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Below is a collection of resources&nbsp;for you&nbsp;to&nbsp;learn more about the&nbsp;latest innovative products and techniques in minimally invasive orthopedics.

AAOS 2025 Annual Meeting: Knee Feature Products

Knee

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A document containing information about Arthrex products and product lines.

Ein Dokument mit Informationen über Arthrex Produkte und Produktlinien.

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Documento que contiene información sobre los productos y líneas de productos de Arthrex.

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Knee Product Spotlight Knee Innovations | 2025 Knee FiberTak® Anchors The First Suture Anchor Developed Specifically for the Knee View the technique Versatile Implants Designed for Multiple Knee Applications Five unique anchor configurations to accommodate various procedures and implant preferences First implant to use SutureTape in a knotless tensionable mechanism, combining the established benefits of tape with the ability to retension the construct after implantation and fixation Double Knotless Knee FiberTak Anchor Double Knotted Knee FiberTak Anchor Shorter guides and inserters allow surgeons to operate closer to the anatomy with instrumentation designed for open surgery Redesigned, softer anchor body for reliable deployment in hard bone and vibrant SutureTape colors for easier visualization and suture management in an open surgical environment Hybrid Knee FiberTak Anchor Knee FiberTak Anchor for InternalBrace™ Technique Knee FiberTak Button Quad ACL With QuadPro™ Harvester and FiberTag® TightRope® II Implant Setting a New Standard in ACL Reconstruction FiberTag TightRope II Implant Simplified graft preparation now upgraded with flat suture to improve tensioning behavior and a redesigned button with an additional fifth locking mechanism; available preloaded with FiberTape® suture for the InternalBrace™ technique QuadPro Harvester 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. View the technique Cruciate Ligament Protection With the InternalBrace™ Technique and Lateral Extra-articular Tenodesis (LET) Significantly lower graft retear rates1,2 Faster and higher rate of return to preinjury activity level with suture tape augmentation3 Minimal bone removal required when performing LET with Knee FiberTak® anchors QuadLink™ ACL Reconstruction With InternalBrace Technique IT Band Tenodesis With Double Knotless Knee FiberTak Anchor References 1. Pettinari F, Carrozzo A, Saithna A, et al. Effect of lateral extra-articular procedures combined with ACL reconstruction on the rate of graft rupture in patients aged older than 30 years: a matched-pair analysis of 1102 patients from the SANTI study group. Am J Sports Med. 2024;52(7):1765-1772. doi:10.1177/03635465241247760 2. Daniel AV, Wijdicks CA, Smith PA. Reduced incidence of revision anterior cruciate ligament reconstruction with internal brace augmentation. Orthop J Sports Med. 2023;11(7):23259671231178026. doi:10.1177/23259671231178026 3. Bodendorfer BM, Michaelson EM, Shu HT, et al. Suture augmented versus standard anterior cruciate ligament reconstruction: a matched comparative analysis. Arthroscopy. 2019;35(7):2114-2122. doi:10.1016/j.arthro.2019.01.054 View the technique SutureLoc™ Implant Knotless, Retensionable Soft Anchor Specifically for Arthroscopic Meniscal Root Repair Double-loaded implant allows for 2 knotless, tensionable repair sutures with only 1 anchor pass, reducing steps from previous techniques while eliminating the need for a posterior medial portal Repair sutures are converted in line and out the anterior tibia, eliminating the potential for the suture to cut into bone Minimal bone removal using a smaller drill pin Multiple stitch configurations for patient customization and surgeon preference Mason-Allen Stitch Configuration Simple Stitch Configuration View the technique ACL Repair TightRope® Implant The Only Products Uniquely Designed for ACL Preservation Versatile FiberRing™ Sutures Available in 4 loop lengths, allowing surgeons to optimize soft-tissue fixation with their choice of suture configurations 25 mm AR-7282-25 35 mm AR-7282-35 45 mm AR-7282-45 55 mm AR-7282-55 Longer length options (45 mm and 55 mm) offer flexibility in suture pass configuration and added length for other procedures, including repair of tibial spine avulsion fractures. View the technique FiberStitch™ 1.5 Implant View the technique 17% Smaller Needle Compared to First-Generation FiberStitch Implant1 The FiberStitch 1.5 implant is a product of relentless innovation. A low-profile delivery needle results in less tissue morbidity and smaller soft implants provide the strongest all-inside meniscal repair fixation on the market.1 (a) (b) (c) (d) 24° bend -12° bend FiberStitch Angles Straight (a) 12˚ up curve (b) 24˚ up curve (c) Reverse curve (d) Reference 1. Arthrex, Inc. Data on file (APT-06136). Naples, FL; 2023. View the full list of knee courses arthrex.com © 2024-12 Arthrex, Inc. All rights reserved. evBR1-002467-en-US_F

Knee Product Spotlight

Asheesh Bedi, MD (Chicago, IL), discusses the evolution of inlay to onlay procedures and relates the progress to knee procedures using all-soft implants.
To learn more about inlay vs onlay literature and applications, read the <a href="https://www.arthrex.com/resources/DOC1-001585-en-US/inlay-vs-onlay-meniscal-repair-and-ligament-reconstruction?objectID=human.resource.en.e3224bf8-c6b3-4362-a73d-02891a13ba21.3&amp;queryID=ded5d0f4f84a213c82e3f2f0638d86d2" title="https://www.arthrex.com/resources/DOC1-001585-en-US/inlay-vs-onlay-meniscal-repair-and-ligament-reconstruction?objectID=human.resource.en.e3224bf8-c6b3-4362-a73d-02891a13ba21.3&amp;queryID=ded5d0f4f84a213c82e3f2f0638d86d2">scientific update.</a>

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Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

Videos von Fallpräsentationen

Cirurgiões que apresentam um ou mais casos clínicos.

Vídeos apresentações de casos

Cirujanos que presentan uno o más casos clínicos.

Video presentaciones de casos

Case Presentation Videos

 Inlay vs Onlay for Knee Repair Surgery: What Does the Data Tell Us?

Rachel M. Frank, MD (Denver, CO), demonstrates her steps for performing a quad ACL reconstruction using a FiberTag® TightRope® II implant with a lateral meniscus root repair using a SutureLoc™ implant. Dr. Frank discusses graft selection, provides drilling tips for concomitant procedures, and explains critical steps when using the SutureLoc implant.&nbsp;
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.

Quad Tendon ACL Reconstruction and Lateral Meniscus Root Repair Using the SutureLoc™ Implant

My name is Rachel Frank. I'm a sports medicine surgeon from the University of Colorado in Denver. And today, we'll be discussing a case of a patient with an ACL tear with a concurrent lateral meniscus root tear, and how we manage both of those pathologies. This is a 31 year old female who injured her right knee while skiing. She presented to the office with knee pain and instability. She had no prior injuries or surgeries to that knee. On her physical examination, she had a large effusion with limited range of motion, a loose ACL examination, and stable collateral ligament examination. As you can see on her advanced imaging here, the MRI, we have evidence of a complete ACL tear as well as a posterior horn lateral meniscus tear. At this point, our diagnosis is clear. We have a complete ACL tear and a lateral meniscus root tear and a young, healthy, active female. And really, our only option at this point is to consider surgery to address both the ACL as well as the lateral meniscus. In this case, our treatment options include ACL reconstruction with quadriceps tendon autograft and an all inside fashion, as well as a lateral meniscus root repair utilizing a knotless all suture based device, the SutureLoc. The challenges with doing concurrent ACL reconstruction and meniscus root repair include tibial management. Real estate can get really tight. You have to think about the order of the steps. Which tunnels are you going to drill first? Are you going to drill the ACL tibial tunnel or the root tibial tunnel? And then you have to think about guide settings so that you don't have your tunnels converge for both the ACL as well as the root. And then you also need to think about, particularly for these cases, how to manage that tight lateral compartment. Because varus is not the same as knee flexion. So you need a really good skilled assistant to help you manage that knee as you're doing this surgery. So for this surgical case my preferred order of steps is as you see here, first we like to harvest the quadriceps tendon autograft. We then do our ACL femoral tunnel with the knee hyper flexed when I do this before I worry about my root, I don't have to worry about my root integrity. With the knee hyper flexed, I then drill my ACL tibial tunnel first. I like to prioritize the ACL tunnel because that has to be perfectly anatomic for a good result. And then we'll do our root tunnel. After we've done that ACL tibial tunnel, then I will tension the root, I'll cycle the knee and then I'll tension my ACL graft. And then I'll retension my root only if needed. So here you can see we're getting ready to perform our quadriceps harvest. This can be done through a transverse or a vertical incision. After we've made our incision we can put the scope into the incision and slide this proximally so that we can see where our quadriceps tendon anatomy is. And that allows us to keep our incision small and cosmetic and minimize fluid extravasation. During the surgery. We'll go ahead and use the QuadPro harvester, the pearl. What this technique is to make full 360 degree circular motions, and this allows for a reproducible graft harvested essentially every time you do an ACL reconstruction. And again, this can be completed through a 1.5cm incision if you wish to keep your incision small and cosmetic in terms of graft preparation. I like to keep my GraftLink at about 65 to 70mm. As you can see here, and I like to harvest a full thickness graft, although certainly partial thickness grafts are acceptable pending the thickness. I like to have at least eight millimeters of graft. We'll go ahead and prep our graft using the FiberTag TightRope. And I like to use InternalBrace suture augmentation for my quadriceps tendon ACL reconstructions. And then we'll place our graft in the compress tubes so that we can get a nice full thickness, really robust graft to use for our ACL reconstruction. We'll hold this on tension on the back table and we'll turn our attention back to the arthroscopy. This is an example of our final graft prep. And you can see the FiberTag TightRope on both sides. Before I do the ACL tunnel drilling and the root tunnel drilling we'll go We'll go ahead and close that defect, particularly if you're doing a full thickness harvest, as you can see here. And that will prevent fluid extravasation during the case, I'm using the knee Scorpion, which allows me to keep my incision again very small and cosmetic. Going back to our case, we can see our patient again who has the complete ACL tear after this skiing injury with a lateral meniscus root tear, as you can see on the picture to the right. And so we'll go ahead and repair our lateral meniscus root using the SutureLoc device. And this is performed after we've done our ACL tunnel drilling. Here you can see we're using the meniscus root repair guide. And we're drilling a 2.4mm cannulated pin up to the anatomic footprint of the posterior horn lateral meniscus. We're passing the nitinol wire and then exchanging that for a linked suture for easier suture passage. And now from the medial portal we'll go ahead and pass our SutureLoc device. And the goal is to seat this device just below the tibial plateau so that we have nice tibial based fixation, which is more anatomic. The root was born attached to the tibia when it's torn. We want to fix it back down to the tibia. We're then using the meniscus or knee Scorpion to go ahead and repair the root, using sutures that are already in the SutureLoc device, as you see here. First passing posteriorly and then passing the second suture a little bit more anteriorly to leave you some working room. Now all we need to do is tension our root repair. And one key pro. When you're doing a lateral meniscus your knee is going to be in a bit of varus. You want to make sure to get the knee back into a neutral position before tensioning, so that you have appropriate tension, because the patient doesn't live in varus. Same thing for a medial root. If the knee is to be in valgus. And we're going to demonstrate in this case again another ACL patient with a concomitant lateral meniscus root. How we actually pass the SutureLoc device. So we've already drilled our 2.4mm pin. And we've exchanged the wire for a link. And now we're going to use that link to shuttle the shuttle the SutureLoc device from the medial portal down to the tibial tunnel. You can see that here. We're passing that device, making sure that we have the bulk limb of the SutureLoc, and we're shuttling that again from the medial portal down the tibial tunnel. And the tibial tunnel has been placed approximately 1cm or 10mm distal to the tibial tunnel aperture for the ACL. So that we don't have tunnel convergence here. You can see I have my assistant shuttling the SutureLoc device into the joint. And we're doing a little curl technique that you see me demonstrating with my wrist. It's not so much of a pull. The pearl here is to actually curl your wrist so that you don't pull the SutureLoc device out of the tibia itself. You want to seat it just below the tibial plateau, and you can see that both on the screen and on the outside. Video here. Once we have the SutureLoc device nice and secured and we've set the anchor, now it's just using the knee Scorpion to go ahead and repair the lateral route. Again. The knee is in figure four or Varus here. And we're going to use both of the pre converted sutures to perform our meniscus root repair. You can see here that the notch is wide open because we've already drilled our ACL tunnel. There's no ACL tunnel in the way. If you're doing an isolated lateral meniscus route it's a little bit more tricky because the ACL tissue's there already. So you just have to be cautious as you're performing this technique. More commonly, though, lateral meniscus root tears occur with ACL injuries and are performed with ACL reconstruction. Here we can see the probe underneath the posterior horn lateral meniscus with the root nicely tensioned and repaired. So here we're going to demonstrate graft passage for the all-inside quadriceps tendon ACL reconstruction. Here we've already passed our ACL graft with the TightRope up the femoral tunnel. And we've flipped our button. This pearl that I'm showing here is what we like to call the tiger tug, where we are marking the TightRope sutures with a marking pen so that we can ensure that they're nice. And even while we're shuttling the shuttling the craft up into the femur. So you can see here the internal brace sutures are in the joint out the portal, which are holding the button across the lateral femoral cortex. And now we're shuttling in our graft using the TightRope mechanism. And we're making sure that those tiger tug marks are symmetric, one one on each strand. So that we know we have perfect use of the TightRope. And we're not long on one side or short on another side, but that the TightRope is working to its full advantage. We'll then go ahead and dock the graft into the tibial tunnel using our previously placed tibial passing sutures. As you can see in the next step coming up. And there's our graft. So here we will demonstrate how we fix the ACL graft and do appropriate sequence of tensioning. When we're using an internal brace, we want to make sure that we tension that first with the knee and full hyperextension. Here we're getting our button down but not all the way. About 90% will pass our internal brace sutures through the SwiveLock suture anchor. We'll go ahead and drill and then tap that SwiveLock suture anchor about one centimeter distal to where the ACL tunnel is, and then again with the knee in full extension, if not hyperextension for those patients who are hypermobile. We'll go ahead and make sure that the ACL internal brace is tensioned. Then we can final tension the tibial side of our ACL graft. And we can also retension on the femoral side. And that's one of the advantages of the FiberTag TightRope that you see here. So back to our case putting that all together. You can see here that lateral meniscus posterior root tear. You can see the SutureLoc device being passed nicely into that tibial tunnel. You can see the knee Scorpion being used with both the blue and the white repair sutures. And the design of this anchor is quite nice, because the blue repair suture gets shuttled through the blue and white passing suture, the white repair suture gets shuttled through the black and white passing suture. So it's really easy to not get these confused, which is nice. And you can see the final tensioning of our lateral meniscus root. Here you can see the ACL portion of the procedure. Our femoral tunnel drilled via an all-inside technique. Our tibial tunnel drilled via an all-inside technique. And our ACL reconstruction with quadriceps tendon autograft all soft tissue with InternalBrace suture augmentation fixated with FiberTag TightRope on both ends. Here's the final reconstruction of both the ACL reconstruction and the lateral meniscus root repair. In these cases, post-operative rehabilitation is really directed by the root repair. We place these patients into a knee brace with toe touch weight bearing for six weeks to really respect the repair of the meniscus root, allow for biology to support the mechanics that the SutureLoc is providing. And then at about six weeks, we get them walking full return to sport takes approximately nine months to one year, as is standard with any ACL reconstruction.

Brian J. Cole, MD, MBA (Chicago, IL), introduces the Knee FiberTak® anchor platform and explains how the features of the Knee FiberTak implant benefit patients.&nbsp;
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.&nbsp;

Animations demonstrating the features and benefits of a specific product.

Animationen, die die Funktionen und Vorteile eines bestimmten Produkts demonstrieren.

Produktdemonstrationen

Animações demonstrando os recursos e benefícios de um produto específico.

Vídeos de demonstração de produtos

Animaciones que demuestran las características y beneficios de un producto específico.

Videos de demostración de productos

Product Demonstrations

Introduction to the Knee FiberTak® Anchor Platform

Today I'm excited to introduce the new Arthrex NE FiberTak anchor platform of suture anchors and instrumentation developed specifically for knee surgery. Over the next few minutes, I will review the five new anchor configurations, highlighting their unique features that may optimize the treatment of knee pathology. The instrumentation, offered in both single use and reusable formats is ergonomic, with a shorter working length, allowing surgeons to operate closer to the anatomy and aids in a more precise drilling trajectory with anchor insertion. Knee FiberTak implants use a redesigned anchor body with a softer, less dense material that enables easier anchor insertion in hard bone, as well as having a more consistent bunching effect of the anchor material in softer bone. The anchor inserter has also been optimized to be more rigid, allowing the ability to self-punching where appropriate, but also to drill or punch a pilot hole with an awl, depending upon the bone quality and anatomy, starting with the double knotless knee FiberTak. This implant features two pre converted double knotless loops, eliminating the step of shuttling that otherwise converts the knotless loop mechanism. This implant features knotless double loops made of SutureTape. The loops are constructed of 1.3mm suture tapes with vibrant colors to improve visualization and suture management. For me, this implant has been particularly useful when I perform an let us procedure specifically using the FiberStaple technique. Here we see how quickly and easily the double knotless FiberTak is self-punching through the pistol grip guide. The IT band strip is shuttled through the pre converted tape loops, and with the knee and the appropriate amount of flexion, the first loop is provisionally tensioned. Now I like to range the knee to ensure appropriate construct tension. And then when I confirm this correct tension, I fully tension the first loop. The IT band strip is then reflected back distally through the Through the second preconcerted loop and tension down to complete the FiberStaple construct if desired. I have the ability to pass the tensioning tales through the graft and tie for additional fixation. The next anchor I want to showcase is the hybrid Knotless ni FiberTak. It's called the hybrid because it includes options for creating both knotless and knotted points of fixation. The hybrid features one Knotless pre converted 1.3mm blue SutureTape loop, and an additional black sliding 1.3mm SutureTape was swaged on curved needles. I perform a large volume of mpfl reconstruction procedures, and I have recently transitioned to the onlay graft fixation technique on the medial patella. The hybrid ni FiberTak instrumentation simplifies the implantation, making it easier to stabilize the patella and the drill guide during implantation. Once my patella ni FiberTaks are placed, I can shuttle the mpfl graft through the pre converted loops and then very easily and precisely tension the graft to the medial aspect of the patella. Another feature that I like is that these sliding suture tapes are perfect for performing an imbrication or retinacular closure, or even augmenting my Mpfl Graf fixation for circumstances where knot tying is required, the double loaded knee FiberTak is a great option. I have found that the blue and black colored SutureTape strands are easy to differentiate, even in a deep, bloody environment. Additionally, the 1.3mm SutureTape creates a stronger, more low profile knot that is less prominent and less likely to cause irritation to the patient. These double knotted FiberTaks have become my go to for joint line fixation in distal MCL, avulsions and reconstructions, as well as anytime I need to spot weld fixation with a suture configuration that includes a knot. This is the NE FiberTak for the internal brace technique. This implant features a FiberTape suture that is swaged down to a single tail for easy suture management, as well as a sliding 1.3mm SutureTape with swaged on needles. The FiberTape suture can be used for an internal brace technique, but can also be used for a construct where a SpeedBridge type repair is desired, whether in the knee, ankle, elbow, or elsewhere. Over the last several years, we've learned more about the benefits of the internal brace technique to augment and protect our soft tissue repair and reconstruction constructs. Like many of my colleagues from around the world, I've adopted the internal brace technique into several procedures that I commonly perform, and notably, MCL repairs. This implant allows me to utilize a minimally invasive approach and a soft body anchor to create a single point of fixation for the primary repair with FiberTape augmentation. The swages on FiberTape limb makes suture passage simple, and can be easily loaded into a 3.9 SwiveLock anchor, or even a knee FiberTak button for TensionLoc distal fixation. This is the NE FiberTak button, similar to the FiberTak button for biceps tenodesis. This implant features two passing links loaded in opposing directions that allow the surgeon to independently prepare a suture construct in tissue using their choice of suturing method, and then pass the two whipstitch suture limbs through the NE FiberTak button in a tension slide construct. The surgeon can then tension the limbs individually to reduce the tension down to the predetermined point of fixation. I found this technology extremely beneficial in treating distal MCL avulsions, as I can create a robust locking Krakow construct that is more easily tensional than with traditional sliding suture anchor fixation. Beyond the conventional approach of standard anchor implantation, I found tremendous value in the ability to unload NE FiberTaks from their metal inserter and shuttle them in a trans osseous fashion, in circumstances where the bone quality may be questionable. For example, placing anchors in or around the fibular head. I like that I can drill a small diameter intraosseous tunnel and shuttle the sutures from my knee, FiberTak in a retrograde manner, and not have to worry about the anchor pulling through the cortex or creating a bony defect. Alternatively, for extensor mechanism injuries like quadriceps tears, placing double knotless knee FiberTaks at the inferior pole of the patella and shuttling the loops and tensioning the tails proximally allows me to create independent suture configurations in the quadriceps tissue with any diameter suture I choose. I can then link through the knotless loops, allowing for intentional and unintentional repair. Construct the knee FiberTak anchor platform is not only the first anchor designed specifically for the knee, but also allows me to treat virtually any pathology around the knee that I might encounter on a day to day basis in my operating room.

Arthrex presents the SutureLoc™ implant, the first all-suture knotless anchor specifically designed for joint-line fixation of the meniscus root.&nbsp;

SutureLoc™ Implant for Meniscal Root Repair

John Xerogeanes, MD (Atlanta, GA), performs a QuadLink™ ACL reconstruction with a lateral extra-articular tenodesis (LET) using the FiberTag® TightRope® II implant with the InternalBrace™ technique and a Double Knotless Knee FiberTak® anchor.&nbsp;
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.&nbsp;

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Surgical Technique Videos

QuadLink™ ACL Reconstruction With a Lateral Extra-articular Tenodesis Using Knee FiberTak® Anchors

I'm John Xerogeanes from Emory University. And today we're going to talk about quad tendon ACL technique with the lateral extra articular tenodesis. To perform this procedure we need the instruments seen on the back table. The first is a QuadPro device the FiberTag TightRope two for the internal brace ACL technique. Fibertag TightRope two ABS and 11 millimeter three hole ABS button. The TightRope drill pin. Low profile reamer FlipCutter three drill FiberSnare blue and black graft clamp the double loaded knotless knee FiberTak for the FiberStaple technique. Knee FiberTak punch. Knee FiberTak guide for the ACL backup Fixation Kit. We have the drill, the 5.2mm tap and a 4.75. Biocomposite. Swivelock. Okay, we're transitioning over to the quad tendon harvest. This is a right knee. You can see the VMO marked out right here. Our incision is just superior to patella a couple millimeters up. Just make sure when you make this incision, you mark it in the same position that you're going to be making the incision. So you don't want to mark it in extension. Flex the knee and then make your incision. So I usually use a couple centimeter incision here. And then you see in there that's the fat layer. It's very important to excise widely the fat layer. So you could see. So you can get in here at a little bit of an angle and always have a few sharp knives ready for you. Because this could actually make things very dull. So your assistant could have those ready. And then if you need them and you see how I'm not taking this out, you know, a little piecemeal, I try to take this and pull on it. So pull on it here and get as much fat. It won't leave a Leave a defect. It doesn't do anything. It's like liposuction for the knee. It'll all kind of flatten out. Okay, so take your time to remove this fat. This takes a little bit of time, but it's worth it for visualization. So then we take a 4x4 and unravel it all the way. And use this to remove the soft tissue that's underneath there. Okay. Then we take a cob elevator and you scrape and you'll feel the VMO here and just scrape above it. And that will remove all that soft tissue. A key elevator also works on the step. And we use an army Navy. So now we take an Army Navy and pull up. Now grab your scope and put it up. You can see the VMO to the right. You can see we have plenty of room and this will tell you the direction you need to go. So we go all the way up. You have plenty of room to get a nice quad tendon graft, and then we pull up and we mark this on the outside of the of the skin. So now we want to mark where the light is. You can see the mark. And now that shows us the direction we're going to harvest. We took the color that goes along with the QuadPro. And this works out very nice. And we cut and we just paint the edge of it. Then I can look down in the graft right in line with here potential graft. And I can hit it. And I get a nice ten millimeter circle that tells me the direction of where I'm going is lined up. It also tells me what size graft I'm going to harvest. For those of you who have not harvested before or haven't done many quads at this point, I like using the old quad double blade quad device for the end of it, and you can just take this and make it. So now I know my size distally is going to be all right. So now that tells me I have about a ten millimeter diameter. Now I go full thickness for the last 2 to 3cm here. So when I come to the edge, I go down. I can feel the edge of the patella. And I just take this piece off here and go full thickness. Don't worry about this. You can see how nice this looks when I when I bring it up. And now I have it on top and on the bottom here. Then I take our quad harvest tenaculum great instrument. Just pinch it and you can get good force on it. Now we're going to take a FiberLoop we hold a little traction on the device. We take the FiberLoop and go under the graft. Now this part seems really simple, but it's important. Add a little bit of traction here, then come through at the very end and pop this through. Now it's really important when you get to this point. If we look at this, this is not a big bulbous end. You can see the end of this is pretty nice if you're worried, if you get a bulbous end, just take a pair of scissors and trim this end so that the QuadPro fits on it nicely. Don't cut your suture. I've done that. Because we don't want a big end to the graft. A lot of times when I cut this, I taper it. Okay, so now that I have this nicely released on the end, you can see that the knee is hanging. Have your assistant hold it, but don't hyper flex it. Just keep some tension on it so the knee doesn't kick up. So we have to take this wire with the needle and put it through the QuadPro. That's how you're going to harvest it. The easiest way to do this is slide it in where you can see it. And then once you get it in, just turn it upside down and let gravity help the needle go through it. Then you grab the needle and you pull it. Now if we pull in line this is important. If you use a leg holder, you want to be parallel to the angle of the femur. So if your knee is kicked up a little bit, You're going to be harvesting in this direction if your knee is perfectly parallel to the ground, like in this case, we want to be parallel. You pull a little bit of tension here, but you don't want to do the work. Let the device work for you and be patient. Do not push this thing. It's very sharp. If you try to get violent with this or try to try to muscle it, then you can have a problem. So what we do is just let it do the work and just 360 degrees and let it go. And it'll cut nicely. Now the length of this you need it between 6 and 7cm. I think when you're starting go ahead and get seven centimeters. If you have a little bit extra, you can always trim it. It's much better to have extra than to be short. Most of the time when I do this, I want six and a half on almost every one when I do it. So one of the things is not to pull this all the way off the graft, just leave it. It makes things easier. Then use something to pull the suture through. Notice we cut the needle off because it's easier. Now, when I put this back down, I easily go in and I see the length I want. There's six and we're going to go to about seven right there. Now I grab this so I can hold it. I hold my QuadPro in place. Do not put too much tension on this. You can actually release your tension when you cut it. And then when we pop this thing off you can see the nice graph we get. You can see that this is a full thickness harvest, maybe a partial thickness in parts. And so what we usually do is use a Scorpion and just put a, put a suture at the apex on the top, and then run a suture all the way down to close this. It doesn't need to be watertight, it just needs to close enough of this so you don't get herniation of the capsule through. So the FiberTag TightRope two is really has a few things that are that are really innovative. Number one, it has an internal brace already in it. It has the tape instead of on the TightRope instead of regular round suture. And then if you follow this out and you look at the needle, it's heavy, it's round and it's sharp. So it passes much easier than one that has bevels on it. So this is a big improvement in the packaging is amazing. So you don't want to see all this I flip it over and it's completely protected. So all my suture that can get wound up is in here. And I don't have to worry about having any problem with it. Now we have the tenaculum. The tenaculum has a little slit right here to fit the card in. And then at the end of the tenaculum, there's little bevels here to grab the FiberTape. So now we're going to sit there and as you slide it in you can see on the side it fits right here and it can hold almost by itself. Then I pull it forward to the very end and I pop it through. And then that bevel hooks on the on the end of it right here. So now I'm ready to go. So I just get to the edge of the graft and I can get to the very end of it. Now, there's a myriad of ways to do this. Today, I think this looks best because you can see what we're doing. You can make this as long as short as you want. I usually go a few millimeters short of it. Use this strong needle. And this is tough tendon. Sometimes a needle driver works, but with this new needle, you almost don't need a needle driver. And then we pull down. You notice I keep two fingers here to provide a tension. This could twist. So if I hold my thumb here and I pull it down, then it won't twist. You can see I'll get it in there. And it's going to lay really nice on my graft. We make sure when you're down here that you pull this good and tight and hold the graft so you don't end up pulling anything. Anything through. Now I come about a third of the way up. Push it through. It's connected nicely. I pull tight. Now, there's several ways to do this. As I said, another way is to go to your person who's helping you and just reach through. And it's very, a very quick way. Then we go up right to almost the point. Put another throw in. So that's two throws. You can pull one limit at a time. You want to make sure that they're about 45 degree angles. And then we pull that tight. So that's two throws go up through this hole here. And this is nice the way this card is. So you can't skewer the shortening complex and go right next to it. This locks it on the graft and again pull down. But I like to have these up. So they're crossing over and it tubular rises the top part of the graft. So we're going to cut one limb of the suture off. And you can throw one suture. Some people will throw a double suture and then you get a little bit of a knot. Now you have two choices here. One is this leave it and have a knot. And if you don't like the knot, you can just bury the knot in the graft. And it goes right through and no knot. Then we cut it on the bottom and then we take this off. The new card also works really well for suture management. One now this comes out. And now look at this. We just pull and all of our sutures are on on one side, our internal braces on the other side, and we're set and ready to go. So I'll have my assistant shorten this, and we'll shorten it till about about 40mm in length. So just you hold a little tension. So then when I pass it it's ready to pass in the joint. It's not going to pop outside the IT band. You have your graft ready to deploy. So in this particular case we did our ACL with our tunnels and our suture passes prior to the Lumiere. You could do it either way you want oftentimes in or I'll do the Lumiere first, at least the dissection first, just so I can see. And on the back table, when we're making the graft, we can do the ACL harvest. We'll make this incision. And again, it doesn't need to be very big, but you need most of it behind it. Now if we get this we get down to the IT band level before we get right down to that level. And then you can feel things easier. It is difficult on people that are bigger to sometimes feel All the landmarks, but I can feel the IT band. I can see the LCL and feel it right here. 5 to 6cm up is what we usually like to do. One of the advantages of doing the IT band first is you can see here we're close to our suture. You just got to be careful not to make sure not to cut it. And then just to make sure your cuts were appropriate. I take this and make sure I'm full thickness and slide it up. Now, once you've ensured that your cut is made, we'll take the key elevator again. Go right underneath this. And make sure that this is this has tension on it. So we have that done very nicely. You can see that right here. Now if we take the Army Navy we hold this underneath here. So then we go up and just cut it proximally. Okay. Then once you have that cut it should be in pretty good shape. So then we reach in and we pull and you have what you're going to do your tenodesis with. If you feel the epicondyle, you want to go a centimeter or so proximal and then a little bit posterior. The mistake is to be not in line with the epicondyle and be an anterior to it. So as long as you're in line with it and proximal, you're going to be in pretty good shape. Now you don't have to cut all the way down to bone. One of the things you can do is the end of this is very, very serrated. So we kind of go in here and just run it back and forth and take this soft tissue. I put my left thumb on. I know I'm a centimeter or so back and now we can hit it with the tap. Now when you use a screw this is a problem okay. Because what if I'm in the tunnel? The perf. I want the perfect position here. I want to see if I'm in the tunnel. Now I can go with the scope and look right in my tunnel. Okay, so you can see I didn't violate it. But what if I did violate the tunnel? The beauty of this is you can violate the tunnel. Stick your implant in because it's a soft implant. You can pull it back and it'll go right out of the tunnel against the cortex. So you can do this in any order that you want and still not worry about your graft, even after your graft is in. That's the beauty of this versus a staple or some sort of screw fixation that's going to go in here or a hard anchor, and then you tap this in. It's much more rigid than, than the FiberTaks for the shoulders. Again, this is specifically made for the knee. And then we can take the sutures out. And you can see the look at the color differential on the sutures. Okay. Then you want to take this, these bunch together with this little white pole suture. And you want to pull tight. This sets it. So if it is happens to be in your tunnel, you're going to pull back and it'll be against the cortex. You can either pull on it or if you want to make sure you're going to get both ends, you can put this. And pull hard. So that sets it. Now you can get rid of this right here. Now we're going to use the mini FiberLoop. And you pull 2 or 3 of these sutures. You don't do very much here just enough to grab the tendon. And you can sometimes put a little bit of force on here. So I like to lock one. It takes two seconds to put the extra suture in, but at least you can pull really hard and not worry about about pulling it off. Okay. Now it's ready to pull through. The LCL is right here, so it's very easy. It's coming off the epicondyle. I'll use either a knife or a little bovie. So we use a 15 blade here. Just be careful. You can feel it. Nice and easy. Do not. Do not cut the LCL itself. And then you can take something sharp, go right underneath. It. And pop right through. And then if you expand this a little bit and pop it, it'll open it up. And then you pull it so that that part goes right through. And then that's ready to go. Now the beautiful thing about this is you have these sutures all set. So if you take a snap and put it through the sutures, we grab these, we pull back up and through. So you want to make sure it's through both loops. And you can see here that that we have these pretty good. We can take the black one. So we have tension. We have this to 30 degrees. And you'll see us pull and it'll pull right down and tension where you want it. So we come back through. Now, when you have a longer graph like this one, you pull it. We push this over and now watch it. It's locked back down again. So there's no way it's going to slide off that slide through. So it's like using two staples. Fast simple very effective easy to see the difference. And then we just cut these. We cut this and we cut these. Now you're ready to pass your graph and finish your ACL. So we're going to go ahead and pull the graph up into the knee. And now we'll grab those blue ones so we can make sure we're we're tensioning this right. And then we want to make sure that we have a big enough incision here. So we're going to stretch this a second. I like to keep the internal brace on the back. So we'll pull here. It's sliding through pretty easy. So we'll pull a little bit more and you feel it pop through. Good. So now it's popped through. The through. The graft is on the back, and now we're going to pull up the graft. And then we want to look down here and take a look at this end here. So there we have the graft perfectly placed. You can't see your FiberTape because it's on the back. It's not going to affect the graft negatively. And then if we extend exactly where you want it. So the nice thing here is everything's connected. You see the FiberTape is already through the button. You put the adjustable loop down and you're ready to tighten this thing so we can bring this up. Eternal brace is through the button you got. The adjustable loop is through the button. Now your assistant holds the adjustable loop. That leg is at extension. And always extend this because if you don't you'll capture the graft. And then we have this come down and we tighten our button where we want it. That's perfect. And now we're ready to fix the internal brace just below it. Okay. Internal Innovation full extension. We have tension on here. Just like you use a normal SwiveLock. We can cut this suture. Okay, so now we're going to retension just to make sure we're taking any laxity out of the system. And we hold this again. Do this at full extension. We're good here. And then we're ready to go. So we got a good looking graft in the right place that we have an internal brace in. We have a mirror and it's a nice reconstruction.

Sommer Hammoud, MD (Philadelphia, PA), demonstrates a hashtag stitch configuration for radial meniscus repairs using the FiberStitch™ 1.5 implant.

 Radial Meniscus Repair Using the FiberStitch™ 1.5 Implant 

Hi, my name is Summer Hamoud. I'm from the Rothman Orthopedic Institute in Philadelphia. Today we're going to demonstrate the repair of a radial meniscus tear utilizing the hashtag suture configuration. So this is a right knee. We've created a radial tear at the posterior horn of the lateral meniscus. This is often seen at the same time as an ACL tear in young patients. This can have kind of very frayed edges as well. So these can be very challenging to repair but are really critical for the young patient and the long term health of their joint to get a nice repair. So we're going to talk a little bit about that. What I'll say is that here I'm coming through my initial lateral portal, which I like to make a little bit higher. But I almost always when I do a lateral meniscal repair because I like to come with my implants to the posterior horn from the ipsilateral side, is that often create a more inferior portal. And so you can see this line of trajectory towards the meniscus is much more direct and allows us to get around the around the condor without scuffing the condyle. So that's just one nice point there. I like to use these atraumatic very small, like the Torpedo or the curved furrow shaver to prepare either meniscal capsular junction or tear edges, and I'll typically just use it on forward. No. No suction. But in these challenging ones you can use a rasp as well for sure, but you can use this to freshen up the tear edges to enhance the biology and ultimate healing. You can always come away and use your suction. So we're going to utilize the hashtag suture configuration here. And so for this configuration I usually place my ripstop sutures on either side of the radial tear first. So we'll go ahead and start there. So I'm going to come in on the ipsilateral side again. When you come in with your sled to introduce the implant's a traumatically. This is a nice way to confirm your ability to reach all points on the meniscus that you want to reach with your implant prior to inserting the implant into the joint or deploying one of the limbs. So this I like very much. So in order not to injure the condyle, I'll typically flip that like that and it'll bring it in. I'll get as close to the radial tear configuration as possible. I'll come in. I'll puncture into the meniscus tissue and then reduce the meniscus. So in this case this is a radial tear. So you want to provide compression. So you don't want to distract the position of your implants by directing it more laterally. So we're going to go ahead and come through the capsule here. But kind of directing a little bit more centrally or medially. So here we're deploying our first. And then we'll come into the meniscus tissue for our second. Again utilize the curve in order to puncture the meniscal tissue. And if I go a little bit too far, I can always retract it a little bit gently so we can actually see the back side on this. And then again we're going to go ahead and reduce that. Got all that on some other good videos. So for these ripstop sutures these do not need to compress the meniscus significantly against the capsule. They're purely really providing our biomechanical ripstop for our horizontal mattress sutures. Go ahead and cut that first one. So we'll come in for our second ripstop suture. You can see here the atraumatic tip on this guide can help us reduce the meniscus and assess our positions. Got all that on there. So in this situation, we also have to be. We're getting close to the midline. So we want to be cognizant of the vessels. But oftentimes it's a little bit more useful to direct the curvature towards the midline initially. But then I will turn it away as I have here to avoid the midline structures more centrally. Again, always start peripherally with these because you'll obliterate your view. It'll just be more difficult to work behind the initial suture if you start centrally. Here's our second ripstop suture that we've placed. So now we're going to go ahead and introduce our first horizontal mattress stitch. Come in with our guide again. Again always important to start peripherally first and then progress centrally. It's important for those ripstop sutures to be as close to the radial tear as possible. Because sometimes you run out of real estate here, particularly as you get closer to the root. So we'll start with our more peripheral stitch. Again angling away from the vascular structures. And here as you see we're utilizing the FiberStitch 1.5. And with the much smaller puncture holes we can get really complex configurations really nicely. See that nice compression happening with the first compression loop. And now the second. We'll use our knot pusher cutter to complete the tensioning. So here we have that final tensioning. Nice compression across the peripheral portion. All right here we're going to put our more central. So here we see our initial tensioning of our more central stitch which is coming out really nice. I'm someone who doesn't mind a little bit of over tensioning on radial repairs because in case there is any loosening, as with weight bearing and compression ultimately, which I restrict for the first six weeks, I like a little bit of over reduction initially. And so here now is our final kind of introduction with the knot pusher cutter can do our final tensioning and do our cut. So this is our final construct. So again our ripstop sutures because again most of these clinically these edges of the tear are typically a little bit friable. You get a little bit of a mop n type appearance. Even in young patients they can be quite devastating. So sometimes you have to position these ripstop stitches even further away. But try to get them as close as possible without them ripping through. But the ripstop stitches. If you're just relying on these horizontal mattresses, you may easily get that rip through. So this is just a really nice construct for these very complex and challenging tears, which fortunately are not very common, but really present the sport surgeon some of their most challenging cases.

This animation demonstrates the technique for QuadLink™ all-inside ACL reconstruction (ACLR) using FiberTag® TightRope® II implants, ACL RetroConstruction™ guides, and the FlipCutter® III drill.
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.

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

Operationstechnik-Animationen

Visão geral incluindo as etapas relevantes de uma técnica cirúrgica Arthrex. Essas animações sempre incluem uma narração explicando o processo.

Animações de técnicas cirúrgicas

Descripción general que incluye los pasos relevantes de una técnica quirúrgica de Arthrex. Estas animaciones siempre incluyen una voz en off que explica el proceso.

Animaciones de técnicas quirúrgicas

Surgical Technique Animations

QuadLink™ All-Inside ACLR Using FiberTag® TightRope® II Implants and the InternalBrace™ Technique

The QuadLink construct includes a TightRope two implant to treat ACL injuries, and is available in a version optimized to support all graft types, with or without a preloaded FiberTape suture for the internal brace technique, allowing surgeons the flexibility to leverage cutting edge TightRope technology with the graft and technique best suited to the unique needs of every patient they treat. Minimally invasive graft harvest is easier and more reproducible using the QuadPro tendon harvester for quadriceps grafts. The FlipCutter three drill provides flexibility to drill sockets six millimeters and 7mm to 12mm in half size increments, all through a 3.5mm hole with a single device. A comprehensive portfolio of ACL and PCL marking hook guides, as well as additional instrumentation for the surgeon to perform the procedure, are available for this particular procedure. We'll be using the tibial ACL reconstruction drill guide and the Footprint Femoral ACL guide to place the ACL femoral guide over the ACL femoral footprint. Arthroscopically adjust the angle of the guide to the desired position and tunnel trajectory, and then lock into place. Push the ratcheting drill sleeve down to bone. Advance a FlipCutter three drill pin through the ACL femoral footprint. Tap the tapered portion of the stepped drill sleeve into the femur seven millimeters or until resistance is felt when reaching the femoral cortex. Using the wheel, deploy the FlipCutter three. Drill to the appropriate size and retrograde. Drill back to the sleeve to create a socket. Remove the FlipCutter three. Drill and pass a blue and white FiberSnare suture through the drill sleeve. Retrieve it from the lateral portal and dock it for later graft passage. Remove the stepped drill sleeve. Place the ACL tibial guide over the ACL tibial footprint. Arthroscopically. Adjust the angle of the guide to the desired tunnel position and tunnel trajectory, and then lock into place. Push the ratcheting drill sleeve down to bone. Advance the FlipCutter three. Drill through the ACL tibial footprint. Tap the tapered portion of the stepped drill sleeve into the tibia seven millimeters, or until resistance is felt when reaching the tibial cortex. Using the wheel, deploy the FlipCutter three. Drill to the appropriate size and retrograde. Drill back to the sleeve to create a socket. Remove the FlipCutter three. Drill and pass a black and white FiberSnare suture through the sleeve. Retrieve both the FiberSnare sutures from the medial portal and remove the stepped drill sleeve with the blue and white FiberSnare suture. Pass the femoral side of the QuadLink. Construct into the femoral socket until the button flips on the femoral cortex. Use the tensioning sutures of the TightRope two implant to advance the QuadLink. Construct into the femoral socket, with the black and white FiberSnare suture. Pass the FiberTape suture for the internal brace technique and the abs. Tightrope two. Implant into the tibia with the knee in extension. Use an 11mm, three hole concave button for tibial fixation of the QuadLink. Construct with the FiberTape sutures for the internal brace technique loaded through the larger oblong hole before it, tensioning the QuadLink construct anchor the FiberTape sutures for the internal brace technique using the ACL backup fixation kit. Using the spade tip drill followed by the 5.2mm tap, place the FiberTape suture for the internal brace technique into the eyelet and screw the 4.75mm SwiveLock anchor into the drilled hole. Take the knee through range of motion and then perform final tensioning on the QuadLink construct.

Matthew T. Provencher, MD (Vail, CO), demonstrates a meniscal root repair using the SutureLoc™ implant. Dr. Provencher also highlights benefits of the all-suture implant, including direct tibial fixation, double-loaded repair sutures, and retensioning.

Meniscal Root Repair Using the SutureLoc™ Implant

And Matthew Provencher from Vail, Colorado. And we're going to be talking today about the SutureLoc implant for knee meniscal root repair. The SutureLoc comes in a kit that has everything you need to do to accomplish a meniscal root repair. There is the meniscal Scorpion needle, a 2.4mm cannulated. Drill the nitinol passing wire, an eight millimeter by three centimeter passport cannula with two spacers, and the SutureLoc implant that comes prepackaged on a card. This is the SutureLoc implant that's actually been taken out of the card. But it's important to see here how the SutureLoc is going to work inside the knee in order to get a secure meniscal root repair. There are basically three parts of the SutureLoc implant. First is the part that's inside the knee where the sutures will do the meniscal root repair. The middle part is what is in the tibia to not only hold the repairs securely right under the tibia cortex, but also have the sheath in the tibial tunnel. The third part are the sutures, which do the conversion and actually pull the meniscus root, repair sutures into the tibial sheath. The SutureLoc implant is very unique in that it has the bunching area, as well as the splicing area to accommodate a secure repair sitting right under the tibial plateau, which is where the loop is on this suture sheath. This provides a very secure fixation rate from the tibial plateau to the meniscus root. The sutures that come out the tibia and come outside the sheath are what will be utilized to finalize the repair. But there's also a suture to help set the sheath and make sure that it is well bunched up under the tibial plateau. This is a 3D model that shows how the SutureLoc implant works inside the knee and specifically the tibia. These are the repair limbs that will be utilized to repair the meniscus root. This is the tibia cortex, in which the sheath will bunch up, under and securely hold the meniscus root. Repair. This is the tibia cancellous bone tunnel in which the SutureLoc sheath is deployed. This represents the anterior aspect of the tibia where the sutures come out in order to do the meniscus repair, but also to set the sheath with the sheath setting. Suture. Once the SutureLoc implant is deployed from the knee joint into the tibia in a retrograde fashion, the sheath comes into the cancellous portion of the tibia bone with the for repair sutures still coming out of the knee joint portal. Once the SutureLoc sheath is just inside the tibia cancellous portion. You can get good tactile feedback to know that this has been put in the correct position. The SutureLoc sheath is then bunched up under the tibia, using a combination of gentle back and forth motion on the four repair sutures, plus the meniscal SutureLoc sheath deployment suture. This shows the unique nature of this implant as it is deployed underneath the tibia cortex. The first thing to do is to pull the four suture limbs and gently set the sheath. You can see that the sheath bunches up right under the tibia cortex, and because of the unique nature of the design of the sheath, does not come back through the tibia, but securely holds right under the tibia cortex. In order to fully deploy the sheath and make sure you have secure fixation, just prior to doing the meniscus repair, you take the meniscal SutureLoc sheath setting suture, which is this one right here with a with a loop. Pull it back to ensure that the sheath is fully bunched up. You can see that the sheath bunches up in order to make sure that the sheath is fully set up against the tibia cortex. You gently toggle this back and forth until it is fully deployed and cinched up securely, right against the tibia cortex. The SutureLoc device is now ready for meniscus repair after the diagnostic arthroscopy is complete. You can easily visualize here a lateral meniscus complete root tear. The scope is in the lateral portal in order to start the diagnostic and also initial preparation of the meniscus root. Here you can see the meniscus root tear, which is a very typical tear right off the footprint of the posterior horn of the lateral meniscus tibia. There are some fibers posteriorly which you can also release depending on the chronicity of the tear. In order to get this mobilized, I use a grasper just to assess the mobility of the posterior horn of the meniscus, just prior to doing the repair and during the preparation, to make sure that you have adequate mobility of the meniscus to come back to the root footprint. Preparation of the meniscal tibial footprint is one of the most important parts of the case. In order to get good biologic healing response of this meniscus tissue. The arthroscope is now placed in the medial portal because the trajectory of the instruments to help with the preparation for this tear is going to be much easier. Now we're going to mark with the ss50 where we want to come out anatomically with the meniscus root guide. The point to point guide is really nice because you have not only the point to put on the meniscus root footprint. But you also have a really good aiming guide on top of the meniscus guide. One of the things I've found helpful when setting the meniscus point to point guide is to just gently tap the 2.4mm sheath with a mallet in order to fully set it up against the tibia cortex. This minimizes deflection of the 2.4mm drill pin. The meniscal point to point route guide is then removed at this point. One thing to keep in mind is that in hard tibia bone, occasionally the center drill tip may slightly become disengaged from the outer drill. If that's the case, you can redeploy the center drill tip and then re drill to make sure you get it fully deployed. In addition, it can also clean out any bone that may be at this orifice so that you can easily pass the night. And I'll wire the nitinol wire is then inserted and grasped through the knee in the medial portal through the passport. Occasionally atemi and the tibial spine. You may have to switch portals with the scope in order to get the right trajectory to grab this, but in this case, we're able to get the nitinol wire pretty easily through this cannula. We now want to remove the two four guide pin. This can either be done just with your hand or facilitation with pliers, but you also want to make sure your assistant holds the nitinol wire so that it stays in position. The nitinol wire is then replaced with a FiberLink suture. This will then be utilized to pass the SutureLoc implant when passing the FiberLink, you want to make sure that the loop stays outside the knee portal, and that you pass the single strand down through the tibia. The SutureLoc implant is then ready for passing through the passport and then down into the tibial tunnel. Keep in mind that these are the repair sutures, and this is what's going to be left coming out of the portal. And we're going to pass this in a retrograde fashion down in the tibia. When I load the FiberLink with the SutureLoc, you want to make sure that all of the sutures come through and that it comes just past the white end of the sheath. This is important for the SutureLoc to be able to deploy successfully and easily into the tibia. We're now going to deploy the SutureLoc into the knee. And we watch it come into the tunnel. You can see that the end of the splice and sheath is coming in, and we just slowly deliver it into the tibial tunnel. Once the FiberLink is out, I then pull the sutures so that we can manage deployment of the SutureLoc against the tibial plateau. So at this point, the SutureLoc sheath is almost fully deployed into the tibia. I generally have my assistant hold the scope at this point so I can manage deployment of the SutureLoc sheath. The key here is you want to just make sure that the mechanism that's going to be doing the bunching of the SutureLoc is just under the tibia. So this is the area that's going to be bunching up. I gently just roll my finger or pull my thumb down in a controlled fashion, and you'll almost feel just a little tiny clunk as it comes into the tibia. We're now going to deploy and bunch up the sheath under the tibia. In order to do this effectively, we're going to gently grab the four sutures out of the passport. I just put my finger against the passport. So it's a controlled poll and I put my finger on the tibia. So it's a controlled poll. And we're gently going to pull this back to set the sheath. You will feel a little bit of give and then the sutures will stop moving. Once that happens, I then do the setting suture which comes out the tibia. This is the black and blue suture that has a loop on it. And you're going to grab this and pull this down in a toggle fashion while controlling the sutures. Here I'm just going to gently pull on this. And this sets the sheath. This doesn't take too long, but you just want to make sure it's fully set right up against the tibia cortex. And the last thing you want to check is that you pull all four of these sutures, and you get no play or movement in those sutures. And now, you know, the sheath is fully secured against the tibial plateau. A hemostat is utilized so that the sutures don't accidentally deploy as you're managing the meniscus root repair. So now we have to manage the sutures. And one of the things that's key is I just want to first pass a vertical suture so that we have a mason Allen configuration in the back of this meniscus. This has been proven biomechanically to be superior when doing the doing the meniscus root repair. So in order to do this, we're going to bring. All the sutures that we're not using into the scope portal. So I'm going to temporarily bring the scope. Into the passport. The first blue suture is then brought through the lateral passport and will be loaded up on the Scorpion to do the vertical repair. Now the first suture is going to be a vertical configuration. And I always like looking at where the needle is going to come out and making sure that that first pass is really robust on the vertical suture configuration. In addition, we're going to make sure we're not too far over here because that will not be enough robust tissue. We want to have enough tissue that holds the suture in nicely. I gently tilt the meniscus Scorpion so that you can see the needle. And look at where this comes out. One pearl is to just slowly squeeze this needle and watch the needle and suture come through the jaws. We now have the first vertical repair suture in place. But now we have to put another suture from top down in order to complete the vertical repair. In this case, we'll utilize the meniscus Scorpion with a FiberLink. This will then allow retrograde passage of the suture for the vertical repair. The FiberLink suture is loaded into the meniscus Scorpion. And actually the link is loaded in. So you can pass it from bottom of the meniscus to top of the meniscus. And then we're going to retrograde down the suture through the link. So the right amount of tissue is grasp, keeping in mind you still need a reasonable bite to accomplish the vertical repair. You can always assess how the link looks after the repair. We're now going to load the FiberLink with the vertical repair suture and shuttle it into the meniscus. This will be the first step in the Mason Allen repair. The next step is then to convert this one. So we get this suture out of the way. But one of the key things here is when we convert it is to not pull it all the way in. So you can still put the meniscus Scorpion under the meniscus and finish the Mason Allen repair. So we load that to the purple line right here. We're going to take the hemostat off off the sheath so that you can then pull the blue and white to effect this conversion. So now I've got the blue and white. It's going to affect the conversion. The purple is right at the loop. We've confirmed that and we're good to go. So we don't want to pull it all the way down until we get the other horizontal suture to complete the Mason Allen in place. We're going to reclamp the sheath coming out of the tibia with the hemostat, so we don't inadvertently deploy it. We're now going to do the horizontal, which just entails one pass. Now one of the keys here is to come just off the edge of the vertical repair suture. And then slide it over and just look where that prior suture is. So we get a good Mason Allen configuration here. You can see the suture really nicely. We're going to be just off axis on that. So this will be a really nice horizontal suture. We're then going to twist just a little bit here with the Scorpion so that you don't run into the condyle and slowly squeeze the needle to deploy the suture. We're just going to check the Mason Allen configuration. You can see we have this vertical component followed by the horizontal component. The next step is to convert the horizontal suture. We'll grab the remaining conversion stitch load it and then pass it through the sheath. We have to make sure that we take off the hemostat before we do the passing. We're going to load this again to the purple and then deploy this. The black and white suture is the one that will be used to convert the horizontal limb. Now we have the horizontal and our vertical limbs ready to final tension. So the last step really is final tensioning. And with the Mason Allen configuration I like doing sequential tensioning, starting first with the vertical blue stitch and then with the white stitch, and then alternating gently back and forth until you affect the final repair. Alternating stitches. You can see how this holds it down. And there's our final meniscus root repair with a mason Allen configuration. One last thing to do is just to probe it and assess the overall tension on the repair. You can see nicely that the meniscus has been approximated back to the root.

A product of relentless innovation, the FiberStitch™ 1.5 implant features a new, low-profile delivery needle, resulting in less tissue morbidity and smaller implants that provide stronger fixation compared to previous FiberStitch implants.1
The implant is available in multiple configurations, including a straight option, a 12˚ up curve, a 24˚ up curve, and a 12˚ reverse curve. Made with 2-0 coreless FiberWire® suture, soft anchors provide secure arthroscopic all-inside knotless meniscal repair with proven superiority when compared to traditional PEEK implant systems.2
References
1. Arthrex, Inc. Data on file (APT-06136). Naples, FL; 2023.
2. Bachmaier S, Krych AJ, Smith PA, et al. Primary fixation and cyclic performance of single-stitch all-inside and inside-out meniscal devices for repairing vertical longitudinal meniscal tears. Am J Sports Med. 2022;50(10):2705-2713.doi:10.1177/03635465221107086

FiberStitch™ 1.5 All-Inside Meniscus Repair Surgical Technique

Fiberstitch. All-inside. Meniscus repair. Determine the depth of penetration using the laser lines on the tip of the FiberStitch and set the depth. Stop accordingly by depressing and advancing the tab to the desired setting. Penetrate the tissue to the desired depth. Roll the deployment wheel backwards to the hard. Stop to deliver the first implant role, the deployment. We'll forward to the hard stop to load the second implant. Advance the needle tip through the tissue in the desired location, and roll the deployment wheel backwards to the hard stop. Roll the wheel forward to complete delivery of the second implant. Upon removing the device from the joint, a suture loop and a loose end of suture will be outside of the portal. Outside of the joint, pinch all the sutures and gently pull to set the implants. Identify the suture loop. Use a probe or similar device to pull the loop suture to compress the suture anchors. Tighten the repair construct by pulling the single suture to reduce the tissue. Introduce a suture cutter to cut the suture at the tissue.

Wiemi A. Douoguih, MD (Washington, DC), demonstrates a new technique for tibial spine avulsion repair using FiberRing™ sutures and the ACL Repair TightRope® implant.
 
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.

Tibial Spine Avulsion Repair Using the ACL Repair TightRope® Implant With FiberRing™ Sutures

Hi, I'm Doctor William DualWave, regional medical director for MedStar Sports Medicine, MedStar Health in Washington, DC. Today, I'm going to be talking to you about my technique for tibial spine avulsion fracture with internal brace. On top you're going to see the FlipCutter three for the tibial tunnel. Below that is the FiberSnare in black. Then you see the TightRope pin for femoral internal brace, followed by the FiberSnare in blue and white. You'll then see two fiber rings for ligament repair. And then you have the FiberTape loaded on a TightRope button for the internal brace technique. Then you have the repair TightRope. Finally, there's a SwiveLock to fixate the internal brace on the tibia. So here we have a tibial spine avulsion fracture. If you look you can see the bony component underneath. And here's this distal tibial insertion of the ACL disruption. So we're going to fix this today using a FiberRing technique and an internal brace. If you look up here you can trace this approximately. You see that the femoral origin is intact. Femoral origin of the ACL is intact up here. And then we have an isolated distal avulsion. So here I typically use a two passport. We're going to insert this into the joint. So the first thing that we're going to do today is we're going to going to drill our tibial tunnel through the tibial tunnel. We're going to pass our repair sutures, but we're also going to pass our internal brace. So we're going to try to get in here right in the base of our tibial tunnel. So here we're drilling right in the anterior margin of the tibial footprint of the ACL. We're going to pass our FlipCutter. We don't deploy it. So we're going to pass our black FiberSnare in through our tunnel that we just drilled. And this is going to be used to pass not only our repair sutures but our internal brace all through the same tunnel. Okay. So now we're delivering the FiberSnare. So now we have our passing suture, and we'll dock that here outside the Anteromedial portal. So now what we're going to do is we're going to turn our attention to the femoral side and get ready to pass it to our internal brace. So now we're going to take our TightRope pin in preparation for creating passage for our internal brace. And we're going to go right through the femoral footprint. Okay. So now we're going to pull our blue white FiberSnare into the femoral tunnel. And then we're just going to dock our suture here. And then we're going to proceed to repair the tibial spine avulsion. So we're going to take our FiberRing sutures first. So first I'm going to pass my suture here. It's our first fiber ring. And we're going to load up our second fiber ring and pass it on the lateral side of the ligament. Okay. Here it's going to be our second suture a little more proximally a little more laterally. Okay. And we'll pull that snug. There we go. So we're going to pass the more medial distal suture first. So I'm going to dock this outside my accessory anteromedial portal. We'll pull this out first here. And that will allow us to work on the medial suture without having to worry about suture management issues. So now we've cut the suture so that we can bring our repair TightRope in. So we're going to bring our repair TightRope up. Here's our repair TightRope. So we're going to start with number one. And if you notice here this is sort of our passing suture. This is what's going to ultimately become the TightRope two. So we're going to pass this through the loop. And then I'm gonna have my assistant pull that through. And this is going to load our first fiber ring. So now we're going to retrieve the second suture. So if you see here this, this suture is all in one. And we're actually going to cut this just distal this convergent point. So now I'm going to pass this through again and then use the other side of our FiberRing passage device to bring it into the knee. And there we are. So now we've passed it through both. And I'm going to continue to pull this through until I am completely loaded the loop from my TightRope. So now we're going to cut this black and white suture. And we're going to discard that. So then you always want to make sure that that you're not tangled as you as you go in. So we're going to take this, our KingFisher and slide it down through the passport just to make sure we're not tangled, which we're not. And now we can proceed to the next step. Cut this black and white because that's just our passing suture. We'll discard that. Now I'm going to free up the second part of this suture. So we're going to take this tail. And the tail is going to go through the loop that's docked outside of our passport cannula. So once we've passed that through there, we're going to pass it through the wire loop in the card. And I'm going to have my after I kind of hold it, pinch it and have my assistant pull that through. And sometimes you got to pull firmly. There it goes. And now you've loaded your TightRope two. So if you look on the back, we're going to release this and loosen everything up. And then we open up the card and we just pull it through. So you have plenty of length. We don't need all this length. And we're going to shorten it down just for ease of passage and to prevent getting tangled in the in the knee joint. Looking inside the joint here, you can see we've got our two FiberRing sutures and we're ready to go. So now we're going to create an internal brace with cortical femoral fixation. And so I'm going to get my passing suture I'm going to come up here and I'm going to grab our passing suture. This is our blue white FiberSnare that we placed in here earlier. We're going to bring it out through the passport. All right. Now I'm going to have my assistant pass the two tails of our number five FiberWire suture that's embedded in our button through the FiberSnare. And we're going to draw this into the socket. We're going to carefully draw our button in through the tunnel that we drilled earlier. We're going to pull it out until it locks on the femoral cortex. Let's pull it back and see if we've locked it. So our button is locked on the femoral cortex now. And that's going to serve as our as our internal brace. So we've got our repair sutures, we've got our two fiber rings, and we have our FiberTape that's going to serve as an internal brace. And now we're going to draw this all through our tibial tunnel. So now we're going to take the internal brace off of our repair TightRope. We don't need this here in this setting. If we're doing an ACL repair on the opposite side on the femoral side, that this would serve as our internal brace. But we have to create a separate internal brace here. And so now we're going to draw all of this through. And you just want to make sure you're not tangled. Let's take our KingFisher. Again this is really critical. You really want to make sure each step of the way that you're not tangled. Because if you get tangled, it's going to be very difficult to kind of get your way out of it. And with that simple step, you can make this into a very simple procedure. Okay. So now we're going to going to draw this all down into the tunnel that we had drilled on the tibial side. There's the button. So now we're coming in. Now my button's out. The internal brace I can actually pull separately. There's the internal brace. So now we just pull this down. So here are my repair sutures tensioning down the distal stump of the ACL. And here's my internal brace. Once we've got that all set up we're going to use the winch mechanism on our TightRope. And we're going to secure our repair. That's the first step. Yep. So I'm going to hold the button as we tension this down to the tibia. So now we're going to do is we're going to tension down our repair suture I like to bring it up to within 20 degrees of extension. And now we're going to bring this button down to the anteromedial tibial cortex. Sort of guiding it right down onto the anterior tibial cortex to make sure our soft tissues are freed from around the button. And then we'll continue to tighten it down so you can tighten it a little bit more. And the nice thing about this technique is you can always retension it. That's perfect. So now that we've had we have that down, now we're going to work on our internal brace. And then we'll replace that with the tap. Perfect. So now we're going to pass our internal brace sutures into the 4.75mm SwiveLock. And you don't want this to be too tight. So what I'll actually do is as we pull this back out, I'll have a little bit of slack built into this. So I kind of go past where my hole is going to be. Find our hole. I'm going to unclean our number two FiberWire suture. And so you can load this. Make sure you're in there about 10 pounds of pressure. It's not going anywhere. We know we're well seated. So before we're done I always like to do my Lachman. Take it through a range of motion. And if for some reason it's not tight enough. The beauty of this is that you can retension your repair sutures. So after you're done, if for some reason you feel like you need to retension it, you can. We'll go take a look inside the knee. So you look here. Here's our internal brace. Nice tension. The internal brace. Real nice tension in our ACL. We've restored our tension. It's well secured. If you're concerned about it, you can tension it some more. We're secure on one side, we're secure on another. We've restored nice tension in the ACL. We haven't over tightened this. I can kind of fit my probe underneath which is good. And I'm very pleased with that construct. So post-operatively I don't treat these any any differently than I would an ACL reconstruction. In general, these tend to move faster because you haven't harvested a graft from somewhere else in the knee. You've preserved proprioception because you've kept the native ACL, so they tend to meet their milestones faster. But the protocol is the same. I found in general that these patients tend to get back a little bit earlier to their activities from a functional standpoint, but this is just a nice technique that you can add to your armamentarium.

The FiberTag® TightRope® implant offers improved performance and reduces quadriceps tendon graft preparation time.1 A FiberTag suture is prestitched onto a TightRope II implant and the GraftClamp instrument is used to hold the tendon and suture card while the graft is prepared.&nbsp;
 
Reference 
1. Arthrex, Inc. Data on file (APT-04275). Naples, FL; 2019.

FiberTag® TightRope® II Graft Preparation

The FiberTag TightRope two implant builds on Arthrex. S legacy of innovation in ACL graft fixation technology by adding optimized features to the revolutionary FiberTag TightRope implant design. The flat tape loop and tensioning strands provide improved strength, feel, and handling. The redesigned cortical button includes a proprietary knotless fifth locking mechanism for increased strength and resistance to cyclic displacement, and allows for precise incremental tensioning of the construct after final fixation. The FiberTag TightRope two implant is available with a preloaded FiberTape suture for the internal brace technique, proven in peer reviewed research to be associated with less pain, improved patient reported outcomes, and a faster and higher rate of return to pre-injury level of activity. Alternatively, the FiberTag TightRope two implant is available preloaded with an additional flipping suture for optimized cortical button deployment. New, shorter locking splices create a shorter minimum loop length to maximize the amount of graft in the socket. A straight tapered needle makes graft suturing smooth and effortless. And an enhanced SutureCast design improves suture management during implant assembly. Mark the graft circumferentially at the desired length of stitching. Load the FiberTag TightRope two SutureCast onto the graft clamp instrument. It's important to fully seat the card into the slot in the jaw of the instrument. The FiberTag implant can be pushed onto the tooth of the graft clamp for further stabilization. Clamp the graft clamp approximately two millimeters from the end of the graft. Pass the improved tapered needle at the marking to provisionally extend the FiberTag implant along the graft. Use the standard FiberLoop technique with two SpeedWhip stitches, working toward the suture card and ensuring the FiberTag implant is captured with each needle pass. After the two SpeedWhip stitches are performed, insert the Insert the needle through the slot in the SutureCast, ensuring the needle passes over the TightRope loop. Place two additional SpeedWhip stitches working back down the FiberTak implant, forming a locking style stitch. Pass the needle into the tissue beyond the end of the FiberTag implant. Cut one suture loop just below the suture. Splice near the needle, ensuring the needle is still attached to the opposite end. Wrap the suture limbs around the graft and tie them securely. Then cut the suture without the needle. Use the needle to bury the knot within the graft. Cut the remaining suture limb flush with the graft. Remove the FiberTag TightRope two suture card from the graft clamp and unclip the remaining sutures from the suture card. Prepare the opposite end of the graft with a FiberTag TightRope two ABS implant in a similar fashion.

Patrick A. Smith, MD (Naples, FL), demonstrates a novel technique for placing a peripheral stabilizing suture through the meniscal allograft. Dr. Smith secures the roots with SutureLoc™ implants in a Mason-Allen configuration, proven for optimal stability by a recent biomechanical study published in the Orthopedic Journal of Sports Medicine. View the study abstract <a href="https://journals.sagepub.com/doi/10.1177/23259671241239575?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">here</a>.

Meniscal Allograft Transplantation Using SutureLoc™ Implants and Peripheral Suture Augmentation

Introducing the SutureLoc™ implant, a soft, all-suture implant designed for joint line fixation of the meniscal root.&nbsp;

SutureLoc™ Implant

Arthrex is continuing our pace of innovation by being the first to market with an all suture implant for meniscal root repair. Introducing the SutureLoc implant, a soft all suture implant designed for joint line fixation of the meniscal root. A double loaded implant allowing for two repair stitches and one anchor pass. Repair sutures that are converted in line retention technology under direct visualization. Minimal bone removal utilizing a smaller drill pen. Going above and beyond. And innovating how surgeons treat their patients better. This is the Arthrex SutureLoc implant.