MegaBiter, Straight Tip, Right Cut, 5.5 mm

MegaBiter, gerader Schaft, Rechtsschnitt 5.5 mm

Finished Product

AR-41006R

Punch, Slender Straight Tip, ø2.75 mm Straight Shaft

Slender Punch, Ø 2.75 mm, Schaft gerade, Maul gerade

Slender Punch, Straight Tip, Straight Shaft, Ø 2.75 mm

Pinza sacabocados estrecha, punta recta, vástago recto, Ø 2.75 mm

Punção delgado, ponta reta, haste reta, Ø 2.75 mm

Punch, Large 2.75 mm, Straight Shaft

Large Punch, Ø 2.75 mm, Schaft gerade, Maul gerade

Large Punch, Straight Tip, Straight Shaft, Ø 2.75 mm

Pinza sacabocados grande, punta recta, vástago recto, Ø 2.75 mm

Punção largo, ponta reta, haste reta, Ø 2.75 mm

Grasper, Mini Straight Tip, ø2.75 mm 15° Up Curved Shaft w/SR Handle

Fasszange - Mini, Ø 2.75 mm, Schaft 15° aufgebogen, Maul gerade, Self Release

Mini Grasper, Straight Tip, 15° Up Curved, Self-releasing Handle, Ø 2.75mm

Pinza de agarre pequeña, punta recta, vástago curvado arriba 15°, mango con liberación automática, Ø 2.75 mm

Pinça de preensão pequenas dimensões, ponta reta, haste com curvatura de15° para cima,libertação automática, Ø 2.75 mm

Punch, Standard Straight Tip, ø3.4 mm Straight Shaft

Standard Punch, Ø 3.4 mm, Schaft gerade, Maul gerade

Standard Punch, Straight Tip, Straight Shaft, Ø 3.4 mm

Pinza sacabocados estándar, punta recta, vástago recto, Ø 3.4 mm

Punção padrão, ponta reta, haste reta, Ø 3.4 mm

Scissor, Serrated Tooth Straight Tip, ø3.4 mm Straight Shaft

Schere, Ø 3.4 mm, Schaft gerade, Maul gerade

Scissors Serrated, Straight Tip, Straight Shaft, Ø 3.4 mm

Tijeras dentadas, punta recta, vástago recto, Ø 3.4 mm

Tesoura serrada, ponta reta, haste reta, Ø 3.4 mm

Punch, WideBiter 15° Up Tip, ø3.4 mm Straight Shaft

WideBiter Punch, Ø 3.4 mm, Schaft gerade, Maul 15° aufgebogen

WideBiter Punch, 15° Up Tip, Straight Shaft, Ø 3.4 mm

Pinza sacabocados WideBiter, punta elevada 15°, vástago recto, Ø 3.4 mm

Punção de mordida larga, ponta 15° para cima, haste reta, Ø 3.4 mm

Punch, WideBiter 15° Up Tip, ø3.4 mm 15° Up Curved Shaft

WideBiter Punch, Ø 3.4 mm, Schaft 15° aufgebogen, Maul 15° aufgebogen

WideBiter Punch, 15° Up Tip, 15° Up Curved Shaft, Ø 3.4 mm

Pinza sacabocados WideBiter, punta elevada 15°, vástago curvado arriba 15°, Ø 3.4 mm

Punção de mordida larga, ponta 15° para cima, haste com curvatura de 15°para cima, Ø 3.4 mm

Grasper, Blunt Straight Tip, ø3.4 mm Straight Shaft w/SR Handle

Fasszange - Atraumatisch, Ø 3.4 mm, Schaft gerade, Maul gerade, Self Release

Blunt Grasper, Straight Tip, Straight Shaft, Self-releasing Handle, Ø 3.4 mm

Pinza de agarre con punta roma, punta recta, vástago recto, mango de liberación automática, Ø 3.4 mm

Pinça de preensão rombo, ponta reta, haste reta, punho com libertação automática, Ø 3.4 mm

Punch, Medium Reverse Straight Tip, ø3.4 mm Straight Shaft

Medium Punch, Ø 3.4 mm, Schaft gerade, Maul gerade, rückwärtsschneidend

Medium Reverse Punch, Straight Tip, Straight Shaft, Ø 3.4 mm

Pinza sacabocados inversa mediana, punta recta, vástago recto, Ø 3.4 mm

Punção inverso médio, ponta reta, haste reta, Ø 3.4 mm

Punch, Medium 45° Right Angled Tip, ø3.4 mm Straight Shaft

Medium Punch, Ø 3.4 mm, Schaft gerade, Maul 45° rechts gebogen

Medium Punch, 45° Right Angled Tip, Straight Shaft, Ø 3.4 mm

Pinza sacabocados mediana, punta angulada 45° derecha, vástago recto, Ø 3.4 mm

Punção médio, ponta angulada direita 45°, haste reta, Ø 3.4 mm

Punch, Medium 45° Left Angled Tip, ø3.4 mm Straight Shaft

Medium Punch, Ø 3.4 mm, Schaft gerade, Maul 45° links gebogen

Medium Punch, 45° Left Angled Tip, Straight Shaft, Ø 3.4 mm

Pinza sacabocados mediana, punta angulada 45° izquierda, vástago recto, Ø 3.4 mm

Punção médio, ponta angulada esquerda 45°, haste reta, Ø 3.4 mm

Punch, WideBiter 90° Right Rotary Tip, 3.4 mm Straight Shaft

Rotary Punch WideBiter, Ø 3.4 mm, Maul 90° rechts gebogen

WideBiter Rotary Punch, 90° Right Tip, Straight Shaft, Ø 3.4 mm

Pinza sacabocados rotatoria WideBiter, punta angulada 90° derecha, vástago recto, Ø 3.4 mm

Punção de mordida larga rotativo, ponta direita 90°, haste reta, Ø 3.4 mm

Punch, WideBiter Rotary 90° Left Tip, ø3.4 mm Straight Shaft

Rotary Punch WideBiter, Ø 3.4 mm, Schaft gerade, Maul 90° links gebogen

WideBiter Rotary Punch, 90° Left Tip, Straight Shaft, Ø 3.4 mm

Pinza sacabocados rotatoria WideBiter, punta angulada 90° izquierda, vástago recto, Ø 3.4 mm

Punção de mordida larga rotativo, ponta esquerda 90°, haste reta, Ø 3.4 mm

Punch, Rotary with Scoop 90° Right Tip, ø3.4 mm Straight Shaft

Rotary Punch, Ø 3.4 mm, Schaft gerade, Maul 90° rechts gewinkelt, mit Schaufel

Rotary Scoop Punch, 90° Right Tip, Straight Shaft, Ø 3.4 mm

Pinza sacabocados rotatoria con punta de pala angulada 90° derecha, vástago recto, Ø 3.4 mm

Punção em concha rotativo, ponta direita 90°, haste reta, Ø 3.4 mm

Punch, Rotary with Scoop 90° Left Tip, ø3.4 mm Straight Shaft

Rotary Punch, Ø 3.4 mm, Schaft gerade, Maul 90° links gewinkelt, mit Schaufel

Punch - Rotary, Ø 3.4mm, Straight Shaft, 90° Left w/Scoop Tip

Pinza sacabocados rotatoria, punta de pala angulada 90° izquierda, vástago recto, Ø 3.4 mm

Punção - rotativo, Ø 3.4 mm, haste reta, ponta com concha esquerda 90°

Grasper, Alligator Hook Tip, ø4.2 mm, Straight Shaft w/SR Handle

Fasszange - Alligator, Ø 4.2 mm, Schaft gerade, Maul gerade, Self Release

Grasper - Alligator, Ø 4.2 mm, Straight Shaft, with Hook Tip Self Release

Pinza de agarre de cocodrilo, Ø 4.2 mm, vástago recto, punta en gancho, liberación automática

Pinça de preensão - tipo crocodilo, Ø 4.2 mm, haste reta, com ponta em gancho, com auto libertação

MegaBiter, Straight Tip, 5.5 mm x 2.5 mm

MegaBiter, punta recta, Ø 5.5 mm x 2.5 mm

MegaBiter, ponta direita, 5.5 mm x 2.5 mm

MegaBiter, Curved Tip, 5.5 mm x 2.5 mm

MegaBiter, gebogenes Maul, 5.5 mm x 2.5 mm

Megabiter, punta curva, Ø 5.5 mm x 2.5 mm

Knee

Product

Knee Hand Instruments

Child (D)

Series I WideBiter™ Punches

Punch WideBiter XL, Straight Tip, ø2.75 mm Straight Shaft

WideBiter Punch XL, Schaft gerade, Maul gerade, Ø 2.75 mm

WideBiter Punch XL , Straight Tip, Straight Shaft, Ø 2.75 mm

Pinza sacabocados WideBiter XL, punta recta, vástago recto, Ø 2.75 mm

Punção de mordida larga XL, ponta reta, haste reta, Ø 2.75 mm

Punch WideBiter XL, Straight Tip, ø2.75 mm 15° Up Shaft

WideBiter Punch XL, Schaft 15° aufgebogen, Maul gerade, Ø 2.75 mm

WideBiter Punch XL, 15° Up Curved Shaft, Straight Tip, Ø 2.75 mm

Pinza sacabocados WideBiter XL, punta recta, vástago curvado arriba 15°,Ø 2.75 mm

Punção de mordida larga XL, haste com curvatura de 15° para cima, ponta reta, Ø 2.75 mm

PUNCH WDBITEXL STR TIP 2.75MM 15°UP CRVD

Punch WideBiter XL, Straight Tip, ø2.75 mm 30° Right Shaft

WideBiter Punch XL, Schaft 30° rechts gebogen, Maul gerade Ø 2.75 mm

WideBiter Punch XL, 30° Right Curved Shaft, Straight Tip, Ø 2.75 mm

Pinza sacabocados WideBiter XL, punta recta, vástago curvado derecha 30°, Ø 2.75 mm

Punção de mordida larga XL, haste com curvatura de 30° para a direita, ponta reta, Ø 2.75 mm

Punch WideBiter XL, Straight Tip, ø2.75 mm 30° Left Shaft

WideBiter Punch XL, Schaft 30° links gebogen, Maul gerade Ø 2.75 mm

WideBiter Punch XL, 30° Left Curved Shaft, Straight Tip, Ø 2.75 mm

Pinza sacabocados WideBiter XL, punta recta, vástago curvado izquierda 30°, Ø 2.75 mm

Punção de mordida larga XL, haste com curvatura de 30° para a esquerda, ponta reta, Ø 2.75 mm

Punch WideBiter XL, 15° Up Tip, ø2.75 mm Straight Shaft

WideBiter Punch XL, Schaft gerade, Maul 15° aufgebogen, Ø 2.75 mm

WideBiter Punch XL, Straight Shaft, 15 Up Tip, Ø 2.75 mm

Pinza sacabocados WideBiter XL, punta elevada 15°, vástago recto, Ø 2.75mm

Punção de mordida larga XL, haste reta, ponta 15° para cima, Ø 2.75 mm

Punch WideBiter XL, 15° Up Tip, ø2.75 mm 15° Up Shaft

WideBiter Punch XL, Schaft 15° aufgebogen, Maul 15° aufgebogen, Ø 2.75 mm

WideBiter Punch XL, 15° Up Curved Shaft, 15 Up Tip, Ø 2.75 mm

Pinza sacabocados WideBiter XL, punta elevada 15°, vástago curvado arriba 15°, Ø 2.75 mm

Punção de mordida larga XL, haste com curvatura de 15° para cima, ponta 15° para cima, Ø 2.75 mm

Punch WideBiter XL, 15° Up Tip, ø2.75 mm 30° Right Shaft

WideBiter Punch XL, Schaft 30° rechts gebogen, Maul 15° aufgebogen, Ø 2.75 mm

WideBiter Punch XL, 30° Right Curved Shaft, 15 Up Tip, Ø 2.75 mm

Pinza sacabocados WideBiter XL, punta elevada 15°, vástago curvado derecha 30°, Ø 2.75 mm

Punção de mordida larga XL, haste com curvatura de 30° para a direita, ponta 15° para cima, Ø 2.75 mm

Punch WideBiter XL, 15° Up Tip, ø2.75 mm 30° Left Shaft

WideBiter Punch XL, Schaft 30° links gebogen, Maul 15° aufgebogen, Ø 2.75 mm

WideBiter Punch XL, 30° Left Curved Shaft, 15 Up Tip, Ø 2.75 mm

Pinza sacabocados WideBiter XL, punta elevada 15°, vástago curvado izquierda 30°, Ø 2.75 mm

Punção de mordida larga XL, haste com curvatura de 30° para a esquerda, ponta 15° para cima, Ø 2.75 mm

The Meniscus Repair and Resection Instrument Set contains Arthrex’s most popular instruments to address various meniscus procedures including meniscal root repair, all-suture meniscus repair, or meniscus contouring. For protection, the instruments are held securely within the slotted silicone pads. A removable shelf uncovers an open area for placement of additional instrumentation.

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© 2019 Arthrex, Inc. All rights reserved. DOC1-000045-en-US_A www.arthrex.com Meniscus Repair and Resection Set AR-4555S Page 01 of 01 Pic. Item Number Qty. Description 1 AR-10010 Hook Probe, 3.4 mm 2 AR-4130 Meniscus Repair Rasp 3 AR-12990 Knee Scorpion™ Suture Passer 4 AR-41006 MegaBiter™ Punch, straight tip, 5.5 mm × 2.5 mm 5 AR-41026 MegaBiter Resector, up-curved 6 AR-41006L MegaBiter Resector, straight, left 7 AR-41006R MegaBiter Resector, straight, right 8 AR-11540 Mini Suture Retriever, 2.75 mm, straight 9 AR-1610MR Meniscal Root Marking Hook 10 AR-1510FS-7 Stepped Drill Sleeve for Side-Release Handle, ratcheting 11 AR-1204F-24I Guide Pin Sleeve for Stepped Drill Sleeve, 2.4 mm 12 AR-1510FD-24 Drill Sleeve for Side-Release Handle, 2.4 mm, ratcheting 13 AR-1610LG Locking Guide for Meniscal Root Marking Hook 14 AR-1510HR Side-Release RetroConstruction™ Handle 15 AR-4555C Meniscus Repair and Resection Instrument Case 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 To obtain a copy of a product’s directions for use (DFU), which includes sterilization instructions, please visit our website a t w w w.arthrex.com/edfu o r contact your local representative. www.arthrex.com © 2019 Arthrex, Inc. All rights reserved. Date of Surgery: Surgeon Name: Account: Representative Contact Information: Set Total: Miscellaneous Notes:

Meniscus Repair and Resection Set (AR-4555S)

Drew Osika Product Manager, Knee/Hip Arthroscopy 05/23/2017 Meniscus Repair & Resection KH1-0389-EN Instrument Set Meniscus Repair & Resection Instrument Set The new Meniscal Repair & Resection Instrumentation Case will be your surgeons new go to for any meniscus pathology encountered during an arthroscopic knee procedure. The new, slender profile, case features secure instrumentation support for optimal access while also allowing for proper cleaning and sterilization. A large pin mat area is revealed beneath a small lift out/removable tray on the right side of the case. This area can be used for additional items requested by your surgeon. The removable tray contains the Meniscal Root Marking Hook and Locking Guide, a side release RetroConstruction™ handle, a 2.4 mm and a stepped 3.5 mm ratcheting drill sleeve with its 2.4 mm insert. The left side of the instrument case has space dedicated for a Knee Scorpion™ suture passer, the MegaBiter™ instrumentation (left, right, up-curve and straight), the new 2.75 mm diameter Mini Suture Retriever, that is low profile for reaching suture in tight knee compartments, as well as an arthroscopic probe and meniscal rasp. A customized set can be built for your account using AR-4555C and substituting account specific instruments. The silicon instrument support rack can accommodate any Series I handheld arthroscopic instruments in place of the four MegaBiter™ instruments and the Mini Suture retriever. NEW PRODUCT LAUNCH BULLETIN DATE SUBJECT NUMBER KN EE A ND H IP This information is provided for internal use only. It is not intended for general distribution. Arthrex, Inc. Naples, Florida Drew Osika Product Manager, Knee/Hip Arthroscopy Resources: Additional information about the newest instruments featured in this set can be located here: Fast Pass Knee Scorpion™ Suture Passer Product Bulletin The low profile and anatomically designed device will facilitate suture passage in tight areas of the knee. Mini Suture Retriever Product Bulletin The Mini Suture Retriever features a 2.75 mm tip, the lowest profile suture grasper and retriever available. The low profile atraumatic grasper can retrieve suture as small as 2-0 FiberWire® without abrading the suture making suture management in limited spaces easier. Root Marking Hook Product Buttetin The new Meniscal Root Marking Hook provides the surgeon with an efficient and reproducible way to address meniscus root pathology. The product bulletin highlights the features and benefits of the marking hook as well as ordering information. Curved Tip MegaBiter Bulletin The MegaBiter is the go-to instrument for the majority of posterior meniscectomies Straight MegaBiter Building on the success of the Up-Curved MegaBiter, the Straight MegaBiter is the latest addition to your armament of meniscal resection instrumentation Left and Right MegaBiter Product Bulletin Left & Right MegaBiters are now available to complement the previously released Curved Tip MegaBiter and the Straight Tip MegaBiter. The Left & Right MegaBiters feature wide arcing cuts for precision meniscus contouring. Knee Scorpion™ Suture Passer Playbook This playbook gives a 360 degree view of the Knee Scoprion™ suture passer including features & benefits and sales positioning strategies. This information is provided for internal use only. It is not intended for general distribution. Arthrex, Inc. Naples, Florida KN EE A ND H IP Drew Osika Product Manager, Knee/Hip Arthroscopy Part Number Description List Price Stocking Price AR-4555S Meniscus Repair & Resection Set 17,858$ 12,500$ - C isc s ir s cti Instrument Case 93 625 Ordering Information: Meniscus Repair & Resection Set (AR-4555S) includes: Meniscal Root marking hook AR-1610MR Locking guide for meniscal root marking hook AR-1610LG Knee Scorpion AR-12990 2.75 mm Mini Suture Retriever, Straight AR-11540 MegaBiter™ Suture Passer, Straight AR-41006 MegaBiter™ Suture Passer, Up-Curved AR-41026 MegaBiter™ Suture Passer, Straight Left AR-41006L MegaBiter™ Suture Passer, Straight Right AR-41006R Probe, 3.4 mm hook AR-10010 Meniscus Repair Rasp AR-4130 Side-Release RetroConstruction™ Handle AR-1510HR 2.4 mm drill sleeve for side release handle, Ratcheting AR-1510FD-24 Stepped Drill Sleeve for side release handle, Ratcheting AR-1510FS-7 Insert, 2.4 mm for Stepped Drill Sleeve AR-1204F-24I Meniscus Repair & Resection Instrument Case AR-4555C This information is provided for internal use only. It is not intended for general distribution. Arthrex, Inc. Naples, Florida KN EE A ND H IP

Meniscus Repair & Resection Instrument Set

Arthrex presents a product demonstration for the point-to-point meniscal marking hook developed for meniscal root repair.

video

Point-to-Point Meniscal Root Marking Hook

Meniscal Root Repair With PEEK SwiveLock® Anchor Surgical Technique Meniscal Root Repair Introduction Meniscal root avulsions are a challenging injury causing meniscal extrusion and loss of hoop stress distribution, which can lead to the development of knee arthritis.1 Securing the meniscus in a small bone socket has proven to be an effective means to restore hoop stresses and improve outcomes.2 The FlipCutter® II reamer and meniscal root marking hook allow for a minimally invasive retroconstruction repair technique that helps preserve bone while securely fixing meniscal tissue. Meniscal Root Repair With PEEK SwiveLock® Anchor A complete system for meniscal root repair includes the meniscal root marking hooks, which have multiple settings to accommodate various anatomies, the Knee Scorpion™ suture passer, and meniscal root repair kit with PEEK SwiveLock anchor. Arthrex offers two meniscus root marking hooks based on surgeon preference. The over-the-back marking hook sits securely over the back of the tibia to allow stable drilling using a 6 mm FlipCutter® II reamer for socket preparation. The point-to-point guide allows surgeons to directly target their drill location at the meniscal root footprint. The low-profile Knee Scorpion instrument simplifies suture passing in tight recesses of the knee. Complete knotless fixation of the sutures with the 4.75 mm PEEK SwiveLock anchor. Knee Scorpion Suture Passer (AR-12990) PEEK SwiveLock Anchor (AR-2324PSLC) Meniscal Root Marking Hook (AR-1610MR) Meniscal Root Locking Guide (AR-1610LG) 02 I Meniscal Root Repair With PEEK SwiveLock® Anchor Point-to-Point Meniscal Root Marking Hook (AR-1610H) Arthroscopic Evaluation and Preparation Probing of the meniscal root should confirm detachment from the tibial plateau. On the tibial plateau, identify the location of meniscus reattachment. This should be as anatomical as possible without excessive stress or deformation of the tissue when pulled to that area. A ChondraDrill™ attachment, ApolloRF® MP90 probe (a), or burr can be used to mark this location for later reference. If visualization or using instrumentation is difficult because of tight joint space, it may be helpful to partially flatten the tibial spine with a PoweRasp™ shaver and/ or perform a small posterior notchplasty with an arthroscopic burr. (a) Tibial Socket Creation Option A: Meniscal Root Locking Guide 1 Engage the lock to prevent rotation of the marking hook while introducing the guide into the joint through a PassPort Button™ cannula. 2 Position the marking hook over the back of the tibia at the desired location for tissue reattachment. Meniscal Root Repair With PEEK SwiveLock® Anchor I 03 3 Adjust the offset by depressing the button on the locking guide and aligning the laser marks with the desired offset. 4 Use a 6 mm FlipCutter® II reamer to create a bone socket. Drill on a forward setting and pull back until the socket has reached a depth of approximately 5 mm to 10 mm. Tibial Socket Creation Option B: Point-to-Point Guide 1 Position the distal tip of the point-to-point guide at the desired exit location at the meniscal root footprint. 04 I Meniscal Root Repair With PEEK SwiveLock® Anchor 2 Once the drill guide has been positioned at the desired location on the tibial plateau, the angle of approach can be adjusted by pulling back on the nob and swiveling the guide to the appropriate angle. The guide can be set at 10°, 20°, 30°, or 40° off center. 3 Use a 6 mm FlipCutter® II reamer to create a bone socket. Drill on a forward setting and pull back until the socket has reached a depth of approximately 5 mm to 10 mm. Suture Passing 4 The Knee Scorpion™ suture passer can be used to pass a size 0 FiberLink™ and TigerLink™ suture to create two cinch stitches. 5 Use the SutureLasso™ needle and passing wire to shuttle the suture to the anterior tibia. Meniscal Root Repair With PEEK SwiveLock® Anchor I 05 6 Extend the tibial incision 1 cm distal from the transtibial bone preparation. 7 Use the spade-tip drill bit to prepare a socket for the anchor. The socket should be prepared to the depth of the positive stop collar on the spade-tip drill. This represents a 20 mm depth. Suture Fixation Pass the suture through the eyelet of the 4.75 mm PEEK SwiveLock® anchor. Tension the suture and place the anchor into the drill hole until the eyelet is fully seated. Maintain tension on the suture and advance the SwiveLock anchor into the tibia. 8 06 I Meniscal Root Repair With PEEK SwiveLock® Anchor 9 Remove the driver first and then the eyelet retention suture. Final fixation. Ordering Information Meniscal Root Repair Kit With PEEK SwiveLock® Anchor Set (AR-4550P) Set Description Item Number Knee Scorpion™ Needle FlipCutter® II Reamer, 6 mm PassPort Button™ Cannula, 8 mm × 3 cm 2-0 FiberStick™ Suture, qty. 2 SutureLasso™ Needle w/ Nitinol Passing Wire 0 FiberLink™ Suture 0 TigerLink™ Suture PEEK SwiveLock Anchor, 4.75 mm × 19.1 mm Spade-Tip Drill Bit SwiveLock Anchor Tap, for hard bone Meniscus Repair and Resection Set (AR-4555S) Set Description Item Number Meniscal Root Marking Hook AR-1610MR Locking Guide for Meniscal Root Marking Hook AR-1610LG Knee Scorpion Suture Passer AR-12990 2.75 mm Mini Suture Retriever, straight AR-11540 MegaBiter™ Punch, straight AR-41006 MegaBiter Punch, up-curved AR-41026 MegaBiter Punch, straight left AR-41006L MegaBiter Punch, straight right AR-41006R Meniscal Root Repair With PEEK SwiveLock® Anchor I 07 Probe, 3.4 mm hook AR-10010 Meniscus Repair Rasp AR-4130 Side-Release RetroConstruction™ Handle AR-1510HR Drill Sleeve for Side-Release Handle, ratcheting, 2.4 mm AR-1510FD-24 Stepped Drill Sleeve for Side-Release Handle, ratcheting AR-1510FS-7 Insert for Stepped Drill Sleeve, 2.4 mm AR-1204F-24I Meniscus Repair and Resection Instrument Case AR-4555C Meniscal Root Marking Hooks Set Description Item Number Meniscal Root Marking Hook AR-1610MR Locking Guide for Meniscal Root Marking Hook AR-1610LG Point-to-Point Meniscal Root Marking Hook AR-1610H Products may not be available in all markets because product availability is subject to the regulatory approvals and medical practices in individual markets. Please contact your Arthrex representative if you have questions about the availability of products in your area. References 1. Pagnani MJ, Cooper DE, Warren RF. Extrusion of the medial meniscus. Arthroscopy. 1991;7(3):297-300. doi:10.1016/0749-8063(91)90131-g 2. Lee JH, Lim YJ, Kim KB, Kim KH, Song JH. Arthroscopic pull-out suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Arthroscopy. 2009;25(9):951-958. doi:10.1016/j.arthro.2009.03.018 This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience, and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level and/or outcomes. View U.S. patent information at www.arthrex.com/corporate/virtual-patent-marking arthrex.com © 2021 Arthrex, Inc. All rights reserved. LT1-00129-en-US_B

Meniscal Root Repair With PEEK SwiveLock® Anchor

Double Bone Plug Meniscus Allograft Transplantation Surgical Technique Double Bone Plug Technique The double bone plug technique for meniscal allograft transplant (MAT) provides a method for implanting the meniscal allograft with rigid fixation at the horn attachments. It has been demonstrated that bony fixation at the attachment site allows for the maintenance of functional hoop stress by the meniscal allograft.1 Graft Preparation Allow 25 minutes to thaw the graft. Proper handling instructions are included with the graft. RetroConstruction™ Drill Guide System Instrument Set (AR-1510S) Graft Preparation | Option 1: Coring Reamer Technique 1 Drill a 2.4 mm guide pin through the attachments of the allograft at angles that approximate the tunnel to be drilled in the tibia. The pin hole should be extended through the middle of the bone bridge. Note: Use a collared pin and coring reamer of corresponding size. 02 I Double Bone Plug Meniscus Allograft Transplantation 2 Insert a collared pin into the bottom of the bone bridge so a coring reamer can be used to cut a dowel. Graft Preparation | Option 2: Freehand Technique 1 Using a 1 mm microsagittal saw, make four box cuts around each of the meniscal horns. Start with the posterior cut, then the anterior cut. Create the medial and lateral cuts. Make these cuts in the same trajectory as the retrograde drilled socket that will be prepared later. Move to the medial side and retract the meniscus to protect the attachment in preparation for the next cut. Make the sagittal cuts about 10 mm medial to the lateral wall of the graft. 2 Use a freehand technique to tubularize the bone plugs using a rongeur and/or a bone cutter tool. Prepare the plugs to have a 7 mm to 8 mm posterior diameter (8 mm long) and a 9 mm anterior diameter (10 mm long). To release the bone plug from the donor, cut the meniscus bone block to a depth of 10 mm. Double Bone Plug Meniscus Allograft Transplantation I 03 Suture Passing 1 Pass #2 FiberLoop® suture through the posterior plug. Place a modified Kessler or horizontal mattress suture incorporating meniscal tissue through the posterior attachment. Pull the suture back down through the posterior plug. Prepare the anterior plug similarly with #2 FiberWire® suture. 2 Place two vertical #2 FiberWire sutures in the meniscus. The first is the posterior horn vertical suture 5 mm from posterior bone plug. The second is the midbody vertical suture 15 mm from the posterior horn suture toward the body of the meniscus. These provide two permanent sutures that will be tied over the capsule posteriorly upon implantation of the construct. Note: Complete these two steps for either technique. Mark the anterior of the graft with an “A.” Not only will this denote the anterior portion, it will show where the last (most anterior) stitch should be placed on the graft. Mark the posterior of the graft with a “P.” 04 I Double Bone Plug Meniscus Allograft Transplantation Note: It can be beneficial to colorize the posterior rim so when the graft is passed, the color acts as a visual indicator to show that the graft has not rotated or twisted across the joint. Posterior Tunnel Preparation Anatomic position: Drill the posterior horn socket in a retrograde manner through the anterior-most portion of the residual nub of the meniscus attachment point. It should be appropriately and anatomically juxtaposed to the PCL. This socket should be just off the shoulder of the cartilaginous portion of the plateau and just behind the eminence medially. 1 Position the RetroConstruction™ guide with the meniscal root marking hook on the middle of the posterior remnant attachment at an angle that is as perpendicular to the tibial plateau as possible. Choose a FlipCutter® drill size 1 mm larger than the diameter of the posterior plug on the donor meniscus. Drill the FlipCutter reamer into the middle of the posterior remnant. Remove the guide and tap the cannula into bone. Flip the FlipCutter II drill into its cutting position and drill backward to a depth of 10 mm. Use the rubber grommet on the FlipCutter II drill to measure the 10 mm distance. After drilling the posterior tunnel, use a curved rasp or shaver to remove any extraneous pieces of tissue from around the tunnel’s superior rim. Any piece of soft tissue or cartilage will present difficulties in reducing the posterior plug. FlipCutter II Drill (AR-1204AF-90) Double Bone Plug Meniscus Allograft Transplantation I 05 3 2 Pass a FiberStick™ suture through the FlipCutter® drill sleeve and retrieve the passing sutures through the medial portal. For graft passage and fixation, follow a standard inside-out suturing technique with a 4 cm incision made on the posteromedial aspect of the knee. Dissect down to the medial head of the gastrocnemius. Follow the tissue plane anterior to the gastrocnemius and bluntly dissect further to the posteromedial capsule. Passing the Allograft With direct visualization and the inside-out technique, pass a Micro SutureLasso™ suture passer (a) through the notch in the dilated portion that was created for the passage of the posterior horn. Use the suture passer to move the passing suture out of the posterior capsule. Then use the passing suture to deliver the posterior horn vertical suture (b) that was placed on the meniscal transplant construct. With the knee in valgus position, use the same technique to place a second passing suture at the midbody of the capsule. This passing suture will be used to deliver the midbody vertical suture that was placed on the meniscal transplant construct (c). Note: A PassPort Button™ cannula can aid in suture management and avoid a soft-tissue bridge between passing sutures. The cannula should be used in at least one anterior portal that is ipsilateral to the transplant. This is critical so the graft does not twist on itself during implantation. Be sure to remove the cannula before passing the allograft while maintaining suture segregation. (c) (b) (a) 06 I Double Bone Plug Meniscus Allograft Transplantation 1 Pass the three posterior passing sutures on the allograft in the following order: 1. Pass the suture on the posterior bone plug with the previously place posterior shuttle suture through the posterior socket and down the tunnel. Note: Do not pass the meniscus at this time. 2. Pass the posterior horn passing sutures. 3. Pass the midbody passing sutures. Prepare for graft insertion by applying valgus stress on the knee. Begin inserting the allograft by leading with the posterior horn. Continue to take up any slack in the other sutures as the allograft is inserted. Use a probe to help guide the posterior bone plug into place. Use a meniscal probe or blunt instrument to maneuver the posterior plug into position while applying gentle traction on the posterior suture. Visualize to ensure that the plug and the meniscus have reduced properly. Pass the posterior horn suture through the capsule and midbody sutures and tie. Double Bone Plug Meniscus Allograft Transplantation I 07 Securing the Anterior Plug 2 Use the 2.4 mm drill sleeve to help protect the patella and soft tis sues to deliver a 2.4 mm pin in the correct anatomic position of the anterior meniscus attachment. Use a low-profile reamer to drill a 10 mm-deep socket. Ensure the anterior horn sutures are safely out of the way before drilling. Using the multiuse marking hook, position the RetroConstruction™ guide into the anterior tunnel. Tap the stepped 3.5 mm drill sleeve of the FlipCutter® reamer cannula onto the tibia to create an orthogonal angle to the anterior bone plug socket. Drill the FlipCutter reamer to the socket, taking care not to flip the FlipCutter reamer. Pass a FiberStick™ suture through the drilled tunnel and retrieve through the medial portal. Pass the anterior bone plug sutures through the tunnel, and using a probe, maneuver the anterior plug into the socket. Pass the anterior bone plug sutures through the eyelet of a 4.75 mm SwiveLock® anchor. Tension the sutures to achieve full reduction of the bone plug into the socket and place the anchor into the tibia to complete anterior bone plug fixation. Alternatively, use a suture button to complete fixation. 3 08 I Double Bone Plug Meniscus Allograft Transplantation 3a Alternate fixation method: Use a SwiveLock® anchor to press fit the bone plug in the socket. The leading edge of the SwiveLock anchor reduces the bone plug. Place the trailing aspect of the SwiveLock anchor on the notch side of the bone plug; this acts as an interference screw to lock the anterior bone plug and meniscus in place. 4 The anterior sutures of the meniscocapsular interface may be placed under direct visualization. Size 2-0 absorbable suture is frequently used for this application. The arthrotomy should be closed so the remaining sutures can be placed using the ZoneNavigator™ system (a) with 2.0 SutureTape meniscus repair needles. Routinely, 6 to 8 sutures are used to secure the peripheral interface. Note: Vertical sutures provide additional strength. (a) Double Bone Plug Meniscus Allograft Transplantation I 09 Ordering Information Product Description Item Number RetroConstruction™ Drill Guide Set AR-4555S Side-Release RetroConstruction Handle AR-1510HR Meniscal Root Marking Hook AR-1610MR Locking Guide for Meniscal Root Marking Hook AR-1610LG Coring Reamer and Collared Pin Set, 9 mm AR-1223S Coring Reamer and Collared Pin Set, 10 mm AR-1224S Low-Profile Reamer, 10 mm AR-1410LP Suture Retriever AR-12540 Suture Cutter AR-12250 Knee Scorpion™ Suture Passer AR-12990 Disposables Product Description Item Number Meniscal Root Repair Kit AR-4550 Knee Scorpion Needle AR-12990N #2 FiberLoop® Suture, w/straight needle AR-7234 FiberStick™ Suture, #2 FiberWire® suture, 50 in AR-7209 TigerStick® Suture, #2 TigerWire® suture, 50 in AR-7209T #2 FiberWire Suture, 38 in w/ tapered needle AR-7200 Micro SutureLasso™ Suture Passer, minor bend AR-8701 FlipCutter® II Reamers, 6 mm – 13 mm AR-1204AF-60–130 Suture Button, 3.5 mm AR-8920 Suture Button, round,12 mm AR-8922 ZoneNavigator™ System System Handle AR-7900 System Cannula, anterior AR-7905 System Cannula, mid/posterior, left AR-7910L System Cannula, mid/posterior, right AR-7910R Mini SutureTape Meniscus Repair Needles w/ 0.9 mm SutureTape and 2 Needles AR-7523 Suture 2-0 FiberWire Meniscus Repair Needles AR-7223 Protector™ Meniscus Suturing Set AR-4060S Meniscal Repair Joystick System AR-4007JS Anchors BioComposite SwiveLock® Anchor, 4.75 mm × 19.1 mm, closed eyelet AR-2324BCC Spade-Tip Drill for 5.5 mm BioComposite SwiveLock Anchor AR-1927D PassPort Button™ Cannulas PassPort Button Cannulas, 6 mm × 2 cm – 5 cm AR-6592-06-20 – 50 PassPort Button Cannulas, 8 mm × 2 cm – 5 cm AR-6592-08-20 – 50 PassPort Button Cannulas, 10 mm × 2 cm – 5 cm AR-6592-10-20 – 50 Products may not be available in all markets because product availability is subject to the regulatory approvals and medical practices in individual markets. Please contact your Arthrex representative if you have questions about the availability of products in your area. 10 I Double Bone Plug Meniscus Allograft Transplantation Reference 1. Chen MI, Branch TP, Hutton WC. Is it important to secure the horns during lateral meniscal transplantation? a cadaveric study. Arthroscopy. 1996;12(2):174-181. doi:10.1016/s0749-8063(96)90007-9 This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience, and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level and/or outcomes. View U.S. patent information at www.arthrex.com/corporate/virtual-patent-marking arthrex.com © 2022 Arthrex, Inc. All rights reserved. LT1-0106-EN_C

Double Bone Plug Meniscus Reconstruction

Meniscal Root Avulsion Repair Surgical Technique Introduction Meniscal root avulsions are challenging injuries causing meniscal extrusion and loss of hoop stress distribution, which can lead to the development of knee arthritis.1 Securing the meniscus in a small bone socket has proven to be an effective means to restore hoop stresses and improve outcomes.2 The FlipCutter® II reamer and meniscal root marking hook allow for a minimally invasive retroconstruction repair technique that preserves bone while securing meniscal tissue. With 2 points of stability for drilling and preparing the bone socket, the meniscal root marking hook can be adjusted to an offset of 5 mm, 7.5 mm, or 10 mm from the posterior tibia. Additionally, the drill sleeve can be rotated to the optimal tunnel location without disengaging the marking hook. Create a socket for tissue reduction using the FlipCutter II reamer. The FlipCutter II reamer and Knee Scorpion™ suture passer are ideal for meniscal root repair and transplantation. In a single step, pass 0 or 2-0 FiberWire® suture using the versatile Knee Scorpion suture passer. Its low-profile jaw allows access to tight spaces in the knee, making it ideal for various stitch configurations. Arthroscopic Evaluation and Preparation: Confirm detachment from the tibial plateau while probing the meniscal root. Identify the location on the tibial plateau where reattachment of the meniscus is desired. This should be as anatomical as possible without excessive stress or deformation of the tissue when pulled to that area. A ChondroDrill™ attachment, Apollo RF® MP90 probe, or burr can be used to mark this location for later reference. If visualization or instrumentation is difficult because of a tight joint space, it may be helpful to partially flatten the tibial spine with a PoweRasp™ shaver and/or perform a small posterior notchplasty with an arthroscopic burr. Tibial Socket Creation 1 Engage the lock to prevent rotation of the marking hook while introducing the guide into the joint through a PassPort Button™ cannula. 2 Position the marking hook over the back of the tibia at the desired location for tissue reattachment. 3 Adjust the offset by depressing the button on the locking guide and aligning the laser marks with the desired offset. 4 Use a 6 mm FlipCutter® reamer to create a bone socket. Drill on a forward setting and pull back until the socket has reached a depth of approximately 5 mm. Suture Passing 1 The Knee Scorpion™ suture passer can be used to pass a size 0 TigerLink™ suture to create a cinch stitch. The size 0 FiberLink™ suture can be passed to create a second cinch stitch. Meniscal Root Avulsion Repair I 03 2 Use the SutureLasso™ needle and passing wire to shuttle the suture to the anterior tibia. 3 Extend the tibial incision 1 cm distal from the transtibial bone preparation. 4 Use the spade-tip drill bit to prepare a socket for the anchor. The socket should be prepared to the depth of the positive stop collar on the spade-tip drill, representing a 20 mm depth. For hard bone, the 4.75 mm SwiveLock® anchor tap should be used. 04 I Meniscal Root Avulsion Repair 5 Pass the suture(s) through the eyelet of the 4.75 mm BioComposite SwiveLock® anchor. Tension the suture(s) to achieve an anatomic reduction of the meniscal root and place the anchor into the drill hole until the eyelet is fully seated. Maintain tension on the suture(s) and advance the SwiveLock anchor into the tibia. 6 Final Construct: After removing the driver, the eyelet retention suture can be removed. Meniscal Root Avulsion Repair I 05 Ordering Information Meniscal Repair and Resection Sets and Kits Product Description Item Number Meniscal Repair and Resection Set AR-4555S Meniscal Root Marking Hook AR-1610MR Locking Guide for Meniscal Root Marking Hook AR-1610LG Knee Scorpion™ Suture Passer AR-12990 2.75 mm Mini Suture Retriever, straight AR-11540 MegaBiter™ Punch, straight AR-41006 MegaBiter Punch, up-curved AR-41026 MegaBiter Punch, straight, left AR-41006L MegaBiter Punch, straight, right AR-41006R Probe, 3.4 mm hook AR-10010 Meniscus Repair Rasp AR-4130 Side-release RetroConstruction™ Handle AR-1510HR Drill Sleeve for Side-release Handle, ratcheting, 2.4 mm AR-1510FD-24 Stepped Drill Sleeve for Side-release Handle, ratcheting AR-1510FS-7 Insert for Stepped Drill Sleeve, 2.4 mm AR-1204F-24I Meniscus Repair and Resection Instrument Case AR-4555C Meniscal Root Repair Kit w/ BioComposite SwiveLock® Anchor AR-4550BC Knee Scorpion Needle FlipCutter® II Reamer, 6 mm PassPort Button™ Cannula, 8 mm × 3 cm 2-0 FiberStick™ Suture, qty. 2 SutureLasso™ Needle w/ Nitinol Passing Wire 0 FiberLink™ Suture 0 TigerLink™ Suture BioComposite SwiveLock Anchor, 4.75 mm × 19.1 mm Spade-tip Drill Bit SwiveLock Anchor Tap, hard bone Products may not be available in all markets because product availability is subject to the regulatory approvals and medical practices in individual markets. Please contact your Arthrex representative if you have questions about the availability of products in your area. References 1. Pagnani MJ, Cooper DE, Warren RF. Extrusion of the medial meniscus. Arthroscopy. 1991;7(3):297-300. doi:10.1016/0749-8063(91)90131-g. 2. Lee JH, Lim YJ, Kim KB, Kim KH, Song JH. Arthroscopic pull-out suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Arthroscopy. 2009;25(9):951-958. doi:10.1016/j.arthro.2009.03.018. 06 I Meniscal Root Avulsion Repair This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience, and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level and/or outcomes. View U.S. patent information at www.arthrex.com/corporate/virtual-patent-marking arthrex.com © 2021 Arthrex, Inc. All rights reserved. LT1-00016-EN_E

Meniscal Root Avulsion Repair

Meniscus Repair Scientific Update

Meniscal Repair and Resection Instrument Set

Orthobiologics

Procedure

Soft-tissue meniscal allograft transplantation techniques continue to evolve with the advancement of fixation devices. Using common meniscal repair devices allows for greater flexibility while ensuring anatomic graft placement. Soft–tissue-only meniscal allograft surgical techniques and clinical outcomes are well documented and have good clinical efficacy.1-4
References
1. Kim SH, Lipinski L, Pujol N. Meniscal allograft transplantation with soft-tissue fixation including the anterior intermeniscal ligament. Arthrosc Tech. 2019;9(1):e137-e142. doi:10.1016/j.eats.2019.09.015
2. Spalding T, Parkinson B, Smith NA, Verdonk P. Arthroscopic meniscal allograft transplantation with soft-tissue fixation through bone tunnels. Arthrosc Tech. 2015;4(5):e559-e563. doi:10.1016/j.eats.2015.06.001
3. Elattar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P. Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc. 2011;19(2):147-157. doi:10.1007/s00167-010-1351-6
4. Myers P, Tudor F. Meniscal allograft transplantation: how should we be doing it? A systematic review. Arthroscopy. 2015;31(5):911-925. doi:10.1016/j.arthro.2014.11.020

James L. Carey, MD, MPH (Philadelphia, PA), demonstrates a soft−tissue-only meniscal allograft transplantation and provides a full overview of the technique, from preparation of the recipient site and allograft through various fixation options for securing the graft.

MegaBiter, Straight Tip, Right Cut, 5.5 mm

AR-41006R

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