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Below is a collection of resources to learn more about the latest Spine and Orthobiologics products to support fusion&nbsp;procedures.

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Orthobiologics New Product Spotlight AutoCart Technique ™ Arthrex Shaver Blades Resect viable tissue Arthroscopic, Single-Stage Cartilage Restoration GraftNet™ System Resect and Collect™ Matrix-Augmented Cartilage Implantation, Simplified Everything you need to harvest and reimplant particulate osteochondral tissue in a single procedure, including point-ofcare preparation of PRP and an autologous thrombin solution for enhanced bone ingrowth and graft fixation.1,2 Learn more about the Arthrex cartilage repair algorithm at JointPreservation.Arthrex.com BioCartilage® Extracellular Matrix The ideal scaffold References 1. Drakos MC, Eble SK, Cabe TN, et al. Comparison of functional and radiographic outcomes of talar osteochondral lesions repaired with micronized allogenic cartilage extracellular matrix and bone marrow aspirate concentrate vs microfracture. Foot Ankle Int. 2021;42(7):841-850. doi:10.1177/1071100720983266 2. Irwin RM, Bonassar LJ, Cohen I, et al. The clot thickens: autologous and allogeneic fibrin sealants are mechanically equivalent in an ex vivo model of cartilage repair. PLoS One. 2019;14(11):e0224756. doi:10.1371/journal.pone.0224756 Thrombinator™ System Autologous sealant Arthrex ACP® System Autologous growth factors Comprehensive PRP Solutions Angel® System The Angel concentrated platelet-rich plasma (cPRP) system is the only fully automated system with proprietary 3-sensor technology for preparation of adjustable cellular concentrations of PRP and cPRP from bone marrow aspirate (BMA). ACP Max™ PRP System The ACP Max triple-syringe system uses a double-spin regimen to produce PRP from 30 mL, 60 mL, or 90 mL of whole blood (WB), resulting in up to 12× over baseline platelet concentration and a greater than 97% reduction of neutrophils.1-3 Arthrex ACP® Double-Syringe System The Arthrex ACP (autologous conditioned plasma) double-syringe system allows for rapid and efficient concentration of platelets from 15 mL of WB, providing a PRP that is low in neutrophils in just 5 minutes. References 1. Arthrex, Inc. Data on file (APT 5368). Naples, FL; 2021. 2. Arthrex, Inc. Data on file (APT 5535). Naples, FL; 2022. 3. Arthrex, Inc. Data on file (APT-5756). Naples, FL; 2022. BioACL™ Technique Improve ACL Bone Tunnel Healing and Redefine Outcomes With Next-Generation Biologics Better patient-reported outcomes, greater range-of-motion, and less bone tunnel widening1 Bone tunnels are filled with the BioACL composite mixture to promote and accelerate tibial and femoral tunnel remodeling.1 Patient A 2 years post-op Non-augmented ACL reconstruction Patient B 2 years post-op BioACL reconstruction Reference Learn more about the BioACL technique 1. Lavender CD, Schaver AL, Taylor S, et al. Anterior cruciate ligament reconstruction augmentation with bone marrow aspirate concentrate, demineralized bone matrix, and suture tape shows no difference in outcomes—but faster functional recovery— versus non-augmented anterior cruciate ligament reconstruction. Arthroscopy. doi:10.1016/j.arthro.2024.06.042 Give Patients the Freedom of Faster Functional Recovery1 AlloSync™ Pure Demineralized Bone Matrix Vortex™ Threaded Recovery Needle Maximize the concentration of medicinal signaling cells (MSCs) from bone marrow aspirate harvested using the Vortex threaded recovery needle. Fill ACL tunnels with an osteoinductive, cuttingedge bone graft made of 100% demineralized bone matrix, with no extrinsic carriers, that resists irrigation. QuadLink™ Presutured Construct Angel® cPRP from BMA The only presutured quadriceps allograft, presized and presutured with #2 FiberLoop® with FiberTag™ suture. Compatible with ACL TightRope® II implants. Process MSCs from bone marrow aspirate with the best-in-class BMA processing system. GraftNet™ Autologous Tissue Collector Easily collect autologous bone into a sterile filtered chamber to enhance bone stabilization and biological healing. References 1. Lavender CD, Schaver AL, Taylor S, et al. Anterior cruciate ligament reconstruction augmentation with bone marrow aspirate concentrate, demineralized bone matrix, and suture tape shows no difference in outcomes—but faster functional recovery—versus non-augmented anterior cruciate ligament reconstruction. Arthroscopy. doi:10.1016/j.arthro.2024.06.042 CuffMend™ Rotator Cuff Augmentation System Fast Fixation. Supports Healing.1,2 Cur ve d St r a i g ht ArthroFLEX® Human Dermal Allograft Provides integration and supplemental support to the native tissue while reducing the incidence of retears.3-5 Implantation of the CuffMend system is designed to be completed in <10 minutes Applications for revision cuff repair, poor tissue quality, and treating patients with comorbidities that impede healing.6 ArthroFLEX is a registered trademark of LifeNet Health. FiberStitch™ RC 1.5 Implant Allows for quick, secure, suturebased medial graft fixation. References 1. Ely EE, Figueroa NM, Gilot GJ. Biomechanical analysis of rotator cuff repairs with extracellular matrix graft augmentation. Orthopedics. 2014;37(9):608-614. doi:10.3928/01477447-20140825-05 2. Smith MJ, Bozynski CC, Kuroki K, Cook CR, Stoker AM, Cook JL. Comparison of biologic scaffolds for augmentation of partial rotator cuff tears in a canine model. J Shoulder Elbow Surg. 2020;29(8):15731583. doi:10.1016/j.jse.2019.11.028 3. Gilot GJ, Alvarez-Pinzon AM, Barcksdale L, Westerdahl D, Krill M, Peck E. Outcome of large to massive rotator cuff tears repaired with and without extracellular matrix augmentation: a prospective comparative study. Arthroscopy. 2015;31(8):1459-1465. doi:10.1016/j. arthro.2015.02.032 4. Bailey JR, Kim C, Alentorn-Geli E, et al. Rotator cuff matrix augmentation and interposition: a systematic review and meta-analysis. Am J Sports Med. 2019;47(6):1496-1506. doi:10.1177/0363546518774762 5. Hartzler RU, Softic D, Qin X, Dorfman A, Adams CR, Burkhart SS. The histology of a healed superior capsular reconstruction dermal allograft: a case report. Arthroscopy. 2019;35(10):2950-2958. doi:10.1016/j.arthro.2019.06.024 6. Kwon J, Kim SH, Lee YH, Kim TI, Oh JH. The Rotator Cuff Healing Index: A new scoring system to predict rotator cuff healing after surgical repair. Am J Sports Med. 2019;47(1):173-180. doi: 10.1177/0363546518810763 BoneSync™ Calcium Phosphate Cement The Answer to Poor Lateral Row Bone Quality Fast setting to allow immediate supplemental fixation and strength to a surgical repair site1 with a collagen-infused calcium phosphate Anchor Fixation at the First Punch Addition of BoneSync bone void filler can significantly increase anchor fixation strength in poor-quality bone.1 Ideal Porosity for Integration Infused collagen provides a macroporosity structure allowing for osseointegration that is resorbed and replaced with new bone. Reference 1. Arthrex, Inc. Data on file (APT-04387). Naples, FL; 2019. Inject and Set The porous calcium phosphate is injectable and hardware-compatible, enhancing structural bone support. Learn more about BoneSync calcium phosphate JumpStart® Antibacterial Dressings Extend Infection Control Beyond the Operating Room Powered by Advanced Microcurrent Technology®, JumpStart antibacterial wound dressings are inspired by the body’s natural electrical healing process. Elemental silver and elemental zinc microcell batteries generate an electric field when hydrated, to provide protection against a broad spectrum of bacteria1-3 and support the body’s natural electrical healing process. References 1. Kim H, Makin I, Skiba J, et al. Antibacterial efficacy testing of a bioelectric wound dressing against clinical wound pathogens. Open Microbiol J. 2014;8:15-21. doi:10.2174/1874285801408010015 2. Banerjee J, Das Ghatak P, Roy S, et al. Silver-zinc redox-coupled electroceutical wound dressing disrupts bacterial biofilm. PLoS One. 2015;10(3):e0119531. doi:10.1371/journal.pone.0119531 3. Kim H, Izadjoo MJ. Antibiofilm efficacy evaluation of a bioelectric dressing in mono- and multi-species biofilms. J Wound Care. 2015;24 Suppl 2:S10-S14. doi:10.12968/jowc.2015.24.Sup2.S10 arthrex.com © 2025-02 Arthrex, Inc. All rights reserved. evBR1-002486-en-US_E JumpStart® ClearFit™ Dressings Features advanced microcurrent technology, with a clear gentle adhesive layer.

Orthobiologics - New Product Spotlight

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Don Kucharzyk, DO (Crown Point, IN), discusses the use of ArthroCell™ viable bone allograft in spinal fusion procedures. He also reviews two cases in which he incorporated ArthroCell grafts into multilevel fusions.&nbsp;

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ArthroCell™ Viable Bone Graft for Spinal Fusion Procedures

I'm Doctor Donald Kucharczyk, a board certified orthopedic surgeon practicing in Northwest Indiana. Today, we're going to spend a little time talking about the role of Osteo Biologics in spinal fusion surgery. As we've seen over the past decade, there are multiple choices available in terms of Osteo Biologics for the surgeon when performing a fusion. The biologic of choice made by the surgeon should meet the criteria and feature what I call the holy triad for fusion. That is, it must possess Osteogenic potential, an Osteoinductive platform and an Osteoconductive matrix. All of these, we know are critical for the cascade of fusion to start, continue, and progress to solid arthrodesis. Arthrocell osteo biologic from Arthrex possesses all of these traits and more. It's a moldable cellular allergenic non-immunogenic bone matrix. It possesses an HTTP allogenic bone scaffold, and it derives the cells from the vertebral body, which, according to the literature, delivers better osteoprogenitor cells than that from the iliac crest, which other osteo biologics utilize cell viability and function is preserved utilizing a novel cryoprotectant that does not require decanting. Unlike similar products in the marketplace, this limits the time required for preparation to placement of the biologic, but more importantly by not decanting. This eliminates some potential sources of error and damage to the biologic that can occur with other products in the marketplace. So, as with anything, it's always important to see how a product works and see how it behaves in a surgeon's hands. And here are a few case presentations. This is a 56 year old lady who had low back pain with bilateral leg pain. She had a history of two prior microdiscectomy and one laminectomy at the four, five and five S1 level. The patient showed weakness to the quadriceps, to the anterior tibialis, the extensor hallucis longus, and gastrocnemius. The patient showed an absent patellar and Achilles reflex on the right and an absent Achilles reflex on the left. The patient had failed conservative treatment and care with medications, physical therapy, and Therapy and epidurals. The patient underwent workup that included x rays and an MRI scan that confirmed pathology at the three, four, four, five, and five S1 level with facet arthropathy central and lateral recess stenosis, as well as spinal instability that was noted on bending films. In addition, the patient also had multiple risk factors being a diabetic, hypertensive, and also having multiple surgical interventions prior to surgery. This is the patient after undergoing surgery at a multi-level fusion two weeks post-op. What we're looking for is, is the bone graft in the posterior lateral gutter. And we see the proper placement of the graft, and we see that it's spanning the area from L3 to S1. This is the patient now at three months. What we're looking for when we look at this is the consolidation and incorporation of the osteo biologic, the development of new bone formation and trabecular bone that's bridging from transverse process to transverse process all the way down onto the sacrum. And then when we look at this at six months, we see further incorporation and enhancement of the osteo, biologic and bone graft in the posterior lateral gutter. And here is the is the patient. Now at nine months bridging bone going from transverse process to transverse process and solid incorporation of the osteo biologic with no pseudoarthrosis lines. And what we don't see is any evidence of any hardware failure or lucency around the screws or the hardware. The next patient is a 68 year old that had progressive back pain and leg pain with the diminished ability to walk. She would notice that she would develop leg pain when she was ambulating, and would even have to have time to sit down and rest. She would notice numbness and tingling and at times weakness to her legs. The more she tried to walk, the patient failed conservative treatment with medications, epidurals, and physical therapy. She had MRI scans that confirmed the pathology of degenerative spinal disease with spinal stenosis. She showed facet arthritis, lateral recess, and neuro stenosis at the l45 and l5-s1 level with a grade one spondylolisthesis that was unstable at L4 five. The patient also carried risk factors that included hypertension, Diabetes and the fact that she had a previous decompressive laminectomy at the l5-s1 level. This is the preoperative x ray standing AP and lateral imaging. On the top image, we see the spine to show a relatively straight appearance to the spine, with no evidence of any scoliosis or curvature. We see prior decompressive laminectomy at the l5-s1 level. On the lateral image, we see an l45 spondylolisthesis with degeneration would collapse of the l5-s1 level. This is her forward bending and backward extension imaging that shows progression of the grade one spondylolisthesis with translation and a change of the intervertebral angle at L 45. It also shows a change in the intervertebral angle at l5-s1 with a relatively stable l34. The patient was taken to surgery and a two level spinal instrument at fusion was carried out. This is the AP and lateral imaging showing proper placement of the screws, inner bodies and posterior lateral bone grafting. This is the patient now at three months where we see incorporation of the of the Osteo Biologic bridging Bone, new bone formation and consolidation with no pseudoarthrosis lines. This is the patient now out at six months where we see further progression to the fusion. Further incorporation, further consolidation and no evidence of any pseudoarthrosis lines and no evidence of any loosening of the hardware. Finally, we see this image at nine months. So in complete bridging of the bone from L4 to S1, solid incorporation with new bone formation bridging trabecular bone, and no further progression of any hardware failure or loosened lines around the hardware indicating any evidence of any nonunion. In conclusion, ArthroCell osteo biologic offers for me in my practice convenience and ease of use. No decanting. It also provides what I consider important in fusion, the holy triad for fusion, which is critical to achieving a solid Arthrodesis. Good patient outcomes and good surgical outcomes. Thank you.

ArthroCell and ™ ArthroCell Plus Allografts ™ Viable Bone Matrices ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices Features and Benefits ArthroCell and ArthroCell Plus allografts are moldable, viable allogenic bone matrices for use in bone defects and remodeling for a variety of orthopedic applications. ArthroCell and ArthroCell Plus allografts are HCT/P allogenic bone scaffolds Available as separate components or premixed Final products are moldable for optimal handling (Figures 1 and 2) Cell viability and function are preserved using a novel cryoprotectant that is DMSO-free and does not require decanting prior to use Product shelf life is 3 years from date of processing when stored at -65 ˚C or colder Preparation time on a back table is less than 20 minutes. Both products have a 4-hour working window for implantation after thaw without loss of cell viability. ArthroCell and ArthroCell Plus allografts are nonimmunogenic alternatives to autograft Donors processed for ArthroCell and ArthroCell Plus allografts undergo rigorous screening, testing, and culturing that meet FDA regulations and American Association of Tissue Banks (AATB) guidelines Arthrocell and Arthrocell Plus allografts provide the essential elements for optimal bone repair: An osteoconductive, 3-dimensional scaffold with cortical and cancellous components1 A demineralized bone component with osteoinductive potential, which provides exposure of signaling molecules and bone morphogenetic proteins2 Viable endogenous bone cells to support osteogenic healing processes3-5 Microparticulate Gel Cells Figure 1. ArthroCell allograft components Figure 2. Premixed ArthroCell Plus allograft Figure 3. ArthroCell and Arthrocell Plus allograft final product 02 I ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices Cellular Advantage Safety ArthroCell™ and ArthroCell Plus™ allograft cellular advantages Cellular component is recovered from donors, frozen, and packaged within 120 hours postmortem Donor tissue processing ArthroCell allograft is processed at VIVEX Biologics in an aseptic manner in Class 100 clean rooms using proprietary procedures and screening criteria that meet AATB requirements Cells are recovered from the vertebral body region, an area known to be rich in MSCs6 ArthroCell allograft is collected from donors who have been screened by licensed laboratories and physicians following a process that meets FDA regulations and AATB requirements for testing Donor testing includes nucleic acid and/or antibody tests for the following pathogens: Cells are preserved in a novel cryoprotectant to preserve cellular identity after thaw DMSO-free Nontoxic Decanting not required prior to use HIV-1 and -2 Additional cell population includes : Hepatitis B and C MSCs Human T-lymphocyte virus Osteoprogenitor cells Syphilis rapid plasma screen Flow cytometry analysis demonstrates high T. pallidum IgG screen 7 expression of markers for pluripotent cells and MSCs (including CD44, CD73, CD90, CD166, and SSEA-4) Cytomegalovirus, (CMV) Ab (IgG and IgM) Medical and social history review ArthroCell Plus Allograft Cellular Components CD44 +++ CD73 +++ CD90 +++ CD166 +++ CD105 +++ CD34 – CD45 – Physical examination +++ ++ + – Expression between 80%-100% Expression between 60%-80% Expression between 40%-60% Expression lower or equal to 5% (if performed) Licensed physician review of donor record Mixed lymphocyte reaction (MLR) assay that do not elicit an immune response.8 To ensure complete safety of the cell component, an MLR assay was performed to assess the potential for activation of T-cell proliferation on samples of ArthroCell allograft along with positive and negative controls.9 MLR Assay Because the test samples (donors 1-4) did not 700 IFNγ(pg/ml) Medical record evaluation, including autopsy MSCs are known to be immune-privileged cells Figure 4. Surface marker expression for ArthroCell Plus allograft. stimulate a significant response compared to the negative control, the MLR assays demonstrated that the viable allogeneic bone scaffold is not immunogenic and does not stimulate an immune response (Figure 5). 15 10 Donor screening: 692 15.2 5 0 Positive Human Control 3 3.3 Donor 1 Donor 2 6.9 5.2 Donor 3 Donor 4 Negative Human Control Figure 5. MLR assay performed by VIVEX Biologics for ArthroCell Plus allograft. ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices I 03 ArthroCell™ Allograft Preparation 1 The product, with all components, will arrive frozen in a sealed pouch. Product consists of 3 components to be transferred aseptically into the sterile field. 3 Thaw the cell vial (~5 minutes) and gel container (~20 minutes) in a room temperature sterile saline or sterile water bath. 04 I ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices 2 Components include a cell vial, particulate bone, and gel. 4 While the cell vial and gel container are thawing, remove the inner and outer lids of the bone particulate jar. Mix the saline and the particulate thoroughly using a spatula. 5 Once the cell vial has thawed, pour the contents of the vial directly into the bone particulate/saline mixture. Mix the cell contents and bone particulate/saline thoroughly using a spatula. Once fully mixed, cap the container and set aside for at least 10 minutes. 7a 6 Divide the thawed gel into 3 to 4 pieces and transfer to sterile mixing syringe (ABS-2000). 7b Unsnap the pushrod from the mixing element. Mix the gel component by pushing/pulling on the mixing element until a paste consistency is obtained, which should occur within 60 seconds of continuous mixing. ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices I 05 8a 8b Snap the pushrod back into the mixing element and remove the syringe end cap. Dispense the paste onto the cell/ particulate matrix. 9a 9b Using a spatula, mix the cell/particulate/paste matrix thoroughly until all components are incorporated. The matrix can then be molded further in a gloved hand until the desired configuration is obtained. 10a 10b The final product is moldable and can be stored capped at room temperature until needed. Total time from cell vial thaw to placement at the surgical site should not exceed 4 hours. 06 I ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices ArthroCell Plus™ Viable Allogeneic Bone Matrix Preparation Guide 1 Open the pouch and remove the syringe. Confirm the syringe cap is securely locked. 4a 2 3 Place the syringe in the ambient sterile bath for 10-15 minutes, ensuring the contents are submerged. Remove the syringe from the sterile bath and unscrew the syringe cap from the top as shown above. 4b Apply slight pressure to the plunger and extrude product out of the syringe into the palm of your hand. 5b 5a 5c ArthroCell Plus™ allograft is now ready to mold to desired shape. Product remains viable for up to 4 hours on the back table in an operative field. ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices I 07 Potential Surgical Applications Promote Osseous Regeneration Across Upper Extremity Fracture Site Voids ArthroCell™ and ArthroCell Plus™ allografts can be used as a bone void filler to help treat clavicle fractures alongside the clavicle plate and screw system (refer to complete surgical technique brochure LT1-0255-EN). The Titanium Volar Distal Radius Plating System includes a graft window for fragment manipulation and bone grafting (refer to complete surgical technique brochure LT1-0416-EN). 08 I ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices Promote Osseous Regeneration Across Fusion Site Voids After preparing the 1st metatarsal phalangeal (MTP) joint for an arthrodesis, ArthroCell™ and ArthroCell Plus™ allografts can be inserted into the joint before final fixation with the low-profile MTP plate. Promote Osseous Regeneration Across Lower Extremity Fracture Site Voids Calcaneal fractures often have defects where the addition of a cellular bone graft like ArthroCell allograft is useful. For final fixation, the calcaneal fracture system provides a comprehensive solution for all classifications of calcaneal fractures. Promote Osseous Regeneration Across Spine Fusion Sites ArthroCell and ArthroCell Plus allografts can be packed into an interbody cage and in the posterolateral gutters to promote fusion and provide a viable scaffold for bone remodeling. ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices I 09 Ordering Information ArthroCell™ Allograft Product Description Item Number ArthroCell allograft, 2.5 cc ABS-2009-02 ArthroCell allograft, 5 cc ABS-2009-05 Mixing syringe, 14 cc (must be ordered for each graft size) ABS-2000 ArthroCell Plus™ Allograft Product Description Item Number ArthroCell Plus allograft, 1 cc ABS-2090-01 ArthroCell Plus allograft, 2.5 cc ABS-2090-02 ArthroCell Plus allograft, 5 cc ABS-2090-05 ArthroCell Plus allograft, 10 cc ABS-2090-10 References 1. Malinin TI, Carpenter EM, Temple HT. Particulate bone allograft incorporation in regeneration of osseous defects; importance of particle sizes. Open Orthop J. 2007;1:19-24. doi:10.2174/1874325000701010019 2. Gruskin E, Doll BA, Futrell FW, Schmitz JP, Hollinger JO. Demineralized bone matrix in bone repair: history and use. Adv Drug Deliv Rev. 2012;64(12):1063-1077. doi:10.1016/j.addr.2012.06.008 3. Risbud MV, Shapiro IM, Guttapalli A, et al. Osteogenic potential of adult human stem cells of the lumbar vertebral body and the iliac crest. Spine. 2006;31(1):83-89. 4. D’Ippolito G, Schiller PC, Ricordi C, Roos BA, Howard GA. Age related osteogenic potential of mesenchymal stromal stem cell from human vertebral bone marrow. J Bone Miner Res. 1999;14(7):1115-1122. doi:10.1359/ jbmr.1999.14.7.1115 5. D’Ippolito G, Diabira S, Howard GA, Menei P, Roos BA, Schiller PC. Marrow-isolated adult multilineage inducible (MIAMI) cells, a unique population of post-natal young and old human cells with extensive expansion and differentiation potential. J Cell Sci. 2004;117(14):2971-2981. doi:10.1242/jcs.01103 6. McLain RF, Fleming JE, Boehm CA, Muschler GF. Aspiration of osteoprogenitor cells for augmenting spinal fusion: comparison of progenitor cell concentrations from the vertebral body and iliac crest. J Bone Joint Surg. 2005;87A(12):2655-2661. doi:10.2106/JBJS.E.00230 7. Vivex Biologics, Inc. Data on file. Miami, FL. 8. Ryan J, Barry F, Murphy J, Mahon B. Mesenchymal stem cells avoid allogeneic rejection. J Inflamm. 2005;2:8. doi:10.1186/1476-9255-2-8 9. Grabowski G, Robertson RN. Bone allograft with mesenchymal stem cells: a critical review of the literature. Hard Tissue. 2013;2(2):22. 10 I ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices ArthroCell™ and ArthoCell Plus™ Viable Bone Matrices I 11 This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience, and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level and/or outcomes. arthrex.com © 2023-10 Arthrex, Inc. All rights reserved. LB1-00060-EN_G Arthrex manufacturer, authorized representative, and importer information (Arthrex eIFUs) US patent information

ArthroCell™ and ArthroCell Plus™ Allografts - Viable Bone Matrices

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AlloSync™ Expand Demineralized Cortical Fibers for Spinal Fusion Cases

Bradley P. Inkrott, MD (Akron, OH), discusses how he uses AlloSync™ Expand demineralized cortical fibers to augment his cervical fusion cases.

Cervical Fusion Augmented With AlloSync™ Expand Demineralized Cortical Fibers

Hello, my name is Brad OATS. I'm the division chief of spine surgery in the department of orthopedic Surgery at Summa Health System in Akron, Ohio. Today, we'll be discussing a pretty extensive spinal revision case, specifically a cervical thoracic osteotomy that was augmented with Arthrex AlloSync expand DBM cortical fibers. This is a 53 year old gentleman who was referred to my office with a significant amount of axial neck pain and weakness, and inability to hold his head in a neutral position. He had what essentially we call in spine surgery as a chin on chest deformity, where he's unable to have his head in a neutral position to maintain horizontal gaze. He works as a manual laborer in a local crossbow factory, which is important because of this significant inability to hold his head up, causes a great amount of fatigue and neck pain throughout the course of the day. This patient also has a past medical history that certainly will affect our biologic choice, most notably diabetes, sleep apnea, and hypertension. As mentioned his previous surgical history, he did have a posterior cervical decompression and fusion from the C3 to C7 levels, with notably a complete C3 and C7 laminectomy on physical exam, as mentioned, he has a significant inability to maintain that horizontal gaze where his chin was essentially stuck on his chest. Extremely limited neck, range of motion, and probably most importantly, weakness in his hands, causing him difficulty to hold and grasp onto objects. Preoperative X-rays essentially showed his previous hardware, while placed in a good position, did show those complete laminectomy defects all the way from C3 to C7, which eventually led to his significant forward migration of his head and essentially inability to hold his head in an upright position. In spine surgery. We call this position a chin on chest deformity, where you can see very clearly on his extension radiographs. Even with maximum effort, it is difficult for him to even attain any sort of horizontal gaze. Advanced imaging reveals again that the hardware, while in decent position, did show that there was extensive foraminal stenosis at the C7 T1 level, which was causing his hand weakness. And more importantly, you can see even laying down, he had to have a bolster of pillows where he's unable to achieve any sort of cervical lordosis or normal curvature of the of the spine. Based on this, we had an extensive conversation on how to proceed and given his quality of life was so miserable he was unable to do his job. Unable to live a meaningful life, we decided to proceed with a revision surgery. This was an anterior and a posterior surgery. Part one of the surgery was to perform what's called an acdf at the c6-c7 level, and additionally at the C7 T1 level to perform a complete vertebral resection and essentially an anterior column osteotomy with a hyper lordotic cervical cage at the c7-t1 level. Then subsequently, on the same day, we went in a posterior approach, exposed all the previous hardware, and did a revision fusion from C3 to T3. But more importantly, we did what's called a Schwab two or a posterior column osteotomy, where we completely resected the C7 and T1 facet joints to allow us to literally break this gentleman's neck in half and get his head back into a more neutral position so he could maintain that horizontal gaze. You can imagine, essentially, because we had to perform such an extensive osteotomy. This requires a very extensive demand from our biologic of choice to get an adequate spinal fusion based on the technology of and the. Conductivity of the DBM cortical fibers. We essentially, based on the data, shows that the Arthrex AlloSync expand fibers could provide a significant biologic boost to the local bone, and provide us with enough biologic to achieve a solid fusion. This is a video showing how we mix these DBM cortical fibers, where the dry weight of fibers is injected into the kidney basin. You essentially have two choices. You can mix saline or blood with the expand DBM cortical fibers to essentially get the handling characteristics desired by the surgeon. In this case, we did saline, knowing that we would eventually mix the product with blood in the in the wound itself. And this is a video showing the final product where you can see very nicely the handling characteristics, where we can mold and keep that bone graft lateral to the screws, which was seen on the previous slide, which is a very important spine surgery, because of course they're in a prone position in surgery. And when they stand upright, we don't want that graft to migrate distally into the wound. This is our two week post-op follow up x rays were traditionally. These patients have a dramatic amount of pain, and it's very difficult the first few weeks with post-operative course. In this case, this gentleman was very happy because his horizontal gaze was improved tremendously. He felt like he didn't. He no longer had to work to keep his head up or his chin off of his chest. And then you can see our hardware is in good position at this initial x ray. As we move out to the three month follow up, you can see the hardware has not moved. And additionally, at the six month follow up, you can see we have a nice beginning of a solid fusion where we can maintain that horizontal gaze. You can see a nice what's called a chin brow vertical axis, where he now can not have to work so much to keep his chin at a neutral position. And we actually just saw this gentleman back recently for his one year follow up visit. And he's very happy with his clinical result and has minimal, if any, neck pain. And as mentioned, the goals of surgery were achieved and that his horizontal gaze was maintained and his hand strength resumed and returned back to normal. Thank you.

AlloSync™ Bone Grafting Solutions

Join the Endoscopic Spine Evolution Table of Contents 02 | Join the Endoscopic Spine Evolution 05 Arthrex Spine 08 Visualization and Instrumentation 10 Orthobiologics Support 17 Patient Outreach and Education J oin the Endoscopic Spine Evolution | 03 Arthrex Spine As a global leader in sports medicine and surgical education, Arthrex continually strives to provide surgeons and patients with groundbreaking ultra-minimally invasive and motionpreserving procedures. Limited nonpermanent options for back pain mean patients must often undergo frequent treatments and invasive procedures that result in limited motion, damage to soft-tissue anatomies, and unsightly scars. Innovation in the medical device industry is largely driven by manufacturers. As a privately held company, we are uniquely positioned to rapidly develop new technologies and advance ultra-minimally invasive procedures that prioritize surgeon needs and patient outcomes. Put simply, there is a gap in today’s continuum of care between conservative treatment and maximally invasive surgical procedures. Backed by more than 40 years of leadership in sports medicine and surgical education, Arthrex Spine bridges that gap with endoscopic surgical approaches and orthobiologic innovations designed to help spare soft tissue, preserve motion, and provide the best possible outcomes for patients. Learn more about Arthrex Spine 04 | Join the Endoscopic Spine Evolution J oin the Endoscopic Spine Evolution | 05 World-class medical education offerings for health care professionals and administrators help make less-invasive surgery simpler, safer, and more reproducible. Our endoscopic spine-specific surgical curriculum pathway includes individualized and expert faculty instruction and immersive, hands-on training in our dedicated spine lab as well as practice support—all designed to help surgeons and facilities succeed with endoscopic spine techniques. We develop our products and procedures with an unwavering dedication to constant innovation, unmatched surgeon education, and world-class scientific research. Together, we can expand your treatment offerings, maximize your practice efficiency, and help make active lifestyles a reality for millions of patients. “ Arthrex is a world leader in less-invasive surgical imaging and product innovation supported by cadaveric surgical skills education and clinically trained representatives across the US to help advance your endoscopic spine proficiency. After 40 years of pioneering arthroscopic surgery, Arthrex is now focused on revolutionizing endoscopic spine surgery. Join the evolution with us. Reinhold Schmieding Arthrex President and Founder Naples, FL 06 | Join the Endoscopic Spine Evolution J oin the Endoscopic Spine Evolution | 07 Visualization and Instrumentation FDA-Cleared, Autoclavable 4K Video Camera and Imaging Networking System for Spine Endoscopy Arthrex offers a comprehensive endoscopic spine bur and shaver blade system via the SynergyResection™ platform. This system includes whisker shaver blades for resection and aspiration of soft tissue near neural structures, as well as a variety of bur options with retractable hoods and integrated suction for efficient bone and soft tissue removal during endoscopic spine procedures. Enhanced visualization with the Synergy 4K camera system and operative endoscope Revolutionizing ergonomics with WishBone™ rotating handle and ring-handled endoscopic instrument options Steerable electrosurgery probes designed for endoscopic spine procedures Bring it all together with a comprehensive instrumentation offering 08 | Join the Endoscopic Spine Evolution J oin the Endoscopic Spine Evolution | 09 Orthobiologics Support With the Most Comprehensive Orthobiologics Portfolio for Spine Arthrex offers the most extensive orthobiologics portfolio in the spine market, uniquely combining innovation, versatility, and clinical value. From advanced bone graft substitutes to next-generation cellular technologies and biologic delivery systems, Arthrex provides a full continuum of solutions designed to support spinal fusion, tissue healing, and regeneration. 1. Angel® cPRP and Bone Marrow Processing System 2. AlloSync™ Expand Demineralized Cortical Fibers 3. BoneSync™ Synthetic Bone Void Fillers 4. Vortex™ Threaded Bone Marrow Recovery Needle 5. ArthroCell™ Viable Bone Allografts 6. GraftNet™ XL Bone Collection Device 1 10 | Join the Endoscopic Spine Evolution 2 3 4 5 6 J oin the Endoscopic Spine Evolution | 11 Arthrex Graft Gun Validated to Deliver 100% Autograft Bone Chips1 Can deliver graft into the disc space for fusion procedures Designed to provide direct visibility for delivering bone graft through a decompression tube Compatible with any combination of autograft/allograft up to 100% autograft chips Reference 1. Arthrex, Inc. Data on file (APT-1022220). Naples, FL; 2025. 12 | Join the Endoscopic Spine Evolution J oin the Endoscopic Spine Evolution | 13 Soft-Tissue Repair and Reconstruction Spine Scorpion™ suture passer can close the fascia up to 75% faster during MIS procedures1 JumpStart® FlexEFit® dressings kill and protect against multiple grampositive and -negative bacteria2-5 The microcurrent technology of JumpStart dressings can reduce the risk of wound infection and promote healing6 References 14 | Join the Endoscopic Spine Evolution 1. Arthrex, Inc. Data on file (APT-05722). Naples, FL; 2021. 2. Banerjee J, Das Ghatak P, Roy S, et al. Silver-zinc redox-coupled electroceutical wound dressing disrupts bacterial biofilm. PLoS One. 2015;10(3):e0119531. doi:10.1371/journal.pone.0119531 3. Kim H, Makin I, Skiba J. Antibacterial efficacy testing of a bioelectric wound dressing against clinical wound pathogens. Open Microbiol J. 2014;8:15-21 doi:10.2174/1874285801408010015 4. Kim H, Izadjoo MJ. Antibiofilm efficacy evaluation of a bioelectric dressing in monoand multi-species biofilms. J Wound Care. 2015;24(Suppl 2):S10-4. doi:10.12968/ jowc.2015.24.Sup2.S10 5. Long DR, Bryson-Cahn C, Pergamit R, et al. 2021 Young Investigator Award winner: anatomic gradients in the microbiology of spinal fusion surgical site infection and resistance to surgical antimicrobial prophylaxis. Spine. 2021;46(3):143-151. doi:10.1097/BRS.0000000000003603 6. Blount AL, Foster S, Rapp DA, Wilcox R. The use of bioelectric dressings in skin graft harvest sites: a prospective case series. J Burn Care Res. 2012:33(3):354-357. doi:10.1097/BCR.0b013e31823356e4 J oin the Endoscopic Spine Evolution | 15 Patient Outreach and Education Patient Outreach Suite The Patient Outreach and Education Resource Kit provides an overview of all available tools for physicians and administrators. It includes descriptions of resources—such as clinic posters, postoperative holographic cards, patient guides—as well as step-by-step instructions for accessing each item, including the media kit and the patient-facing website featuring the Find a Doctor tool. Learn more about patient education 16 | Join the Endoscopic Spine Evolution J oin the Endoscopic Spine Evolution | 17 The Ultra-Minimally Invasive Endoscopic Spine Curriculum Pathway and the Arthrex Surgical Skills Experience Arthrex has developed a structured educational pathway to train surgeons in endoscopic spine surgery. This curriculum is designed to help them adopt endoscopic spine techniques into their practice. It includes a series of courses that begin with foundational, lower-risk procedures. Each course level adds new techniques and knowledge for a safe, step-by-step learning experience. This progressive approach to adopting endoscopic spine surgery ensures surgeons gain competence and confidence as they develop toward a more advanced skill set. Arthrex has more than 100 surgical skills labs throughout the United States. Train. Evolve. Lead. Follow a curriculum pathway, rooted in reproducibility, precision, and motion preservation. Alaska Arthrex trains more than 50,000 surgeons around the world annually. Alaska Learn more about Arthex Spine courses Canada Canada Hawaii 18 | Join the Endoscopic Spine Evolution Hawaii J oin the Endoscopic Spine Evolution | 19 This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level or outcomes. Arthrex manufacturer, authorized representative, and importer information (Arthrex elFUs) US patent information © 2026-05 Arthrex, Inc. All rights reserved. LB1-000440-en-US_K arthrex.com

Join the Endoscopic Spine Evolution

Arthrex offers a variety of endoscopic-length shaver burs in multiple sizes and tip geometries with integrated suction to provide efficient bone removal during a wide range of endoscopic spine procedures.

Animations demonstrating the features and benefits of a specific product.

Animationen, die die Funktionen und Vorteile eines bestimmten Produkts demonstrieren.

Produktdemonstrationen

Animações demonstrando os recursos e benefícios de um produto específico.

Vídeos de demonstração de produtos

Animaciones que demuestran las características y beneficios de un producto específico.

Videos de demostración de productos

Product Demonstrations

Endoscopic-Length Shaver Burs: Features and Benefits

This animation highlights the key steps for instrumenting bilateral pars fractures at L4 using Arthrex Fully Threaded Spine Compression Screws.

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

Percutaneous Pars Fracture Repair

Speaker  The ultra minimally invasive, endoscopic assisted percutaneous approach for pars fractures using Arthrex spine compression screws is indicated for adolescent and adult population. During this procedure, a spine specific endoscope may be used for visualization and direct access of the fracture site for preparation and biologic delivery. The Synergy imaging system, in conjunction with the ergonomic instruments, provides innovative new technology to treat this pathology. Localize using AP and lateral fluoroscopy based on pre-op imaging and CT. Mark a line along the inferior edge of the lamina of the level being treated. Mark midline under AP. Determine the screw trajectory and mark from the top of the pedicle to midline. Repeat on both sides for bilateral treatment using lateral fluoroscopy. Determine the screw trajectory and mark the skin. This will provide a reference for the AP entry point. Using AP and lateral fluoroscopy, Make a skin incision and insert the introducer needle. Docking on the inferior edge of the lamina. Remove the stylet and insert the guidewire through the cannula of the introducer needle. Use AP and lateral fluoroscopy to make fine adjustments to the entry point. Use a pin driver to advance the guidewire across the fracture, confirming the trajectory with AP and lateral fluoroscopy periodically during insertion. Widen the skin incision to accommodate the dilator and drill guide diameter. Speaker  Remove the introducer needle, then insert the dilator and drill guide over the guidewire, granting the bevel of the tip of the drill guide to best match the patient's anatomy. Remove the dilator and insert the drill bit over the guidewire. Position the drill bit coaxial with the guidewire and drill to the desired implant. Depth, confirming trajectory and depth with fluoroscopy periodically making sure to not advance the guidewire while drilling. Observe the drill depth via the laser line and the corresponding measurement on the drill guide to determine implant length. Reverse the drill bit under power 10 to 15mm. Stopping before the drill bit tip passes the fracture location. Remove the guide wire and insert a new guide wire. Continue to remove the drill bit using a ratcheting handle while maintaining the guide wire depth and location. Load the compression screw firmly under the screwdriver. Place the cannulated implant and screwdriver over the guide wire and advance to the desired depth. Periodically taking AP and lateral fluoroscopy to prevent advancement of the guide wire. The compression screw will be fully seated when the laser line on the screwdriver is flush with the back of the drill. Guide to confirm proper position. Remove the instruments. Close the incision and place a JumpStart bandage over the incision site.

Below is a collection of resources to learn more about the latest Spine and Orthobiologics products to support fusion procedures.