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Below is a collection of resources&nbsp;for you&nbsp;to&nbsp;learn more about the&nbsp;latest innovative products and techniques in minimally invasive orthopedics.

AAOS 2025 Annual Meeting: Synergy Imaging and Resection Feature Products

Imaging and Resection

This animation demonstrates the features and benefits of the ApolloRF® i90 probe.

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ApolloRF® i90 Probe

Experience the Synergy Vision™ imaging system. Integrating the capabilities of the SynergyID™ system and fluorescence into the next generation of visualization, this all-in-one system features 4K with an expanded field-of-view, compatibility with the NanoNeedle Scope, and picture-in-picture viewing to route multiple images onto a single monitor.

Synergy Vision™ Imaging System

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SynergyResection™ System Resection Engineered With Biologics in Mind PowerPick™ Attachment Excalibur Shaver Blade Torpedo™ Shaver Blade Bone Cutter Shaver Blade PoweRasp™ Attachment GraftNet™ Autologous Tissue Collector The SynergyResection™ system offers a wide variety of shaver blades and specialty resection devices to perform a multitude of biological stimulating procedures. When connected to a SynergyResection arthroscopic shaver, the GraftNet device may be used to collect bone, cartilage, or soft tissue from a surgical site. The GraftNet autologous tissue collector makes gaining access to autograft tissue as simple as resect and collect. Harvested tissue is collected in the tissue collector BioACL™ Technique BioACL Technique Animation Bone Cutter Shaver Blade Bone Collection During ACL Reconstruction Resect: The Bone Cutter shaver blade is a dual-purpose blade designed for fast and aggressive ACL stump debridement when in oscillation mode and bone removal to prepare the notch when in forward or reverse. Collect: When performing a notchplasty or drilling tibial and femoral tunnels, the GraftNet™ autologous tissue collector can be used to collect bone to backfill the BTB harvest site or to make a composite graft to prefill ACL tunnels for a BioACL™ procedure. 5.5 mm Bone Cutter Patella grafting decreases anterior knee pain, kneeling pain, and extension loss compared to nongrafted defects1 GraftNet Autologous Tissue Collector Autograft Bone Collected Using the GraftNet Device Reference 1. Lameire DL, Abdel Khalik H, Zakharia A, Kay J, Almasri M, de Sa D. Bone grafting the patellar defect after bone-patellar tendon-bone anterior cruciate ligament reconstruction decreases anterior knee morbidity: a systematic review. Arthroscopy. 2021;37(7):2361-2376.e1. doi:10.1016/j.arthro.2021.03.031. Harvested Bone Stabilizing and Harvesting Articular Cartilage AutoCart™ Procedure Surgical Technique Torpedo™ and Bone Cutter Shaver Blades Cartilage Repair Thoroughly cleaning and preparing the cartilage defect is essential for optimum results. The SynergyResection™ system has resection attachments for arthroscopic cartilage debridement, harvesting articular cartilage, and marrow-stimulation procedures. The Torpedo shaver blade allows easy access into and around the joint space. The smooth window configuration assists in creating stable borders by leaving smooth, stable edges. The Bone Cutter's distal tip cuts efficiently, removing the calcified layer and creating a raw subchondral surface before applying microdrilling techniques. 4 mm Torpedo Shaver Supports AutoCart™ cartilage repair technique: Both the 4 mm Torpedo and 4 mm Bone Cutter shaver blades harvest medium-sized cartilage particulate while maintaining high cell viability (>80%)1 4 mm Bone Cutter 4 mm Torpedo Shaver Particulate Reference 1. Arthrex, Inc. LA1-000143-en_US. Naples, FL; 2022. 4 mm Bone Cutter Shaver Particulate Microdrilling Cartilage Defects Microdrilling With the PowerPick™ Device PowerPick™ XL Attachment Cartilage Repair Patient-reported outcomes were significantly improved for those treated with the PowerPick attachment vs conventional chondral picks1 Consistent 1.5 mm × 6 mm drill holes Additional 2 mm of drill depth compared to standard PowerPick attachments Single-handed technique Allows a single-handed technique that takes significantly less time than traditional chondral picks2 Improved bone marrow stimulation Drilling cleanly removes bone, allowing free access channels to the marrow space Conventional Microfracture 3 PowerPick Attachment Microdrilling References 1. Beletsky A, Naveen NB, Tauro T, et al. Microdrilling demonstrates superior patient-reported outcomes and lower revision rates than traditional microfracture: a matched cohort analysis. Arthrosc Sports Med Rehabil. 2021;3(3):e629-e638. doi:10.1016/j. asmr.2020.10.006 2. Arthrex, Inc. LA1-00103-EN. Naples, FL; 2018. 3. Kraeutler MJ, Aliberti GM, Scillia AJ, McCarty EC, Mulcahey MK. Microfracture versus drilling of articular cartilage defects: a systematic review of the basic science evidence. Orthop J Sports Med. 2020;8(8):2325967120945313. doi:10.1177/2325967120945313 PowerPick XL Attachment Biological Augmentation of RCR Biological Augmentation of Shoulder Repairs Scientific Update Excalibur Shaver Blade Biological Augmentation of RCR Subacromial bursa provides an easily accessed source of cellular tissue progenitor (CTP) cells when performing an arthroscopic RCR. The sharp-toothed Excalibur blade is our most efficient shaver for extensive soft-tissue debridement that maintains 87% CTP cell viability after harvest.1 Rotator cuffs augmented with CTP cells from subacromial bursa have shown greater healing potential and lower retear rates compared to those treated without augmentation.2 4 mm Excalibur Live/Dead Cell Assay1 Excalibur 0 Hours Competitor 3 Weeks 0 Hours Living cells are labeled with green immunofluorescence while dead cells are labeled with red immunofluorescence. References 1. Wellington IJ, Hawthorne BC, Messina JC, et al. Efficacy of arthroscopic shavers for the retrieval and processing of connective tissue progenitor cells from subacromial bursal tissue. J Clin Med. 2022;11(5):1272. doi:10.3390/jcm11051272 2. Hernigou P, Flouzat Lachaniette CH, Delambre J, et al. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop. 2014;38(9):1811-1818. doi:10.1007/ s00264-014-2391-1 3 Weeks Preparing Tuberosity for RCR Preparing Tuberosity With PoweRasp™ and PowerPick™ Attachments PoweRasp™ Attachment for Decortication Preparing Tuberosity for RCR With 1.5 mm reciprocating motions, easily prepare the greater tuberosity and superior glenoid for RCR or superior capsule reconstruction. Removes osteophytes Creates bleeding bone surface to accelerate tendon-to-bone healing 1.5 mm reciprocating motion prevents wrapping of healthy soft tissue PoweRasp Attachment PowerPick™ Attachment for Microdrilling Crimson Duvet Procedure Bone marrow stimulation decreases retear rate after primary arthroscopic RCR1 Maximizes vascular channels by removing bone rather than compacting All-suture, anchor-friendly marrow stimulation technique leaves cortical layer intact PowerPick Attachment Reference 1. Ajrawat P, Dwyer T, Almasri M, et al. Bone marrow stimulation decreases retear rates after primary arthroscopic rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2019;28(4):782-791. doi:10.1016/j.jse.2018.11.049 Ordering Information PowerPick™ and PoweRasp™ Attachments 3.5 (Drill depth, mm) 4 (Drill depth, mm) PowerPick Attachment Initially designed to make quick work of microfracture procedures by using the shaver handpiece to power the Ø 1.5 mm drill tip, the 30° and 45° angled shafts facilitate use in a variety of other applications, including ACL femoral tunnel location and crimson duvet techniques in the shoulder AR-8150PP-30 (30°) AR-8150PX-45 AR-8150PP-45 (45°) AR-8400PR (45°) AR-8350PR PoweRasp Attachment Use for acromioplasties, distal clavicle resections, preparing the greater tuberosity, notchplasties, osteophyte resection, and other bony work 6 (Drill depth, mm) AR-8550PR Description Large Hub Options: Fit Large Shaver Handpieces Description 3.5 (Ø mm) Excalibur Sharp-toothed blade makes this the most aggressive shaver for extensive soft-tissue debridement Torpedo™ Blade Tapered tip and scissor-like cutting action allow easy access into joint space and rapid soft-tissue resection; outer oval window to limit tissue size and help reduce clogging Bone Cutter Dual-purpose blade designed for fast and aggressive tissue debridement when in oscillation mode and for bone removal when run in the forward or reverse direction 1. Hip length (19 cm), curved 2. Small joint length (7 cm), large hub 3.8 (Ø mm) 4 (Ø mm) AR-8380EX AR-8400CEX AR-8400EX (curved) 4.2 (Ø mm) AR-6420EX AR-6420CEX1 5 (Ø mm) 5.5 (Ø mm) AR-8500EX AR-8550EX AR-7400TD 2 AR-7350TD AR-8400TD AR-6420TD AR-8400CTD AR-6420CTD1 AR-8500TD (curved) AR-8400BC AR-8380BC AR-8400CBC (curved) AR-6420BC AR-6420CBC1 AR-8500BC AR-8550BC GraftNet™ Autologous Tissue Collector BioXpress™ Graft Delivery Device Product Description Item Number Product Description Item Number GraftNet autologous tissue collector ABS-1050 Blunt-tip cannula, 10 cm ABS-10053-10 Angled-tip cannula, 10 cm ABS-10053-10-45 Blunt-tip cannula, 15 cm ABS-10053-15 Angled-tip cannula, 15 cm ABS-10053-15-45 Optional Accessories Product Description Item Number Mixing and delivery kit, large joint ABS-1000-L Mixing and delivery kit, small joint ABS-1000-S Mixing and delivery kit, hip joint ABS-1000-H arthrex.com © 2023-06 Arthrex, Inc. All rights reserved. LB1-000403-en-US_B

SynergyResection™ System: Resection Engineered With Biologics in Mind

Arthrex provides an overview of specialty resection products.

Arthrex Specialty Resection Products Overview

The Arthrex Torpedo. Its tapered tip is designed for ease of access into and around the joint space. It seems to attack the tissue very well without going deep into the bone. The utilization of the Torpedo provides an effective and efficient manner of debridement. Meaning that it tends to take the stuff you want it to take and not everything else. The ShaverDrill affect my ability to treat my patients better in many ways. Provides a sharp, sterile drill for each patient. So that you don't have to use the chucks and the large drills in these arthroscopic procedures that we're going to save time. Since the shaver handpiece is already open, it is no longer necessary to prepare the battery powered drill systems for these procedures. These products feature a retractable hood that allows the surgeon to alter the amount of burr head exposure. I can now retract the sheath of the burr, and as you can see, this retractor is protecting me from those superior vessels. Here's our Arthrex PowerPick. And you can see that the tip protrudes out about four millimeters. And go in flush. Pull straight out. You can see it looks like honeycomb. Here we are looking at the four zero PoweRasp in the shoulder. I think it is aggressive. It's just the right size. It's kind of PoweRasp this bone off in a very controlled setting. And that reciprocating action really hits the bone very nicely.

ApolloRF® SJ50 Probe for the Knee A Low-Profile RF Solution for Knee Arthroscopy and Nano Applications ApolloRF® SJ50 Probe AR-9845 The ApolloRF SJ50 probe is anatomically curved for optimized aspiration in the tight areas of the knee. Its 360° edge control and low default ablation setting is designed for precise ablation and coagulation while minimizing the effect on surrounding tissue. Features and Benefits Optimal RF solution for knee arthroscopy applications Shortened working length of 110 mm promotes maneuverability and control within the knee joint Smaller diameter of 3.3 mm allows access to tight joint spaces in the knee. Efficient and effective 360° edge control feature to clean up frayed tissue within the knee Smaller electrode face enables surgeons to mark precise anatomical locations as well as anchor locations Ordering Information Product Description Item Number ApolloRF SJ50 probe AR-9845 The ApolloRF SJ50 probe fits underneath the medial condyle to reach the posterior aspect of the meniscus to prepare for a meniscal root repair. Applications Precision Chondroplasty Meniscal Repair Effortlessly fits underneath and around the condyles to reach the periphery of the menisci Precise markings of anchor locations for meniscal root repairs on the tibial plateau near the meniscal root attachment Chondroplasty Efficient removal of damaged cartilage with a low default ablation setting of 4 ACL/PCL Repair Easier maneuverability around the walls of the femoral condyle and intercondylar area Effective removal of frayed tissue near the repair site with the 360° edge control feature Nano Techniques Optimize minimally invasive procedures through Nano arthroscopy Footprint Preparation: PCL Repair 360° edge control feature for precise contouring of any irregular cartilage surfaces Low-profile electrode design 3.3 mm diameter Anatomical 50° curve 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.com © 2023-11 Arthrex, Inc. All rights reserved. LB1-000461-en-US_A Arthrex Manufacturer, Authorized Representative and Importer information: elFU - Arthrex View U.S. patent information at arthrex.com/corporate/ virtual-patent-marking

ApolloRF® SJ50 Probe for the Knee

This video discusses how the SynergyResection™ portfolio pairs with biologics for optimal results.

Blades and Biologics: Resection Engineered With Biologics in Mind

I like to use this Torpedo shaver to remove any of the loose articular fragments from the periphery of the lesion. The 45 degree PowerPick to do my microfractures. I find it to be twice as fast as the standard Stedman picks. We're going to use an oscillator to get what we believe to be the proper particulate size. We just want to collect as much as we can from our notched plastic end of the GraftNet. That looks great. We're going to have really nice consistency. We've got great biology and we've got great bone fill, as opposed to leaving Bursa intact or using an entire sheet of bursal tissue. Mechanical chopping or processing of the bursal tissue helps with cell migration. You can see as we're using this device how nice and evenly it decorticate the bone. First step is to prepare the footprint to get good healing. And for that I utilize the Arthrex PowerPick.

Christopher Cooke, MD (Detroit, MI), presents an overview of the benefits of the SurgeonVault® system.

Benefits of the Synergy Surgeon™ App and SurgeonVault® System

Hi, my name is Christopher Cook. I'm an orthopedic surgeon, sports medicine specialist out of Detroit, Michigan. Today we're going to be talking about the benefits of the SynergyRF Surgeon app system. This system allows you to pull Interoperative pictures and videos and show them to the patients immediately after the case. It allows you to download them and save them, whether it's for case presentations, education, or uploading to your social media platforms. It is easy to use templates, which very quickly and reproducibly allow you to label the images and send them to patients. Here's a case presentation. A 54 year old male recreational golfer has two months of right shoulder pain status post a slip and fall accident where he sustained a rotator cuff tear. He had pain, decreased strength and decreased range of motion. We performed a right shoulder arthroscopy, fixing the rotator cuff tear using a double row technique with the Arthrex SpeedBridge fixation. These surgical photos and videos were saved on my iPad utilizing the Arthrex SynergyRF Application pictures can be quickly and easily annotated right on the iPad after the case. You can take the patient and their family through the injury pathology, how you went about fixing, for example, sutures and SwiveLock anchors, and then you can show them the final product of a rotator cuff repair. You then can take the videos and very quickly edit the videos, for example showing beforehand with the torn rotator cuff, then quickly flashing till afterwards with the final fixation repair. Patients and their families can better understand what went on in the O.R. and how to further improve using rest and physical therapy. Afterwards, you can send the patient, their families, their own surgical images and videos using the Arthrex SynergyRF HIPAA protected email platform. This allows them to both see their surgical images, then afterwards have post-operative wound care instructions, rehabilitation exercises, and allows access for them to contact you with any questions. One of the benefits of this system is the images and videos are available on any desktop app. It eliminates printer and associated costs of ink and paper. You can send the patients their reports from any location, any various hospital or clinic you work at. Then these images and pictures can also be uploaded to various amounts of social media platforms. Oftentimes, patients look up on these platforms the injuries they have trying to seek out medical advice, and local physicians who can be able to treat them. Surgical photos and videos can be easily edited and uploaded to professional social media platforms. They can be better used to educate the public. Past patients and future patients who might need your help. Another one of the benefits of the SynergyRF application is patient satisfaction with receiving their own images and post-operative instructions using the HIPAA protected email. Over 90% of patients agree that the emails were easy to understand and navigate, and that it was very informative and helpful to have access to both their surgical images, their post-operative instructions, and any contact information you choose to give them.

Imaging & Resection New Product & Technique Highlights Apollo Bipolar Ablation RF ® Optimized radio frequency waveform for effective tissue ablation 360° edge control for precise ablation around sensitive tissues Full line of probes with unique electrode designs and optimized aspiration to maintain superior visual clarity and evacuate tissue particulate The SynergyRF bipolar ablation system volumetrically ablates tissue and coagulates bleeding vessels to ease efforts during tissue resection. The ablation system is the first to integrate with the imaging monitor to include a heads-up display. Fluid Management and Containment The Synergy fluid management systems are designed to provide the highest levels of clarity and anatomic visualization, allowing everyone in the OR to focus on the patient. “The DualWave™ pump works extremely well at controlling intra-articular pressures. Now I experience consistently clear visual fields with much less bleeding, resulting in less overall fluid consumption and improved overall efficiency while keeping operating room costs down.” Gautam P. Yagnick, MD MIAMI, FL Mats promote a safe, comfortable, and efficient OR with antimicrobial properties that can aid in reducing the risk of cross contamination CoolCut™ series of shaver blades and burrs offers over 125 unique attachments, so you can always find the right device for the procedure Unique, doublesealed, highspeed handpieces offer a light, ergonomic feel with multifunction buttons and optional removable suction valve for easy cleaning Low-profile and multifunction/ wireless footswitches promote less fatigue and offer a customized approach to user preferences Shaver Systems The SynergyResection™ system provides a complete arthroscopic tissue and bone resection portfolio with innovative solutions designed to meet surgeons’ needs. 4K Imaging Technology The SynergyID™ and SynergyUHD4™ systems enable advanced visualization by combining state-of-theart 4K visualization with augmented reality features for surgeons to see more than ever before. Heads-up display keeps the surgeon in control of imaging, shaver, pump, and RF settings at all times Programmable camera head buttons provide customized functionality at surgeons’ fingertips 4K imaging, LED lighting, advanced image management, and integration from a single console Synergy.net™ data integration software seamlessly connects with your EHR, PACS, or vendor-neutral archive to share surgical worklists and intraoperative media The Synergy Matrix™ video integration system distributes 4K video to multiple displays in or out of the OR Synergy OR Command™ room status provides surgeons and staff with a centralized dashboard view of simultaneous video streams across all operating rooms Integration Arthrex redefined the OR experience with innovations designed to fully integrate with your hospital’s EHR, PACS, or information system to optimize visualization, and enhance workflow efficiencies. Quality products designed and serviced to maximize operating room uptime and support the Arthrex mission of Helping Surgeons Treat their Patients Better™ Flexible service plans meet a variety of service needs: choose from flexible agreements and payment terms Save money and ensure against costly, unbudgeted repairs while receiving priority service and unlimited replacements for the term of your agreement The Arthrex NanoSuite Expanding least invasive arthroscopic surgery from the OR to the treatment room without general anesthesia 93% 96% patients would recommend a Nano arthroscopy procedure1 patients returned to normal function within 4 weeks2 References 1. Murawski CD, Kennedy JG. Anteromedial impingement in the ankle joint: outcomes following arthroscopy. Am J Sports Med. 2010;38(10):2017-2024. doi:10.1177/0363546510369335 2. Colasanti CA, Mercer NP, Garcia JV, Kerkhoffs GMMJ, Kennedy JG. In-office needle arthroscopy for the treatment of anterior ankle impingement yields high patient satisfaction with high rates of return to work and sport. Arthroscopy. 2021;S0749-8063(21)00848-3. doi:10.1016/j.arthro.2021.09.016 synergy.arthrex.com © 2022 Arthrex, Inc. All rights reserved. LB1-000364-en-US_B 87% patients prefer a procedure room versus an OR under sedation2

Imaging & Resection: New Product & Technique Highlights

Gautam P. Yagnik, MD, (Miami, FL) describes why he prefers the DualWave™ arthroscopy pump.

DualWave™ Arthroscopy Pump Fluid Management System

I love the DualWave pump. I've been using it for over five years now, and it's really become an integral part of my O.R. setup. The thing I like the most about the DualWave pump is its consistency. The setup is easy. I can personalize my own settings, and regardless of where I'm operating, whether it's in the hospital setting or a surgical center, I know I'm going to get a nice reproducible visual field. So what I found lacking in other fluid management systems was that oftentimes I would get wide fluctuations in the fluid inside the joint space, too little fluid, and I would get bleeding. Too much fluid. I'd get a lot of soft tissue swelling and extravasation. Personally, I like to use the outflow on all my cases. I think that really allows me to optimize all the features of the pump. I can keep my suction toggle wide open and that minimizes the bleeding as well as the fluid fluctuations that I often saw before. It allows me to use different features, like the lavage feature, where I get a just a short time cycle of increased pressure, and also the rinse feature, which is just an increase in flow and allows me to clear debris and maintain a nice clear field.

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Benefits of Synergy Matrix™ 4K Integrated OR

Discover the state-of-the-art Pano™ scope. Experience clinical benefits from potential portal negation to visualizing pathology in fewer movements. When combined with the Synergy Vision™ imaging system, surgeons can toggle between a 30°, 70°, and ultrawide view with the push of a button.

Synergy Pano™ Scope

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Foot and Ankle

Hand and Wrist

Knee

Spine

NanoNeedle Scope Arthroscopy System

Walter R. Lowe, MD (Houston, Texas), demonstrates the benefits of the Synergy Vision™ imaging system with Pano™ scope technology to increase precision in complex knee cases. Dr. Lowe uses the Pano scope and NanoNeedle Scope at multiple angles for complex graft placement.

Synergy Vision™ Imaging System With the Pano™ Scope and Nano Vision™ Feature

This is showing the new Synergy Vision platform with the NanoScope. At the touch of a finger, we can move between our typical 30 degree angle of viewing to 70 degree viewing, and then to a wide angle view that gives you sort of a panorama view of the joint. So this is just your typical 30 degree, and I'll just kind of run through it from the notch in the lateral portal. Good view of the ACL looking down at the anterior horn of the medial meniscus coming back to the back. And then that same view, if we come just moving to the panoramic view, we have a much broader angle. Now if you look up at the front, you not only see the ACL insertion, the whole anterior horn of the medial meniscus and coming around to look up the gutter from here, which is always a very hard view, switch to the 70 degree view and easy from the medial side to see all the way up the medial gutter. And so if I just look at the notch and take it through these, you know, back at the usual 30 and then to this panoramic view, you can really get a good feel for the whole joint. Great view of the whole lateral meniscus, the root, the ACL insertion, all those things we'd have to struggle to get around with just your typical 30 degree scope. Seven degree scope where I found it just great looking at the PCL insertion, you know, very difficult view to see. This is where it would have been at the 30 and 45. You get back to the 70. Pretty easy to see all the way down the back of the tibia. Come into the root area at 70. Not such a great view. Go to 30 our typical view go to 45. See all the way around this posteromedial corner. So again, just views you're not used to seeing with the touch of a finger. If we're looking up at the front of the we'll go to the Pano view You looking down. And here, actually, you see the anterior and lateral meniscus. Inner meniscal ligament coming around. Anterior horn of the medial meniscus and the ACL insertion. And this view will be particularly great when we're doing a meniscal transplants combined with an ACL where this territory here, there's not much room between everything we do. And honestly, this is the best view I've ever seen of that. You know, to start with the plan where the tunnels of these two are going to be without intersecting with each other. So I've sort of prepared this like I'd be doing a repair from a proximal avulsion. And so we'll sort of go through this is looking down at 7030. And then this is the panoramic view or the 140 degree angle wide angle view. So I have our 6 to 9 guide in through the anterolateral portal. And this is a very difficult place to see and position your guide pin for passing. You know, your button part of your repair and TightRope later. And so when I'm looking back to the left. This is a view, honestly, as much of this as I do, I've probably never seen with this wide angle view. Here's the lateral wall and back. There's over the top. In the back there's lateral meniscus below and the posterior compartment. So like I said this as much of this as I do, this is a view I've really never seen before. So I'm going to be very confident with this view that I am repairing back to an anatomic location, which is one of the most difficult parts of a repair when you're working around an ACL in the notch. This wide angle sort of panoramic view, just cleaning out the notch. And you know, when you're allowing trainees to do this, you worry about them injuring the root of the lateral meniscus. And this this wide angle or panoramic view is just incredible. I can see it perfectly. I can see the sidewall perfectly. And you can tell I've already debrided the ACL stump out of here. So for viewing through the anterolateral portal or typical lateral wall view where you have to push up against the wall, If I go to the wide angle, it just immediately comes into view and gives me a much better depth perception. I don't feel like I'm working down a sheet of paper or something. And so the depth perception, I don't know if you can notice it here, but from 30, you know, for me to get to that back wall, I kind of have to come in, move my hand over to angle at it in the wide angle view. It just puts it all in view right there. Even keeping the articular cartilage in my field of view, which I think will make it safer, we're still in that panoramic view. If I come to the root, you know, from a teaching standpoint, at 70, I get a pretty good look at this root. And when the root is truly off at the root, you can see this insertion so good here that the insertion is way up here okay. And so it's not often an area you see you know knee figure for trying to look to the back through a 30 degree scope. And so I think a lot of root repairs that I've seen in this country are done with their drill tunnels back here, and they actually need to be, you know, much more anterior if we want to recreate the, you know, normal posture, root attachment. So this view both going from 70 really even at 30. But the panoramic view for sure, you can see that that this area for repair, you know isn't here. It's way up here. So we're sort of taking out a PCL like we would be doing in a multi league knee. You're going to do you know by cruciate reconstruction at the same time you know I'm looking away from that. I'm viewing from the anterolateral portal straight over. This is the 30 degree view. If I go to the wide angle view again it just brings the whole condyle into focus. So now I'm looking down. And. Let's go to the 70 degree view. And so this is just with the straight shaver Debriding. Breathing. You can see the PCL tibial stump here. We can go down beside it and see all the way down, right over at the posteromedial edge of the medial meniscus. So this view right now is a 70 degree view. I couldn't get without switching out scopes and switching out everything. You know, the wide angle view gives us sort of poster horn, medial meniscus, lateral meniscus and PCL stump right there. And I'm already looking in this posterior medial ramp sort of area where I'll be putting a cannula to work back here, just, you know, putting in the posteromedial portal with this panoramic or wide angle view here. And again, you're just seeing this posterior pouch, you know, posteromedial corner with a much bigger view than you normally would get and can come in immediately. Switch back to my 70 degree view that now takes me right down into the the PCL footprint. Now viewing the nano can be, you know, as obviously hooked into the same console and console and then projected on the same screen that. So we can work back and forth from front to back. Now I'm actually looking at the nano, looking at what I want to see down here in the back. Now we're looking with the nano through the back at the PCL sort of fossa and the residual of the tibial stump. My view from the scope in the front is looking back at the nano, looking at the stump of the PCL, which is kind of weird. You can see the nano come in now, but again, you'll see when we clean this out, this will be a view of the back of the tibia that you don't get to see much for drilling, you know, without having to change out scopes or anything else. I go immediately to a 70 and can work all the way down. You know, to breed the rest of the PCL stump. So here's our insertion here. Here's where we'll want to put our PCL guide. So again, I'm preparing the footprint so that when I bring my FlipCutter in, I'm in. I'm not going to have all this soft tissue around it, but you can see I'm all the way down the back of the tibia. This is the most inferior part of the PCL insertion right here. And from the anterolateral portal. I have a perfect view of this, both with 45 and with the 70 degree scope. So when I bring my guides through, I know exactly where I am. And for me doing a PCL, this view always has to happen through the Posteromedial portal for me. Just can't get this view. Even with the 70 degree. I don't think I see this. I think the the ability to widen the angle just gives you this perspective. And that's the root of the lateral meniscus looking down root of the medial meniscus. And you can see anatomically how that PCL insertion of the tibia is a little medial of center. And that's where the tunnels for reconstruction have to go. So you have to sort of orient yourself to the nano view coming from the back looking forward. So to the left is the posterior part of the tibia okay. So that's down this is the footprint of the PCL that we're looking at right here. And then the, you know, the pusher capsule is to the right. So coming in through the medial portal. Now if you look at the nano you'll see my tibial guide for the PCL come into play on the nano. And when I get to that view automatically I just quit looking away. If I look at my panoramic view through the anterior part, you see a beautiful view and go to 70. Look how much you can see coming all the way down, you know, and this view is good enough. I probably wouldn't get out to see ARM if I was seeing this good. And in every case probably. And then you look at the nano view and the other side and you just confirm, you know, looking the opposite direction, that you're indeed sitting down there at the PCL insertion, where we're going to put our socket to do our PCL reconstructions.

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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

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Darren J. Friedman, MD (New York, NY), demonstrates the use of the ApolloRF® i90 probe for shoulder arthroscopy procedures.

ApolloRF® i90 Probe in Shoulder Arthroscopy Procedures

Darren Freedman, sports medicine physician at a New York City. We're here today to discuss the latest addition to the Apollo portfolio, the I-90. I'm going to introduce the I-90 into the anterior rotator interval portal. And you can see, due to the Torpedo shaped electrode, the ease of insertion in and out of the portal, in and out of the joint. This device also easily fits through a five millimeter cannula as well. As we look into the front of the joint, you can see the MJHL here, which is draped over the subscapularis. Due to the shape and the tapered electrode, it's very easy to get in between tissue planes that may be tight. And as we activate the device, it's easy to loosen up and release those adhesions anteriorly. And you can see how efficient this device is at releasing that tissue. So as we get even more medially on the scap, you can see how effective the I-90 is at taking down that MJHL for a capsule release and getting in between tight tissue planes. As you look at the lateral bicipital sling here or the medial bicipital sling. And if we wanted to taper that down, you can see the plasma activation affecting the tissue, taking down some of that redundant tissue as we move more superiorly above the subscapularis. If you wanted to do a rotator interval release due to the geometry of the electrode, it's very easy to work in the planes above the subscapularis and remove some tissue in this region. If you're going to be performing a subscapularis repair or performing a release anteriorly, as we're working more medially on the subscapularis, you can see some medial adhesions here towards the medial aspect of the rotator interval, getting towards the base of the coracoid. Once again, due to that anatomy and the design of the tip of this device, it easily navigates those tissue planes, allowing for a facile release of some of those adhesions as we work medially. And you can see we have a nice open release of that interval, complete excursion and mobilization of the subscapularis tendon. So introducing the I 90 into the joint. You can see the labrum here. Some degeneration degenerative labral tear to breed that. As I activate the device, you can see the plasma formation over the face and on the sides of the device. The plasma is really well contained with the I 90. And because of that well contained plasma, you've got something called edge control where if you just put the edge of the device against the target tissue, you get really focused, targeted treatment of that degenerative tissue. It's going to change my view. If you look more inferiorly some degeneration down low as well. Once again activating the device you can see that target tissue react taper down and get smoothed out. I'm going to look at the superior labrum. So it looks like the patient has degenerative slap tear. If we're going to breed a little of that superior labrum here. Same technique activAT the device just off the tissue, you can see that plasma form. And as it contacts the target tissue, you see those macroscopic changes in the tissue moving on to the to the glenoid. Some degenerative kind of grade two three chondral changes. This device works well when treating chondral lesions for achondroplastic due to that well contained plasma field, as the plasma contacts that diseased cartilage. You can see some macroscopic changes in the cartilage, allowing for debridement and stabilization of the lesion once again. The anatomy and the geometry of this device is great. You can see on the tip you get a really well defined field of plasma. And that tip can just hover over that cartilage lesion creating some changes in the tissue to breeding, removing the diseased tissue but preserving the healthier tissue underneath. So it really allows for precision of use because of that well contained plasma field. So if we look at the labrum now degenerative tear is stabilized. Free tissue has been tapered. Minimal impact on the surrounding tissue. And looking at the glenoid we can see that the cartilage lesion is stabilized. Less degenerative free tissue. After after treatment with the with the I 90 and last. You're looking at that rotator interval. We can see that subscapularis completely mobilized and released interval released in preparation for any potential subscapularis repair. Or if you're doing any work underneath the the coracoid. So in preparation for a set pectoral biceps tenodesis I-90 is very efficient at completing the tenotomy in the joint. I usually start about one centimeter off the stump the insertion and let the I-90 do do its work. Very clean, very efficient. Quick tenotomy in preparation for a tenodesis. All right. So we've moved up to the subacromial space. We've got a lateral portal. We're going to put our I-90 in there. You can see how easily that slides in with the Torpedo shaped electrode does not catch up on the tissue. And when I start my subacromial decompression I always start with the RF. It does a really good job of resecting tissue. This specimen does not have a significant amount of bursitis. I oftentimes will create a little bit of a window here in the deltoid fascia, which allows for ease of insertion of my other instruments if I'm going to be passing sutures through the rotator cuff. As we look medially, we can see some adipose on the undersurface of the acromion. So as we're doing our decompression and prep for a rotator cuff repair, you can see how efficient the I-90 is at resecting tissue removing the tissue. It does a really nice job of releasing tissue off the acromion. If you look at the face of the device, there's three large aspiration ports. And the beauty of that is that there's a fair amount of aspiration as you activate the device, which does two things. Number one, it minimizes the amount of bubbles, which is great. It also really reduces the the risk of clogging as we work medially back to the acromial spine. You can see it just kind of peels off the tissue, allowing for mobilization of the sided fibers of that rotator cuff. Visualization is clear. Minimal bubbles very efficient at resecting Excess tissue. In addition, the geometry in the tapered tip really allows for ease of passage medially, rarely gets held up or caught on tissue as we move laterally. You can see some adhesions anteriorly, and sometimes in individuals will have large retracted rotator cuff tears. You want to do a complete mobilization, and you can see it does a really nice job of breaking through those tissue planes, freeing up that underlying rotator cuff. You can see here some of that deltoid fascia is adherent anteriorly. We're going to open that up and release, which will make it easier for us to perform a rotator cuff repair. As we look laterally as we're preparing our lateral gutter for a double row repair, oftentimes that deltoid fascia will be adherent to the bone laterally. And once again, the geometry of the I-90 allows for ease of insertion into the lateral gutter. Rotate the device 90 degrees and release some of those adhesions down by the inferior part of that footprint, to allow for space and geometry and real estate to put our lateral row anchors in for a cuff repair. So plenty of space now after we've released that fascia in the lateral gutter. All right. So once again viewing from the lateral side instruments coming in posteriorly. We've completed our subacromial decompression. We've released back to the scapular spine. Our lateral gutter is released in preparation for our lateral row anchors. Essentially, the bone is ready for an acromial plasty if indicated. I think in wrapping up, the beauty of this device is it's unbelievably efficient at removing tissue in a volumetric fashion, but it's also extremely precise due to that well contained plasma field and the edge control. So this can be utilized when trying to resect tissue in the subacromial space and prep for a cuff repair or acromial plasty. But it can also be used around sensitive tissue like cartilage or labrum. Due to that edge control and that precision on the edge of the I-90.

A scientific report from the Arthrex Orthopedic Research Department stating an objective, methods and materials, results, and discussion and conclusion.

Ein wissenschaftlicher Bericht der Arthrex Orthopedic Research-Abteilung, der ein Ziel, Methoden und Materialien, Ergebnisse sowie Diskussion und Schlussfolgerung beinhaltet.

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Relatório científico do Departamento de Pesquisa Ortopédica da Arthrex declarando um objetivo, métodos e materiais, resultados, discussão e conclusão.

Informe científico del Departamento de Investigación Ortopédica de Arthrex que establece un objetivo, métodos y materiales, resultados, discusión y conclusión.

Thermal Response of the ApolloRF® i90 Aspirating Probe Arthrex Research and Development Introduction During radiofrequency (RF) ablation procedures, management of intra-articular fluid temperature is critical due to the onset of cellular and tissue damage at temperatures ranging 45-55 °C.1,2 The purpose of this testing was to evaluate the change in temperature in a simulated joint space environment with the ApolloRF i90 probe. Methods The joint space was simulated using a clear acrylic cuboid with a volume of approximately 115 mL, which falls within the range of knee joint space volumes.3 Irrigation fluid pressure was set at 35 mmHg for the tests. Each probe was placed into a silicone rubber test substrate, which was used to simulate tissue and provide a consistent testing environment. A temperature sensor was inserted through the side port of the simulated joint space at approximately 2 cm to 3 cm from the probe’s distal tip (Figure 1). Figure 1. Thermal Response Test Setup Each ApolloRF i90 probe was tested at the default ablation setting of 7, and the device aspiration vacuum was set at 304 mmHg (12 inHg). Each probe (n = 5, respectively) was activated continuously for 1 minute, and the simulated joint space temperature was measured by the temperature sensor. The maximum temperature difference was calculated by selecting the first data point from each data set and subtracting that value from the maximum temperature present in the data set for each trial run. The resultant value represents the maximum temperature increase within each trial. Results The results for the temperature differences for each trial are displayed in Table 1. With the ApolloRF i90 probe running for 1 minute at its default ablation setting and recommended pump setting per the directions for use, the average change in temperature was 0.8439 °C.4 Table 1. Maximum Temperature Differential Observed During Each Trial Sample Apollo i90 probe RF Synergy RF™ console Temperature sensor data collection Apollo RF i90 probe Simulated joint space Vacuum pump Temperature sensor Temperature Differences (°C) Trial 1 Trial 2 Trial 3 Trial 4 Trial 5 1.7426 0.5601 0.7219 0.4730 0.7219 Figure 2. Maximum Temperature Increase With the Apollo RF® i90 Probe Maximum temperature increase (°C) Change in Temperature (°C) 3.5 3 2.5 2 Conclusion At default ablation settings, the ApolloRF i90 probe’s average temperature change was less than 1 °C. “The temperature of the irrigation fluid has been proposed as the most influential variable in intra-articular temperature variation during arthroscopic procedures.”5 The use of RF ablation devices under recommended parameters provides minimal temperature increases during ablation. 1.5 1 0.8439 0.5 0 ApolloRF i90 probe References 1. Horstman CL, McLaughlin RM. The use of radiofrequency energy during arthroscopic surgery and its effects on intraarticular tissues. Vet Comp Orthop Traumatol. 2006;19(2):65-71. 2. Voss JR, Lu Y, Edwards RB, Bogdanske JJ, Markel MD. Effects of thermal energy on chondrocyte viability. Am J Vet Res. 2006;67(10):1708-1712. doi:10.2460/ ajvr.67.10.1708 3. Matziolis G, Roehner E, Windisch C, Wagner A. The volume of the human knee joint. Arch Orthop Trauma Surg. 2015;135(10):1401-1403. doi:10.1007/s00402-015-2272-0 4. Arthrex, Inc. Data on file (PLM107445). Naples, FL; 2024. 5. Longo UG, De Tommasi F, Salvatore G, et al. Intra-articular temperature monitoring during radiofrequency ablation in ex-vivo bovine hip joints via Fiber Bragg grating sensors. BMC Musculoskelet Disord. 2023;24(1):766. doi:10.1186/s12891-02306836-6 arthrex.com © 2024-12 Arthrex, Inc. All rights reserved. LA1-000202-en-US_A

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