elbow

Hand and Wrist

Shoulder

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

Bio-Tenodesis™ Screw System

Chirurgen-Newsletter

Boletins para cirurgiões

Boletines para cirujanos

Surgeon Newsletters

Arthrex Presents: Breakthroughs in Foot and Ankle Technology Summer 2019

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

Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

Videos von Fallpräsentationen

Cirurgiões que apresentam um ou mais casos clínicos.

Vídeos apresentações de casos

Cirujanos que presentan uno o más casos clínicos.

Video presentaciones de casos

Case Presentation Videos

Tibialis Anterior Reconstruction

My name is David Pedowitz. I am a foot and ankle surgeon at the Rothman Institute in Philadelphia. And today we're going to talk about tibialis anterior tendon reconstruction. This case is a 78 year old male who plays tennis three times a week and golfs every weekend. He relays a new four week history of having tripped while playing tennis, and he's felt weak ever since. His wife states that he drags his toe and he's tripped many times, although he's not fallen. As you can see in the clinical photograph, he inverts when he attempts dorsiflexion, recruiting both the perineal tendons and the extensor digitorum longus. He has a palpable mass right below the extensor retinaculum, and all other muscle groups are five out of five strength without pain. And he really has no palpable tibialis anterior tendon, as you can see here in the MRI. He has a tibialis anterior tendon tear. It sort of disappears as we go down a little bit further. He does have a complex tear of the Peroneus brevis, but it's clinically silent regarding his options. The patient was unhappy with his function, and he wanted to be able to resume tennis and golf. So we presented to him the possibility of using a plastic ankle foot orthosis or a brace or surgical reconstruction, and he elected to go ahead with surgical reconstruction. So the overview of the plan, and this is really important because the actual order of the steps helps prevent additional errors. So the first step was just exposure and tendon debridement. Then the pin for the bony tunnel preparing part of the graft, repairing the extensor retinaculum, determining the length of the graft needed. Preparing the distal graft, passing that graft with a tension slide technique and then securing it with a screw. So here's our exposure. It's an anterior medial incision along the course of the tibialis anterior tendon. And we then debride the proximal tibialis anterior to get down to healthy tendon and then remove the non salvageable distal tendon. We then go towards the bone and find the mid portion of the medial caniform. This is an important step. One might think that we were just working with the tendon. Why are we now going to the bone? We'll start doing this step at this point allows us to not tangle up sutures in the wires. We're passing the wire in the reamer. The concept here is we're going to advance the pin through the plantar cortex of the Cartiform. Then we're going to ream over that pin, too, but not through the plantar cortex. The next step is we prepare the tibialis anterior tendon allograft with a locking stitch at one end. I used a number two FiberWire, and we were really only preparing the proximal end of the graft at this point. Here you can see the pin in the medial cuneiform. Right below that is the native distal tendon with a locking stitch and then the graft with a locking stitch proximally. We then sew the native tendon to the graft itself. And then what we do is we repair the extensor retinaculum. It's important to understand that you need to repair the extensor retinaculum under no tension, because once the tendon has been repaired, the retinaculum will be under too much tension and will just rupture. This prevents bowstringing. Next step is we dorsiflex the ankle in order to prepare the distal graft. So what we're doing here is we want to determine the length needed for the distal end of the graft. And when it goes into the bony tunnel. And I generally think of this as about one centimeter longer than the distance of the graph to the bone. And we mark that distance with a pen. We then place a FiberLoop in the distal graph for transfer, and we sort of trim down the graph so that it's almost bullet shaped. So it will go into the bony tunnel very nicely. We then paste a suture button on the distal sutures. And this is just a graphic of that. And the suture button is passed through the pinhole. And you can see it going through there. It is then flipped and then brought back up against the planar aspect of the medial cuneiform. And you can see where we're passing the needle with our graft sutures through the button. There is a suture passer where we pass the button. We then dorsiflex the ankle and pull the tendon into the bony tunnel. You can see that I have a bump against my chest pushing this into dorsiflexion. And as this next video shows, you can show us tensioning and really shimmying the tendon graft into the bony tunnel. And then subsequently it's fixed using an interference screw, and you can hear the interference screw, making that bony contact and reassuring us that we have good strength for our time. Zero fixation on the AP. You can see that the button has been placed through the bony tunnel, and it's subsequently been flipped. And on the lateral x ray you can see it's on the plantar cortex of the medial cuneiform. When you take away this bump, the ankle should not plantar flex. And this is a good example of how our repair is nice and strong. This is that patient nine months post-operatively. You can see he's walking without any great difficulty. As you can see, this tension slide technique allows me to get suture button fixation underneath the cuneiform, which gives me reassurance as well as the cortical fixation of the interference screw, allowing this patient to rehabilitate quicker and really get an outstanding result that he was expecting after this surgery. Thank you very much.

Animationen für die Patientenaufklärung

Animações — Educação do paciente

Animaciones de educación para el paciente

Patient Education Animations

Flatfoot Repair With the InternalBrace™ Ligament Augmentation Procedure

The Arthrex internal brace. Spring Ligament Augmentation Repair is a surgery for people who have flat foot due to weakness or rupture of the spring ligament or posterior tibial tendon. Spring ligament is the connecting tissue located under the foot that connects the calcaneus and navicular bone. This ligament is often repaired in people that have a condition called flat foot. It is when the arch of the foot collapses coming into contact with the ground. The repair begins with the surgeon making a cut on the side of the ankle, where the calcaneus, navicular bone, and medial cuneiform are located. Next, the surgeon will create a bone tunnel by drilling into the sustentaculum tally of the calcaneus using a guidewire and drill guide. The bone tunnel is made in the calcaneus to prepare for a SwiveLock suture anchor loaded with FiberTape. The SwiveLock anchor is screwed into place. Next, the FTL tendon, also known as flexor digitorum longus, located on the medial side of the leg, is identified, cut, and then tagged with a FiberLoop stitching technique. A bone tunnel is made in the navicular to prepare for an additional SwiveLock anchor. The ankle structures are tensioned and fixed into place by taking one part of the FiberTape and passing it from top to bottom with a suture passing wire. Then take the other part of the FiberTape with the sutures from the FTL tendon, and passing it from bottom to top. The surgeon then holds it in place by inserting the SwiveLock from bottom to top. The remaining sutures are cut. The supporting structures of the arch of the foot are now repaired and held together, with the internal brace, causing the arch of the foot to be restored.

FDL Implant System

Educational Resources and Products

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Flatfoot Repair With the InternalBrace™ Ligament Augmentation Procedure

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

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

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Surgical Technique Animations (1)

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

Surgical Technique Guides (1)

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

Brochures (1)

Bio-Tenodesis™ Screw System

Case Presentation Videos (1)

Tibialis Anterior Reconstruction

Catalogs (1)

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

Surgeon Newsletters (1)

Arthrex Presents: Breakthroughs in Foot and Ankle Technology Summer 2019

Related Products (6)

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AR-1555BC-CP

AR-1676ST

AR-1688-CP

AR-1555CDS

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