ACL TightRope, Drill Pin, Open Eyelet, 4 mm

Zieldraht für ACL TightRope, 4 mm mit Fadenöse

Drill Pin, ACL TightRope, Open Eyelet, 4 mm

Aguja perforadora, ACL TightRope, ojal abierto, Ø 4 mm

Finished Product

AR-1595T

Knee

Procedure

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 a minimally invasive in that no grafts need to be harvested, no tunnels 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)

Arthrex offers a comprehensive selection of soft-tissue fixation devices for a variety of techniques. Innovative designs and cutting-edge materials allow surgeons to achieve strong, less invasive anatomic ACL reconstructions with soft-tissue grafts.

ACL Soft-Tissue Graft Fixation

Product

As the first adjustable-loop cortical suspensory fixation implant to use a flat SutureTape design, the new ACL TightRope® II implant offers better handling characteristics and is more resistant to graft abrasion or tissue pull-through than traditional round sutures.1 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.

ACL TightRope® II Implant

Once the minimally invasive or open incision is made and proper soft tissue windows are established, the Fibular, Tibial, and/or Femoral Collateral Marking Hooks are used for anatomic precision and osseous measurements when drilling the appropriate reconstruction tunnels. Using the Femoral Collateral Marking Hook in conjunction with the Parallel Drill Guide will increase the efficiency of anatomic femoral drilling by significantly reducing convergent tunnels and allowing for accurate guide pin placement at multiple incremental distances. During tunnel creation the spooned ends of the Collateral Ligament Retractor are used to protect the neurovascular structures and the Collateral ligament rasp is used to chamfer the aperture of the completed reconstruction tunnels. The prepared grafts are then passed with the use of FiberWire or FiberSticks and tensioned into the desire position prior to graft fixation.
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.

Anatomic Collateral Ligament Reconstruction

Collateral Ligament Reconstruction Set

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

Collateral Ligament Graft Fixation

The Collateral Ligament Reconstruction Set is based upon over a decade of international scientific research to improve the safety, accuracy and efficiency of posterolateral and medial/posteromedial knee reconstructions. This unique instrument set has been designed to accommodate all anatomic and isometric-based ligament reconstructions on the outside of the knee.

Collateral Ligament Reconstruction Set

The GraftLink technique provides the ultimate in anatomic, minimally invasive, and reproducible ACL reconstruction. Used in combination with anatomic guides, the FlipCutter® III drill allows independent femoral and tibial "retrodrilling" to create sockets while maintaining the cortices to maximize fixation. Femoral and tibial TightRope® II implants, with a proprietary 5-point locking system, make the GraftLink technique the most reproducible ACL reconstruction available.
<ul>
 <li>Anatomic:&nbsp;Independent tibial and femoral socket preparation with FlipCutter III reamer and/or low-profile reamers facilitate unconstrained placement of the ACL graft.</li>
 <li>Minimally Invasive:&nbsp;Socket preparation with the FlipCutter III reamer limits soft-tissue dissection and helps preserve bone and periosteum.&nbsp;</li>
 <li>Reproducible:&nbsp;The GraftPro® graft preparation system simplifies graft preparation; the tapered graft and adjustable ACL TightRope II buttons facilitate graft passing, fine tuning of graft depth, and graft tensioning from the femoral and tibial sides.</li>
</ul>

GraftLink® Technique

The goal of lateral extra-articular augmentation or reconstruction is to eliminate residual laxity and reduce the risk of ACL graft rupture. Two common techniques include iliotibial band (ITB) tenodesis and anterolateral ligament (ALL) reconstruction. These procedures play a role in augmenting rotational stability in the ACL-reconstructed knee. Patients who see the greatest benefit include hyperlax patients, revision cases, pivoting athletes, and those with IKDC grade III pivot shifts.
There are several distinct advantages of using adjustable, tensionable implant technology, such as the Knotless FiberTak® or FiberTag® TightRope®, when compared to traditional techniques using staples or interference screws. These advantages include:
<ul>
 <li>Simple: Quick, easy, and reproducible techniques.</li>
 <li>Safe: Reduced risk of ACL femoral tunnel convergence as Knotless FiberTak anchor sets just below the cortex. The self-punching anchor technique is designed to reduce the risk of damaging ACL graft as seen with traditional techniques that require drilling. No risk of graft laceration as described with interference screw techniques.1</li>
 <li>Low Profile: Techniques using additional hardware, such as staples, may lead to pain or discomfort, warranting hardware removal. There is no prominent hardware when using an anchor or TightRope implant.1</li>
 <li>Preserves Anatomy: The Knotless FiberTak onlay technique avoids drilling a socket. The FiberTag TightRope Implant minimizes the length of graft required for harvest.</li>
 <li>Titratable Graft Tensioning: With these techniques, a surgeon can provisionally tension and incrementally retension the graft after checking for isometry and overconstraint</li>
</ul>
Reference
1. Muller B, Willinge GJA, Zijl JAC. Minimally invasive modified Lemaire tenodesis. Arthrosc Tech. 2020;10(1):e29- e36. doi:10.1016/j.eats.2020.09.006

ACL TightRope, Drill Pin, Open Eyelet, 4 mm

AR-1595T

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