Arthrex continues to make advancements in graft fixation devices. With the input of some of the most innovative surgeons in sports medicine, Arthrex has created a comprehensive and innovative line of graft fixation products available. Our family of TightRope products, along with industry leading BioComposite fixation devices, and a variety of PEEK and metal fixation, allow surgeons to choose from a wide variety of safe and effective fixation devices that are right for their patients.

Knee

Product

The FiberTag TightRope II implant adds optimized features to the revolutionary FiberTag TightRope implant design. New shorter locking splices create a shorter minimum loop length to maximize the amount of graft in the socket. A flat-tape loop and tensioning strands improve strength, feel, and handling.1
 
Additionally, the FiberTag TightRope II implant is available with a preloaded FiberTape® suture for the InternalBrace™ technique, which peer-reviewed research associates with lower graft retear rates,2 less pain, improved patient-reported outcomes, and a faster and higher rate of return to preinjury level of activity.3
 
The redesigned cortical button includes a proprietary knotless fifth locking mechanism for increased strength and resistance to cyclic displacement, allowing for precise, incremental retensioning of the construct after final fixation.4 Finally, the enhanced design of the packaging card improves suture management during implant assembly.
References
1. Arthrex, Inc. Data on file (LA1-00038-EN_B). Naples, FL; 2017.
2. Daniel AV, Wijdicks CA, Smith PA. Reduced incidence of revision anterior cruciate ligament reconstruction with internal brace augmentation. Orthop J Sports Med. 2023;11(7):23259671231178026. doi:10.1177/23259671231178026
3. Bodendorfer BM, Michaelson EM, Shu HT, et al. Suture augmented versus standard anterior cruciate ligament reconstruction: a matched comparative analysis. Arthroscopy. 2019;35(7):2114-2122. doi:10.1016/j.arthro.2019.01.054
4. Arthrex, Inc. Data on file (APT-G01155). Munich, Germany; 2020.
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.&nbsp;

FiberTag® TightRope® II Implant

The FiberTag TightRope implant facilitates attachment of single-ended grafts, such as quad tendon grafts, to the ACL TightRope RT and ABS implants. FiberTag suture is integrated into the TightRope implant for a strong,1 consistent connection between the suture and TightRope loop. A simplified suturing technique, along with innovative packaging and the new GraftClamp graft preparation instrument, make preparing quadriceps tendon grafts faster and more reproducible than ever.
Reference
1. Arthrex, Inc. LA1-000023-EN_A. Naples, FL; 2020.

FiberTag® TightRope® Implant

The next evolution in adjustable cortical suspensory fixation, the ACL TightRope II implant includes a flat-tape TightRope loop for improved graft interface and handling characteristics during graft tensioning and greater resistance to graft abrasion.1 Engineered to enable precise graft tensioning and incremental retensioning of the construct after cortical button fixation, this implant features a proprietary 5-point locking design that resists cyclic displacement and offers excellent pull-out strength.2
 
 
An ideal choice for all inside ACL reconstruction, the ACL TightRope II RT implant can be used for femoral fixation and combined with an ACL TightRope II ABS implant and concave ABS button for tibial fixation to facilitate incremental graft advancement and tensioning of both the femoral and tibial ends of the graft.
References
1. Arthrex, Inc. Data on file (LA1-00038-EN_B). Naples, FL; 2017.
2. Arthrex, Inc. Data on file (APT-G01155). Munich, Germany; 2020.

TightRope® II RT Implant

For use with bone-tendon ACL grafts, the TightRope II BTB implant combines the simplicity and strength of the ACL TightRope RT implant. The BTB TightRope implant features the same adjustable, four-point locking system as the ACL TightRope RT but allows graft placement through a small drill hole in the cortical bone block.&nbsp;&nbsp;
BTB TightRope II implant advantages:&nbsp;&nbsp;&nbsp;
<ul>
 <li>Simplified BTB graft fixation with anatomically placed sockets created with the FlipCutter® drill</li>
 <li>Dependable cortical fixation regardless of bone tunnel quality</li>
 <li>Graft adjustability within the femoral socket; ideal for graft-tunnel length mismatch</li>
 <li>360° of graft contact to the socket and improved ACL footprint filling vs internal fixation screws</li>
 <li>No tying knots or cinching suture against the bone block</li>
</ul>

TightRope® II BTB Implant

The TightRope attachable button system (ABS) revolutionized minimally invasive, adjustable-loop suspensory fixation grafts used in knee ligament surgery. Suitable for all graft types, TightRope II ABS implant loops can be attached to a variety of button configurations for fixation over sockets created with a FlipCutter® drill or full tunnels with concave buttons.&nbsp;
The flat-tape TightRope II ABS implant loop improves handling characteristics and can reduce graft abrasion.1 Able to easily pass through narrow bone tunnels, the two-piece TightRope II ABS implant allows increased cortical fixation with the assembly of a large button over the cortical bone. During all-inside ACL reconstruction, use the TightRope II ABS implant for tibial fixation in QuadLink™ and GraftLink® techniques or graft fixation over small bone tunnels created during transtibial ACL reconstruction.
Reference
1. Arthrex, Inc. Data on file (LA1-00038-EN_B). Naples, FL; 2017.

TightRope® II Attachable Button System

An innovative approach to ACL preservation, the ACL Repair TightRope implant allows precise, incremental repair tensioning and retensioning. Additionally, the FiberRing suture allows for simplified and reproducible suture passing and implant loading. Careful analysis of historical data has revealed that certain ACL tear subgroups, especially proximal tears with good tissue quality, have positive clinical outcomes with primary ACL repair.1
Reference
1. Arthrex, Inc. DOC1-000178-en-US_B. Naples, FL; 2020.

Repair TightRope® Implant With FiberRing™ Sutures

Suspensory Fixation

Secondary (C)

Available in five anchor configurations, each Knee FiberTak anchor has unique features optimized for treating pathology around the knee, including a redesigned, softer anchor body for reliable deployment in hard bone and vibrant new SutureTape colors for easier visualization and suture management in an open surgical environment. The anchor inserter and hole-prep instrumentation have a shorter working length, allowing for more ergonomic anchor insertion much closer to the anatomy.&nbsp;
Additionally, the instrumentation is available as a disposable kit or as a reusable guide, drill, and punch. The anchors can be inserted either in a drill hole, a pilot hole using the punch, or even self-punched in the appropriate bone density.
A variety of implants address various pathology and surgeon preferences:
<ul>
 <li>Double Knotless Anchor: Features 2 preconverted knotless tensionable loops of 1.3 mm SutureTape loops; great for LET and ALL fixation&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</li>
 <li>Hybrid Anchor: Includes 1 preconverted tensionable knotless SutureTape loop and a sliding 1.3 mm SutureTape with swaged-on needles; perfect for onlay MPFL reconstruction</li>
 <li>Double Knotted Anchor: Features 2 sliding 1.3 mm SutureTapes with swaged-on needles; a great option for any application that requires knots</li>
 <li>InternalBrace™ Technique Anchor: Features 1 sliding 1.3 mm SutureTape with swaged-on needles and a low-profile 1.7 mm FiberTape® loop swaged to a single tail for easy passage and loading; revolutionary for collateral repair using the InternalBrace technique</li>
 <li>Button Anchor: Features 2 passing links for fixation of independent tension-slide constructs; an excellent option for MCL and LCL tension slide</li>
</ul>
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.

Knee FiberTak® Anchor

Interference screws are constructed using the high quality that is synonymous with the Arthrex name. The complete family includes biocomposite interference screws (comprised of 30% biphasic calcium phosphate and 70% PLDLA), PEEK interference screws (made from PEEK-OPTIMA™), metal interference screws (made from titanium for femoral and tibial fixation of soft-tissue or bone).
 
PEEK-OPTIMA is a trademark of Invibio.

Interference Screws

The ACL Backup Fixation System includes the implants and instruments needed to back up the fixation sutures of an ACL graft, or the InternalBrace™ ligament augmentation of an ACL reconstruction or primary repair. The kit contains a 4.75 mm SwiveLock® implant, as well as a spade-tipped drill and disposable tap. One factor of successful ACL reconstruction is strong tibial fixation. This system provides a reliable and reproducible augment to ACL tibial fixation.

ACL Backup Fixation System

 ACL Backup Fixation Systems

The 4.5 mm-diameter bicortical post has an extremely low-profile head to reduce soft-tissue irritation. A 2.5 mm drill for bicortical post is used to broach the cortical bone, while the depth device provides accurate sizing information. The optional low-profile, spiked washer may be used in conjunction with the bicortical post for soft-tissue tendon fixation of soft tissue tendons directly to bone.&nbsp;
The posts and washers are manufactured using titanium ASTM F-136 alloy. The smooth, concave-shaped washer securely traps attached sutures and bulky suture knots atraumatically under the low-profile washer to eliminate potential soft-tissue irritation. The spiked washer facilitates direct soft tissue or ligament fixation to bone.
Ligament staples with a low-profile bridge reduce the frequency of secondary removal due to patient discomfort caused by soft-tissue irritation. The cobalt chrome spiked fixation staple has sharp leg points for easier penetration into cortical bone without predrilling. The staple driver with attachable impactor/extractor allows complete impaction since the staple driver tip is flush with the staple bridge. The staple seating punch may be used for further impaction. All staples are 20 mm.
Finally, the two-piece TensionLoc™ implant system is designed to fix suture during ligament reconstruction procedures. Using this technique, tibial suture fixation is shown for a single- or double-bundle anterior cruciate ligament reconstruction (ACLR). A unique alternative to standard suture buttons, the TensionLoc implant allows suture-button maintenance for suture tension adjustments during knot tying. The low-profile PEEK implant sits flush and securely within the tunnel.

Fixation Devices

Suspensory Fixation

Knee FiberTak® Anchor

Interference Screws

ACL Backup Fixation Systems

Other Fixation