AlloSync Expand fibers are 100% demineralized bone that provide controlled expansion into bone voids to improve bone gap fill. A unique geometry and structure give way to the fibers' excellent handling characteristics and the preservation of the demineralized bone's osteoinductive potential. AlloSync Expand fibers may be hydrated with bone marrow, blood, and other physiological fluids to create a cellular bone graft solution for bone voids.

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

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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.

Steve M. Douthett, DPM (Eugene, OR), presents a series of ankle arthrodesis cases he augmented using ArthroCell™ viable bone graft, AlloSync™ Expand demineralized cortical fibers, and autograft bone harvested using the OsteoAuger™ system.&nbsp;

Ankle Arthrodesis Augmented Using ArthroCell™ Bone Graft and OsteoAuger™ Bone Harvester

My name is Steve Douthat. I'm a foot and ankle surgeon based out of Eugene, Oregon. Today I'm going to be discussing two different cases. These cases are ankle arthrodesis, which I augmented with both ArthroCell bone graft and the OsteoAuger bone harvesting system. Arthrocell is a combination of viable cells, bone particulate and collagen gel. The viable cells include mesenchymal stem cells, osteoprogenitor cells, and Miami cells. The bone particulate has both cortical and cancellous bone and acts as a scaffolding. And the collagen gel is bone derived and allows the product to be moldable. The OsteoAuger bone graft harvesting system has an quickconnect. It does not require a pilot hole. It mausoleums as it cuts and it has a plunger to evacuate the collection. It comes in six, eight and ten millimeter options. I like to use this when I harvest bone graft from the calcaneus, or distal tibia. For the first case, I had an 80 year old female complaining of pain in her right ankle. She suffered an ankle fracture back in the 70s and states that her bones were set. She never had any type of fixation at that point in time. She failed injections and bracing in recent years and wanted to move forward with surgery. Radiographs show a varus angulation of the ankle joint with end stage arthritic changes, and she has pain and crepitus with range of motion of the ankle joint. Here you can see the varus angulation of the talus in respect to the tibia. And on the lateral view you can see complete obliteration of the ankle joint. Considerations for this patient would be her advanced age and poor bone quality. In this case I used ArthroCell to augment my repair for the cystic changes. My plan was to use an autograft harvested from the calcaneus with the OsteoAuger for the varus angulation. My plan was to do a lateral approach with a plate, and I was going to fixate it with a lateral ankle, arthrodesis plate and a 7.0mm threaded screw for compression. Here you can see me harvesting bone graft from the calcaneus. I can do this in less than a one centimeter incision. Next, I'm mixing my autograft with the ArthroCell. I like to do this for a fairly consistent mixture. Next, you can see me preparing the ankle joint with the Arthrex joint distractor. I like to use the Miss Burr to remove cartilage subchondral bone plate, and I can also use this to create bone tunnels within the distal tibia and talus. Taylor's. Next, I pack the ArthroCell and autograph slurry into the joint, and here you can see the patient after four months with the lateral plate fixation and the 7.0ft screw. She has bony integration, she has excellent alignment, and the patient's doing well. Here's her clinical image at four months post-operative. And you can appreciate the accommodative motion that she has. The patient's doing excellent at this point in time. And she's walking pain free. For the second case, I have a 54 year old male with a history of an open ankle fracture in the late 80s. The fracture was reduced, but he did not have surgery. The patient had an extensive wound that required skin grafting and months of wound care. The radiographs show that the patient has end stage arthritis of the ankle, and the ankle is pretty rectus. In this case, the biggest consideration is the anterior friable skin that the patient had and he had deep adhesions. Here you can see the radiographs both lateral and AP. On the lateral view. You can see that the patient has end stage arthritis as well as on the AP view. Here's the clinical image showing the deep adhesions that the patient has along with poor skin quality on the anterior ankle. Considerations for this patient would be his poor anterior skin quality. My plan was for an ankle fusion with a posterior approach for bony incorporation. In this case, I used ArthroCell bone graft AlloSync expand with ACP OsteoAuger for the autograft and for fixation I used a 7.0mm cannulated Arthrex screw and a posterior pilon primary arthrodesis plate for the OsteoAuger. I harvested the bone from the distal posterior tibia below where the plate was AlloSync expand is demineralized cortical fibers. It expands upon hydration. I like to hydrate this with either BMC or ACP to increase cell signaling. In this case we used ACP. In this case, our armamentarium consists of ArthroCell expand and the OsteoAuger along with ACP. In this image, you can see the bone graft that I collected from the posterior distal tibia with an eight millimeters OsteoAuger. You can also see the expand which is hydrated with ACP as well as the ArthroCell. To the right. You can see where I've mixed them all together. And this is the immediate post-operative image showing the fixation. You can see that I used a posterior pilon primary fusion plate, along with a cannulated headed 7.0mm Arthrex screw. Here you can see the radiographs at three months post-operative. The oblique shows that there is bony incorporation of our fusion site. The AP shows the contour of the plate and the lateral view shows complete bony incorporation. Here are the patient's three month clinical images. He's transitioning into shoes at this point in time and ambulating without assistive devices. So in summary these cases highlight the use of ArthroCell bone graft, which contains viable cells. The OsteoAuger Autograft solution AlloSync expand, which is demineralized cortical fibers and can be hydrated with ACP or BMC and Arthrex hardware. In this case, I used a lateral ankle fusion plate, a posterior primary pilon fusion plate, and a 7.0mm fully threaded compression screw, as well as a 7.0mm headed Arthrex cannulated screw. Thank you.

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AlloSync™ Expand Demineralized Cortical Fibers for Spinal Fusion Cases

The unique long-strand geometry of AlloSync™ Expand 100% demineralized cortical fibers maximizes graft cohesion1 and provides a 3D interconnected matrix to promote cell migration across the bone void. AlloSync Expand fibers have demonstrated superior bone-forming capacity compared to standard particulate demineralized bone marrow.2 After hydration, the graft will expand to fill the void and create endplate-to-endplate contact in spinal fusion cases. AlloSync Expand fibers can be hydrated with biologic fluids, such as platelet-rich plasma or concentrated bone marrow aspirate.
References
1. Walsh WR, Lovric V, Russell N, Kim P, Larson MJ, Vizesi F, et al. Improved performance of SeaSpine demineralized bone fibers vs. three commercially available demineralized bone matrix products in an athymic rat posterolateral fusion model. IsoTis – Clinical Affairs. 2020.
2. Martin GJ, Boden SD, Titus L, Scarborough NL. New formulations of demineralized bone matrix as a more effective graft alternative in experimental posterolateral lumbar spine arthrodesis. Spine. 1999;24(7):637-645. doi:10.1097/00007632-199904010-00005.

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

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The AlloSync™ bone grafting solutions product line includes AlloSync Pure demineralized bone matrix and the AlloSync demineralized cancellous sponges and cortical fibers. These bone grafts are derived from 100% human allograft bone and can be hydrated with biologically active fluids.

Arthrex. Allosync is a comprehensive bone grafting solutions line derived from human allograft bone. The AlloSync grafts maintain optimal osteoinductive and osteoconductive potential while providing excellent handling characteristics for various orthopedic applications. Allosyncpure is an osteoinductive bone matrix derived from 100% human allograft bone with no extrinsic carriers. The AlloSync line also includes demineralized, cancellous, sponges, and cortical fibers, which are processed in a manner that optimizes the residual calcium level and osteoinductive. Allosyncpure is provided in a ready to use mixing jar and may be hydrated with PRP, BMC, or other biologic fluids to create the desired consistency during preparation. The compression of the graft mixture helps to incorporate the demineralized bone matrix with the bioactive fluid. Alternatively, AlloSyncPure can be prepared using the ABS 2000 mixing syringe. The graft and biologic fluid are added to the syringe and prepared with the internal mixing element until thoroughly mixed. The proprietary rice shaped fiber technology used to process AlloSyncPure allows the graph to resist irrigation and be used in a fluid environment when prepared as directed. Adding additional fluid to the graft allows the clinician to decrease the viscosity of the AlloSyncPure. For injectable applications such as iabp. The accelerated cellular ingrowth with AlloSyncPure has been histologically proven with in-vivo testing at 28 days post implantation. All five elements of bone formation, including new bone, bone marrow, osteocytes, chondrocytes, and cartilage are present. Allosync, demineralized, mineralized sponges and fibers are available in a variety of shapes and sizes, including cancellous strips, cubes, chips, and cortical fibers. These graphs maintain the natural bone architecture with interconnected porosity, providing an optimal scaffold for cellular attachment and proliferation while preserving native bone morphogenic proteins. The AlloSync de mineralized cancellous, sponges, and cortical fibers can be hydrated with bioactive fluids such as platelet rich plasma or bone marrow aspirate during hydration. The graft will naturally wick up and retain the surrounding fluid, making it an ideal scaffold for cells and growth factors. Once hydrated, the AlloSync sponges and fibers become compressible like a sponge, allowing for flexibility to fit in and around different types of bone defects. Allosync pliable handling characteristics facilitate minimally invasive surgical procedures with the incorporation of allograft bone. For fusion cases such as an ankle arthrodesis AlloSync demineralized. Sponges soaked in BMA can be placed at the fusion site for maximum biologic healing. Allosync mineralized sponges can also be interposed at the site of tendon bone repair in rotator cuff tears. The compressible nature of the grafts allows the sponge to be delivered and secured at the repair site arthroscopically. This construct has been shown to result in superior structural and biomechanical properties as compared to a standard of care repair. Histologically. Rotator cuff repairs with an interposed DBM strip have been shown to mimic normal rotator cuff tendon insertion to bone, compared to repairs without an interposition graft. Allosync bone grafts are processed sterile to device grade standards and stored at ambient temperature.

AlloSync™ Expand Demineralized Cortical Fibers

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AlloSync™ Expand Demineralized Cortical Fibers

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AlloSync™ Expand Demineralized Cortical Fibers for Spinal Fusion Cases

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AlloSync™ Expand Demineralized Cortical Fibers for Spinal Fusion Cases

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Orthobiologics - New Product Spotlight

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Cervical Fusion Augmented With AlloSync™ Expand Demineralized Cortical Fibers

Ankle Arthrodesis Augmented Using ArthroCell™ Bone Graft and OsteoAuger™ Bone Harvester

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AlloSync™ Expand Demineralized Cortical Fibers for Spinal Fusion Cases

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