TightRope II BTB, with FiberTape for InternalBrace Technique

TightRope II-BTB, Rekonstruktion mit InternalBrace-Augmentations-Bandnaht

TightRope II BTB, Reconstruction with InternalBrace Ligament Augmentation Repair

TightRope II, BTB, con aumento de ligamento InternalBrace

Finished Product

AR-1588BTB-IB

Human

Knee

Procedure

Arthrex offers a comprehensive selection of fixation devices for a variety of bone-patellar tendon-bone (BTB) graft techniques. These options include adjustable, continuous-loop suspensory fixation, and interference screws in a variety of materials. The TightRope® implant, which has been used in 2 million procedures globally,1 was designed to simplify ACL reconstruction and facilitate advanced techniques, such as the GraftLink® technique. BioComposite FastThread™ interference screws, which are composed of time-tested material with more than a decade of clinical success and implantation, allow for faster screw insertion and better graft protection.2
References
1. Arthrex, Inc. Data on file (sales data as of September 18, 2018). Naples, FL; 2018.
2. Arthrex, Inc. LA1-0199-EN_E. Naples, FL; 2018.
Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA.

BTB Autograft ACL Reconstruction 

Child (D)

Product

As the first adjustable-loop cortical suspensory fixation implant to use a flat SutureTape design, the ACL TightRope II implant offers better handling characteristics and is more resistant to graft abrasion or tissue pull-through than traditional round sutures.1&nbsp;
Engineered for precise graft tensioning, the adjustable-loop mechanism allows for incremental retensioning of the graft construct after the implants have been secured on the cortex. The redesigned cortical button now incorporates a proprietary knotless fifth locking mechanism, increasing strength and resistance to cyclic displacement.2 To accommodate various graft types and techniques, TightRope II implants are available in RT and BTB configurations loaded with an additional flipping suture or preloaded with a FiberTape® suture for the InternalBrace™ technique. Available options for the ABS implant include standard or open.
References
1. Arthrex, Inc. LA1-00038-EN_B. Naples, FL; 2017.
2. 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.

ACL TightRope® II Implant

Once the minimally invasive or open incision is made and proper soft-tissue windows are established, use the fibular, tibial, and/or femoral collateral marking hooks for anatomic precision and osseous measurements when drilling the appropriate reconstruction tunnels. Using the femoral collateral marking hook with the parallel drill guide will increase anatomic femoral drilling efficiency by significantly reducing convergent tunnels and allowing for accurate guide pin placement at multiple incremental distances. During tunnel creation, use the spooned ends of the collateral ligament retractor to retract the neurovascular structures and the collateral ligament rasp to chamfer the aperture of the completed reconstruction tunnels. Then use FiberWire® or FiberStick™ suture to pass the prepared grafts and tension to the desired position prior to graft fixation.

Anatomic Collateral Ligament Reconstruction

Orthobiologics

The BioACL technique harnesses the power of next-generation biologics to provide the ultimate anatomic, minimally invasive, reproducible approach for taking patient outcomes to the next level.
By prefilling ACL bone tunnels with a powerful composite of concentrated platelet-rich plasma (cPRP) from bone marrow aspirate (BMA) or whole blood processed with the Angel® system, the patient’s own bone collected with the GraftNet™ device, and AlloSync® Pure demineralized bone matrix, the BioACL technique provides all the necessary healing components for an ACL reconstruction procedure.
In conjunction with the QuadLink™ with InternalBrace™ technique, the BioACL technique has been shown to result in earlier range of motion, improved limb symmetry, less bone-tunnel widening, and improved patient-reported outcomes as compared to nonaugmented ACL procedures.1&nbsp;
 
 
Reference
1. Lavender CD, Schaver AL, Taylor S, et al. Anterior cruciate ligament reconstruction augmentation with bone marrow aspirate concentrate, demineralized bone matrix, and suture tape shows no difference in outcomes—but faster functional recovery—versus non-augmented anterior cruciate ligament reconstruction. Arthroscopy. Published online July 22, 2024.&nbsp;<a href="https://doi.org/10.1016/j.arthro.2024.06.042">https://doi.org/10.1016/j.arthro.2024.06.042</a>
 
The&nbsp;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&nbsp;InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.

BioACL™ Technique

Many products are available to assist the surgeon with bone-tendon-bone (BTB) graft harvesting and preparation. 

 
 
The parallel graft knife—with parallel blades to create a precise cut in a single pass—is designed for harvesting the patellar or quadriceps tendon during an ACL or a PCL reconstruction. 
 

 
Graft harvesting cutting guides and saw blades can harvest an ideal trapezoidal-shaped bone plug with predrilled suture holes from both the patella and the tibia; the cutting guides provide consistent, reproducible 
results during tendon harvest. 
 

 
Additional instrumentation for BTB graft preparation, including a graft harvesting osteotome and ACL graft shaper, are also available.&nbsp;

BTB Graft Harvest and Preparation Instruments

Multiple collateral ligament reconstruction techniques, from aperture fixation using the BioComposite SwiveLock® tenodesis system with biocomposite interference screws to suspensory fixation using TightRope® technology, are available.
FiberTak® soft anchors and biocomposite suture anchors, which come preloaded with needles, are part of a comprehensive line of anchor fixation devices supporting primary or hybrid collateral ligament repair and reconstruction techniques.

Collateral Ligament Graft Fixation

Arthrex offers the most advanced techniques and instruments for hamstring harvesting and preparation. Harvesting can be accomplished safely and reproducibly both from the traditional anterior approach or through a posterior approach using the minimally invasive hamstring harvest technique and specialized tendon strippers. 
 

The Arthrex Graft Prep Station offers a variety of interchangeable clamps and posts to facilitate graft tensioning and suturing. 
 

Graft preparation has been revolutionized with the FiberLoop® line of suture and SpeedWhip™ technique. The continuous loops of #2 or #0 suture and free-floating straight or curved needles allow reproducible graft suturing in half the time of traditional straight sutures.

Hamstring Graft Harvest and Preparation Instruments

MCL reconstruction is typically performed when the MCL is severely injured or in cases of chronic MCL laxity. During an MCL reconstruction, autograft or allograft tissue is used to reconstruct the injured ligament. Graft-fixation technology for MCL reconstruction has evolved from staples, posts and washers, and interference screws to less invasive and easier-to-use suspensory fixation, including the TightRope® implant, and 
all-suture anchor technology, such as the Knee FiberTak® anchor.&nbsp;
Adding the InternalBrace™ technique to an MCL repair may result in lower failure rates and less residual laxity post-op as well as shorter immobilization times and faster return to play.1 Additionally, FiberTape® suture has been used for more than 15 years in more than 4 million cases, including tendon and ligament-bridging repairs.
The InternalBrace surgical technique is intended only to support the primary repair and is not intended as a replacement for the standard of care using biologic augmentation in a primary repair.&nbsp;The InternalBrace surgical technique is intended only for soft-tissue-to-bone fixation and is not cleared for bone-to-bone fixation.
Reference
 
1. van Eck CF, Nakamura T, Price T, Linde M, Smolinski P. Suture tape augmentation improves laxity of MCL repair in the ACL reconstructed knee.&nbsp;Knee Surg Sports Traumatol Arthrosc. 2021;29(8):2545-2552. doi:10.1007/s00167-020-06386-7

Medial Collateral Ligament (MCL) Reconstruction

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, with FiberTape for InternalBrace Technique

AR-1588BTB-IB

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