#2 FiberSnare suture, 26" length with 2” closed loop (Black/White)

#2 FiberSnare mit FiberWire #2, Geflochtener Polyblend Faden, Schwarz/Weiß mit Schlaufe, ca. 66.0 cm und 30.0 cm versteiftem Ende

#2 FiberSnare with #2 FiberWire Braided Polyblend Suture, Black/White with Closed Loop, 26 inches, One End Stiffened, 12 inches

Finished Product

AR-7209SNT

Knee

Product

FiberStick™ is blue FiberWire® with the first 12 inches stiffened to allow convenient andeasy advancement through most cannulated instruments, alleviating the need fora monofilament suture or wire suture shuttle. FiberSticks come with a thinplastic tube which protects the stiffened suture until use. TigerStick® is similar to FiberStick but whitewith a black stripe in the suture, making suture identification easier.

FiberStick™ and TigerStick®

Child (D)

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 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

An innovative approach to ACL preservation, the ACL Repair TightRope implant allows 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. DOC1-000178-en-US_B. Naples, FL; 2020.

ACL Repair TightRope® Implant With FiberRing™ Sutures

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

Collateral Ligament Reconstruction Set

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

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

Collateral Ligament Reconstruction Set

Orthobiologics

For meniscal allograft transplant, the double bone plug technique involves medially implanting the meniscal allograft with rigid fixation at both horn attachments. The technique can also correct meniscal deficiency using bone plugs and minimally invasive suspensory fixation and allows the meniscal allograft to maintain functional hoop stress.

Double Bone Plug

The Double Bone Plug technique for meniscal tear/deficiency utilizes bone plugs that can either be prepared freehand or by using a coring reamer. The freehand technique is performed using rongeurs and a high speed burr. For detailed information about this technique and/or Arthrex products utilized in this technique, visit the educational resources tab or products tab below. The double bone plug technique for meniscal allograft reconstruction provides a method for implanting the meniscal allograft medially with rigid fixation at both horn attachments. It has been demonstrated that bony fixation and bony healing at the attachment site allows for the maintenance of functional hoop stress by the meniscal allograft.

Double Bone Plug Meniscal Transplant

The new larger loop FiberSnare suture was specifically engineered for convenience and ease of use when shuttling sutures during ligament reconstruction and repair procedures. The FiberSnare suture has an overall working length of 26” in and the construct consists of a #2 FiberWire® suture with a 2 in loop on one end while the opposite end is stiffened 12 in. FiberSnare sutures can be used for both retrograde (outside-in) or antegrade (inside-out) drilling techniques as a shuttling suture. The new unique color patterns (black/white and white/blue striped suture) also allow for easier suture identification and management.

FiberSnare® Suture

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 prep 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 anatomic double-bundle technique replicates the native shape of the medial patellofemoral ligament (MPFL), provides stability in both flexion and extension, and effectively limits rotation throughout ROM, helping minimize postoperative instability. The technique, if accomplished directly and anatomically, can also allow for more aggressive rehabilitation protocols and earlier return to activity.1
Successful MPFL reconstruction is dependent on anatomic placement of the graft. The technique incorporates the use of a femoral template to ensure proper placement of the graft in the femur. This position provides a static fixation point that equalizes the tension across the graft in flexion and extension, thus helping minimize stress across the patellofemoral joint.
Other options include Knee FiberTak® anchors for onlay MPFL techniques as well as 4 MPFL convenience packs to address each patient's unique needs and each surgeon's fixation preference. The newest kits use 3.9 mm BioComposite SwiveLock® anchors for patellar fixation and either a 6 mm × 20 mm BioComposite FastThread™ interference screw or an ACL TightRope® implant for femoral fixation.
Reference
1. Schöttle PB, Hensler D, Imhoff AB. Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):147-151. doi:10.1007/s00167-009-0868-z

MPFL Reconstruction

Arthroscopic-assisted surgical reconstruction of the PCL using the FlipCutter® drill with RetroConstruction™ technology allows for more anatomic placement and safer drilling in the posterior aspect of the knee. Anterograde drilling can also be performed using low-profile reamers in a far lateral portal to avoid iatrogenic injury. Allograft fixation is accomplished with biocomposite, PEEK, or titanium interference screws. Either a single- or double-bundle allograft reconstruction can be performed using these techniques. Some surgeons may elect to use backup, extracortical fixation.

PCL Soft-Tissue Graft Fixation

The streamlined PCL ToolBox contains all the necessary instruments for performing a variety of modern PCL reconstruction techniques. The set includes the RetroConstruction™ Drill Guide System with drill sleeves for use with the FlipCutter® reamer, RetroDrill® reamer, and standard 2.4 mm guide pins.
 
 
Femoral and tibial RetroConstruction marking hooks allow safe, reproducible placement of pins and drills into the anatomic footprints. Also included in the set are double-bundle femoral drill guides, curved instruments for tibial preparation, a knee obturator for safe and easy posterior portal placement, tunnel plugs, drills, screwdrivers, notchers, and other accessories. This toolbox facilitates standard transtibial PCL reconstruction as well as modern techniques such as the arthroscopic inlay and GraftLink® all-inside PCL technique.

PCL ToolBox

Quadriceps tendon grafts offer unique benefits for cruciate ligament reconstruction, such as a predictably large diameter, low morbidity,1 and a preferable stiffness profile for knee ligament reconstruction.
The QuadPro™ tendon harvester is designed to safely, easily, and quickly harvest a quadriceps or patellar tendon graft using a minimally invasive technique.2-4 The sharp tip cores out an approximate cylindrical graft. Its ergonomically designed handle features graduations on the clear shaft to allow visualization of approximate graft length during harvesting. Available in four sizes (8 mm to 11 mm), the QuadPro tendon harvester can accommodate each patient’s unique needs as well as the surgeon’s preference for graft diameter.
The FiberTag® TightRope® implant facilitates attachment of single-ended grafts, such as quad tendon grafts, to the ACL TightRope RT and ABS implants. FiberTag suture is integrated into the TightRope implant for a strong, consistent connection between the suture and TightRope loop. A simplified suturing technique, along with innovative packaging and the new GraftClamp graft preparation instrument, make preparing quadriceps tendon grafts faster and more reproducible than ever.
References
1. Arthrex, Inc. LA1-00100-EN_K. Naples, FL; 2021.
2. Xerogeanes JW, Mitchell PM, Karasev PA, Kolesov IA, Romine SE. Anatomic and morphological evaluation of the quadriceps tendon using 3-dimensional magnetic resonance imaging reconstruction: applications for anterior cruciate ligament autograft choice and procurement. Am J Sports Med. 2013;41(10):2392-2399. doi:10.1177/0363546513496626
3. Hadjicostas PT, Soucacos PN, Berger I, Koleganova N, Paessler HH. Comparative analysis of the morphologic structure of quadriceps and patellar tendon: a descriptive laboratory study. Arthroscopy. 2007;23(7):744-750. doi:10.1016/j.arthro.2007.01.032
4. Krebs N, Yaish A, O’Neill N. Anatomic evaluation of the quadriceps tendon in cadaveric specimens: application for anterior cruciate ligament reconstruction graft choice. SMRJ. 2019;4(1):7961. doi:10.51894/001c.7961
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;InternalBrace surgical technique is intended only for soft-tissue-to-bone fixation and is not cleared for bone-to-bone fixation.

#2 FiberSnare suture, 26" length with 2” closed loop (Black/White)

AR-7209SNT

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