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There has been a renewed interest in ACL primary repairs as the treatment for Sherman type I and type II ACL ruptures. 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
 
Studies reporting outcomes of remnant-preserving ACL surgeries have shown encouraging results and a greater potential for early healing and better functional outcomes compared with remnant-resecting surgeries.2 Preservation of the native ACL using the primary repair technique can achieve short-term clinical success and result in good clinical outcomes at 3-year follow-up in this carefully selected patient population.3
 
Arthroscopic primary repair is minimally invasive because no grafts need to be harvested, no graft tunnels or sockets need to be drilled, and revision surgery, if necessary, is more analogous to primary reconstructions.4 The goal of the procedure is to preserve the remnant native ligament. By doing this, the native nerve endings and blood supply are preserved.5
References
1. van der List JP, DiFelice GS. Role of tear location on outcomes of open primary repair of the anterior cruciate ligament: a systematic review of historical studies. Knee. 2017;24(5):898-908. doi:10.1016/j.knee.2017.05.009
2. van der List JP, DiFelice GS. Successful arthroscopic primary repair of a chronic anterior cruciate ligament tear 11 years following injury. HSS J. 2017;13(1):90-95. doi:10.1007/s11420-016-9530-8
3. Jonkergouw A, van der List JP, DiFelice GS. Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):21-28. doi:10.1007/s00167-018-5338-z
4. DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy. 2015;31(11):2162-2171. doi:10.1016/j.arthro.2015.08.010
5. DiFelice GS, van der List JP. Arthroscopic primary repair of proximal anterior cruciate ligament tears. Arthrosc Tech. 2016;5(5):e1057-e1061. doi:10.1016/j.eats.2016.05.009

ACL Repair

Child (D)

An innovative approach to ACL preservation, the ACL Repair TightRope implant enables 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. Data on file (DOC1-000178-en-US_B). &nbsp;Naples, FL; 2020.

ACL Repair TightRope® Implant With FiberRing™ Sutures

The CuffMend system provides an efficient, simplified approach for augmenting partial- and full-thickness rotator cuff tears. The system employs the benefits of a thick ArthroFlex dermal allograft, which provides mechanical strength and supports healing.1,2&nbsp;Introduce the graft using the graft spreader and use the FiberStitch™ RC implant for medial soft-tissue fixation to the rotator cuff tendon. Use self-punching PushLock®&nbsp;anchors, spanning the graft over the tuberosity footprint, for lateral bony fixation. Implantation of the CuffMend system is designed to be completed in less than 10 minutes. Scientific literature supports the use of acellular dermal grafts as a safe and effective solution for rotator cuff augmentation.3
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):1573-1583. 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

Rotator Cuff Healing Index (RoHI) Risk Factors

CuffMend™ Rotator Cuff Augmentation Technique

As the next evolution of knotless rotator cuff repair, the FiberTak SpeedBridge technique is completed with 2.6 FiberTak RC soft anchors on the medial row and FiberTape® sutures fixated laterally with trusted SwiveLock® anchors.
This knotless repair creates a quick, secure construct in as few as three suture-passing steps. The small size of the 2.6 FiberTak RC anchors allows for three points of medial-row fixation where previously only two fixation points could be achieved.
Knotless 2.6 FiberTak RC anchors are adaptable and can conform to traditional repair techniques while providing the additional benefits of tensionable knotless technology for incorporating biologics or increasing medial-row compression.

FiberTak® SpeedBridge™ Rotator Cuff Repair

The Knotless SwiveLock suture anchor for tensionable knotless soft-tissue repair is the most universal and adaptable knotless suture anchor on the market. The knotless mechanism is appealing to surgeons for unique tissue tear patterns while still achieving the core fixation from a SpeedBridge™ rotator cuff repair (RCR).
The standard SpeedBridge RCR technique has been trusted by surgeons for their patients since 2008. It has a proven success rate through multiple publications that have shown significant improvements in patient-reported outcomes that were durable at a minimum of 5 and 10 years postoperatively.1,2
References
1. Pogorzelski J, Fritz EM, Horan MP, et al. Minimum five-year outcomes and clinical survivorship for arthroscopic transosseous-equivalent double-row rotator cuff repair. J Am Acad Orthop Surg. 2019;27(24):e1093-e1101. doi:10.5435/JAAOS-D-18-00519
2. Johannsen AM, Arner JW, Elrick BP, et al. Minimum 10-year outcomes of primary arthroscopic transosseous-equivalent double-row rotator cuff repair. Am J Sports Med. 2021;49(8):2035-2041. doi:10.1177/03635465211015419

Knotless SwiveLock® Suture Anchor

LoopLink suture facilitates a strong and efficient suture construct for defect closures associated with various procedures, including the harvest of quadriceps and patellar tendon grafts for ACL reconstruction, as well as IT band closure following lateral extra-articular tenodesis. The LoopLink suture loop is composed of 0.9 mm SutureTape, a flat-braided design for improved handling characteristics and knot security with a smaller knot stack and increased resistance to tissue pull-through compared to FiberWire® suture.1
 
LoopLink suture's unique design was developed to provide robust closure with minimal soft-tissue disruption. Running double limbs created during the initial luggage tag stitch provide superior strength as compared to #2 suture1 and 1.3 mm SutureTape.2
 
LoopLink suture can be passed manually using the swaged-on curved needle or through a minimally invasive incision using a FastPass Scorpion™ suture passer under direct visualization or arthroscopic assistance. Either running or locking passes can be used for LoopLink suture closure, depending on surgeon preference. 
 

References
1. &nbsp;Arthrex, Inc. LA1-00038-EN_B. Naples, FL; 2017.&nbsp;
2. Arthrex, Inc. Data on file (Suture strength). Naples, FL; 2020.

LoopLink Suture

2.6 FiberTak RC anchors are specifically designed for surgeons who prefer an all-suture anchor for the medial row of a double-row, bridging rotator cuff repair. They are combined with Knotless SwiveLock® C anchors for the lateral row. The unique 2.6 FiberTak RC anchor has a 1.7 FiberTape® suture fixed to the sheath so that it cannot slide, making it easy to tension the lateral row for a totally knotless construct. The 2.6 FiberTak RC anchor is available with a tensionable knotless mechanism or a sliding 1.3 mm SutureTape that can be incorporated into the repair, or discarded, for ultimate flexibility.
The self-punching inserter for select FiberTak anchors allows for direct insertion into bone without creating a prepunched or predrilled socket for anchor insertion. The self-punching FiberTak inserter may be used with or without a guide and can be placed directly into bone or used with a transtendon insertion technique.

2.6 FiberTak® RC Soft Anchors

A technique gaining popularity, PCL repair is generally indicated for bony avulsions that can occur on either the femur or tibia.&nbsp;
PCL injuries can happen during sports-related activities or high-velocity, traumatic accidents. Applications for operative treatment of PCL tears include acute injuries, tears in active young patients, and either isolated grade 3 tears or a combined injury, such as grade 2 tears with posterolateral corner instability.
PCL tears can be treated with innovative, minimally invasive procedures using the PCL Repair TightRope® implant and FiberRing™ sutures.

Posterior Cruciate Ligament (PCL) Repair 

The PushLock anchor is designed for simple and secure arthroscopic glenohumeral joint instability repair. The knotless technique saves valuable time and eliminates the possibility of knot impingement. This suture-first technique allows surgeons to independently pass suture through a desired amount of tissue prior to anchor implantation. Multiple suture configurations, including simple cinch and mattress stitches, can be accomplished with FiberWire®, FiberLink® SutureTape, FiberStick™, SutureTape, or LabralTape™ sutures using the Labral Scorpion™ or QuickPass™ SutureLasso™ suture passers. Tissue tension can be visualized and adjusted, if necessary, prior to final anchor implantation.
Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA.

PushLock® Anchor Technique - Anterior

The PushLock anchor is designed for simple and secure arthroscopic glenohumeral joint instability repair. The knotless technique saves valuable time and eliminates the possibility of knot impingement. This suture-first technique allows surgeons to independently pass suture through a desired amount of tissue prior to anchor implantation. Multiple suture configurations, including simple, cinch, and mattress stitches, can be accomplished with FiberWire®, FiberLink®&nbsp;SutureTape, FiberStick™, SutureTape, or LabralTape™ sutures using the Labral Scorpion™ or QuickPass™ SutureLasso™ suture passers. Tissue tension can be visualized and adjusted, if necessary, prior to final anchor implantation.
Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA.

PushLock® Anchor Technique - MDI

The PushLock anchor is designed for simple and secure arthroscopic glenohumeral joint instability repair. The knotless technique saves valuable time and eliminates the possibility of knot impingement. This suture-first technique allows surgeons to independently pass suture through a desired amount of tissue prior to anchor implantation. Multiple suture configurations, including simple, cinch, and mattress stitches, can be accomplished with FiberWire®, FiberLink®&nbsp;SutureTape, FiberStick™, SutureTape, or LabralTape™ sutures using the Labral Scorpion™ or QuickPass™ SutureLasso™ suture passers. Tissue tension can be visualized and adjusted, if necessary, prior to final anchor implantation.
Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA.

PushLock® Anchor Technique - Posterior

The PushLock anchor is designed for simple and secure arthroscopic glenohumeral joint instability repair. The knotless technique saves valuable time and eliminates the possibility of knot impingement. This suture-first technique allows surgeons to independently pass suture through the desired amount of tissue before anchor implantation. Multiple suture configurations, including simple cinch and mattress stitches, can be accomplished with FiberWire®, FiberLink®&nbsp;SutureTape, FiberStick™, SutureTape, or LabralTape™ sutures using the Labral Scorpion™ or QuickPass™ SutureLasso™ suture passers. Tissue tension can be visualized and adjusted, if necessary, prior to final anchor implantation.
Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA.

PushLock® Anchor Technique - SLAP

Scorpion suture passers are used in shoulder arthroscopy for rotator cuff and labral repair.
Designed for simplicity, the easy-to-use FastPass Scorpion™ SL (side-loading) suture passer supports more successful suture passes. The front side of the bottom jaw is solid to prevent suture and soft tissue from entering the bottom jaw when positioning onto the tendon. The suture-retrieving top jaw helps seamlessly pass and retrieve #2 FiberWire® suture.
The Labral Scorpion™ QL suture passer has a quick-loading bottom jaw and suture-retrieving top jaw. This intuitive suture passer's streamlined, low-profile jaws are designed for easily maneuvering the glenohumeral space, fit through a 6 mm cannula, and are ideal for passing and retrieving #2 FiberWire suture through a single portal.

Scorpion™ Suture Passers

Relatively uncommon knee injuries, tibial spine avulsion fractures typically occur in children and adolescents.1 Despite the low incidence of tibial spine avulsion fractures, they deserve ample attention to ensure knee function and stability are correctly restored.
Innovative FiberRing™ sutures provide a simple and reproducible technique for securing the distal remnant to achieve anatomic reduction. The ACL Repair TightRope® implant offers titratable knotless fixation to ensure ACL length is appropriately restored and maintained.
Finally, the ACL InternalBrace™ ligament augmentation button accommodates the InternalBrace technique to help prevent excess range of motion during the healing phase and potentially reduce the chances of secondary injury.2,3
References
1. Williams NR, Yin S, Guzman AJ, et al. Tibial spine avulsion repair with FiberRing suture and anterior cruciate ligament repair TightRope.&nbsp;Arthrosc Tech. 2023;12(12):e2381-e2385. doi:10.1016/j.eats.2023.08.008
2. Mackay GM, Blyth MJ, Anthony I, Hopper GP, Ribbans WJ. A review of ligament augmentation with the InternalBrace™ the surgical principle is described for the lateral ankle ligament and ACL repair in particular, and a comprehensive review of other surgical applications and techniques is presented. Surg Technol Int. 2015;26:239-255.
3. Smith PA, Bley JA. Allograft anterior cruciate ligament reconstruction utilizing internal Brace augmentation. Arthrosc Tech. 2016;5(5):e1143-e1147. doi:10.1016/j.eats.2016.06.007

Tibial Spine Avulsion Repair

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