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Técnica de reconstrução da articulação AC crônica

A técnica de reconstrução da articulação AC crônica envolve a reconstrução de separações crônicas da articulação AC de forma anatômica, usando um enxerto de tendão com fixação mecânica. A técnica utiliza parafusos de tenodese de PEEK de 5,5 mm x 8 mm para obter uma fixação de enxerto forte na clavícula, permitindo a re-criação das bandas de ligamento conoide, trapezoide e coracoclavicular. O enxerto é protegido durante o processo de cicatrização usando um fio de FiberWire como fixação mecânica de apoio.

Shoulder

Arthroplasty Shoulder

Elbow

Imaging and Resection

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

Gregory S. DiFelice, MD (New York, NY), demonstrates an acute AC repair using a knotless, push-through AC implant. This procedure is performed through a small incision and the tunnels are drilled under fluoroscopic guidance. The implant can also be inserted under fluoroscopic guidance, allowing for a minimally invasive, percutaneous AC repair.

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

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Knotless Acromioclavicular Repair

Okay. We're here today to talk about the Knotless AC TightRope device. It's a rather simple device that's main focus is to be used to treat acute AC separations, where we're going to try and reduce the AC joint and see if we can get those ligaments to heal. You can see here we have the Knotless device that's coming through the large pec button. And as we go to the opposite end, you can see here that we have our clavicle button. We have a cadaver specimen here. We have mini c-arm coming in to try and give us a good fluoro shot so we can really localize that coracoid under the clavicle. Typically I use the beach chair setup in the operating room. We have the standard landmarks in the shoulder. We have the acromion, the clavicle, and the tip of the coracoid. But rather than use the arthroscopy to kind of localize our drillhole and pass our fixation device for this technique, we're going to simply use fluoro. And what that does is make it quicker and easier to easier to accomplish the same goal. Typically, I'll take the wire that we're going to use to drill, and I'll localize where we are for the coracoid. Now, the coracoid has quite a number of variations, and what we're trying to do is get towards the base of it, as you can see here. And I think there, we're pretty well centered. Now we can bring that up onto the top. And what we'll do is make a mark for our incision. And that's about all you need. You don't really need much for this procedure. Now, the one thing that's critically important is we want to be safe. And everybody knows that when we're drilling around the shoulder, we want to be cognizant of the nerves and vessels that pass by. So we want to make sure that we're drilling vertically through the two bones to the base of the coracoid, and we're going to try not to stray too posterior with that tip or to anterior. Either way is inappropriate. In addition, we want to be centered on the clavicle front to back so that we're trying to center Center ourselves on the clavicle. A to P and on the coracoid. Medial. Lateral. So we get a nice vertical compression vector to bring that clavicle down and allow the ligaments to heal. So we're going to make a small incision straight down to bone. Usually I'll use a freer elevator or something to clear off the periosteum a little bit. So we have a nice landing spot for our clavicle button. And then I'll feel with the elevator, the front of the clavicle, and the posterior aspect of the clavicle so that I get a good impression that I'm in the center. The incision is really too small to even place a retractor in, so we're just going to go percutaneous on this. The next thing we're going to do is take a fluoro shot. And it really looks nice here that we're centered on both the coracoid and the clavicle. It's important in both the setup and the positioning and the confirmation by fluoro that you're going in the correct direction in Direction in multiple planes. So what we're going to do now is just drill quadratically, and I'm going to leave the fluoro on so we can follow that. There goes the first cortex. There goes the second cortex. And now I can bounce. I'm bouncing on the base of the coracoid. And we're going to follow that through. There goes the third cortex and there goes the fourth cortex. You can see it's an extremely controlled maneuver. What we're going to take the pin out. And now we have this all in one device. So we're just going to exchange the two. Now you can use fluoro for this too. And here you see that we're at the top. And we're going to just tap down through the through the first cortex. Through the second cortex. Third cortex. And fourth cortex. At this point, we can remove the pin that holds that pec button on. And you'll see the pec button come free. In just a moment we're going to release the. We're going to take the pin out releasing the button. And we'll release the device from the top. In addition. Once we've done that, the handle is free. And I usually like to pull the handle out slowly so I can help to have that flip the button. As you can see there on fluoro, I push down so the button flips and then I remove that handle. And now we've flattened out that button on the undersurface of the coracoid very safely and effectively. Now on top we have the clavicle button. And it's through the Nautilus TightRope with the the latest TightRope technology. And we're just going to slowly advance by adjusting tension on either of the limbs, as you can see on the floor. We've brought it down nicely. We've got excellent tension in the system here. We're not going to over tighten because we don't want to over reduce that clavicle. We just want to get it down to where the AC joint is reduced symmetric to the opposite side. We've got great fixation. We've got we don't need to throw any backup knots with the new technology. And we can just cut that there. We've got a low profile button. So there you have it. About as quick and easy as you can get. Nice and safe because we're using floral guidance. And we've accomplished a percutaneous AC joint TightRope with the new AC TightRope device.

Peter Millett, MD, (Vail, CO) demonstrates his arthroscopic technique for a subacute AC joint reconstruction using the Dog Bone™ Button, FiberTape® and an allograft wrap around the coracoid. He utilizes a new adjustable AC guide to drill 3 mm tunnels in the clavicle and coracoid and uses a Switching Stick and Obturator to facilitate arthroscopic allograft passage around the coracoid.

Arthroscopic Subacute AC Joint Reconstruction Using the Dog Bone™ Button and Allograft

We're going to perform the shoulder arthroscopic AC reconstruction using cortical fixation buttons with a dog bone button and a clavicle button and a graft. Ac dislocation it's subacute. It's about six weeks old, and she's just not done well at all. With conservative treatment. You can see how unstable we did some floral views in here, and we're going to do an AC reconstruction of a right shoulder. So this is typical standard anterior portal that we use. Just make it a little bit high and a little bit on the lateral side. This is a five by seven millimeter blue Arthrex cannula I like this cannula because it slides in pretty easily. And then I'll take the shaver. We're going to use a tibialis allograft. It's being prepared now it's an eight millimeter graft. So we'll just clean up the joint here a little bit. You can see she has a little bit of arthritic changes already in her joint. So now the now the next step. Is to open the rotator interval. Typically here's the middle glenohumeral ligament right here. So we'll stay above that. And we'll stay below the superior gluteal ligament. And we'll do a little opening here much like you do for a subcoracoid decompression or to expose the coracoid for a coracoid plasty. We'll open that space. Just cut the capsule here until we see the coracoid. And then we'll skeletonize the coracoid, which kind of has a relatively low coracoid. So it's going to be hard to work underneath it from this portal. So what I always do is create an accessory anterior inferior portal so that we can work down below this and clear all this out so we can pass our graft and we can drill through it safely. At this point, I usually just put the arm in a little bit of forward flexion. I'm going to put in an 8.25mm cannula. So we're going to come in from the front here. And I'm a little bit high there, so I'll come just a little bit below that. Okay. This is an 8.25mm cannula. We'll come in from the front right there just behind the conjoint tendon and a coracoid. Next step is then to switch to a 70 degree scope so we can see medially. Now using this low portal I can get safely underneath the coracoid here and clean out all the tissues. I want to get down until I can really see along that anterior scapular body. So I make sure that I'm posterior enough on the coracoid when I do my reconstruction, extend the arm a little bit. So there you can see where it's starting to go, just into the anterior scapular body here. And that's that tells us that we're right at the base of the coracoid. So you can see it right here. It's just starting to turn down. Now, what I'll do is I'll usually just roughen this up just a little bit, because this is where our graft is going to go. So we want it to heal to the bone. So I just roughen the cortex a little bit. I'll take a spinal needle and I'll try and just go medial to the coracoid process here. And I should be able to see it as it comes through at this point. This helps us to figure out where we need to make our superior incision. There's our spinal needle right there. So that tells us that's as far medial as we're going to need to be with our incision. So our superior incision is going to be about here is all we're going to need. Just a small about a 2.5cm incision. And that's going to be used to pass our graft. And then at this point I'll take the bovie and I'll just split the central portion of the clavicle about two centimeters. So the medial limb is going to go on the posterior side of the clavicle. So I'll clear off the periosteum here posteriorly and then the lateral limb, which would be the trapezoid ligament, is going to be anterior. So I'll clear that off here anteriorly. This is a special guide that we've made that allows it to pivot. The idea is for this to sit right under the coracoid right here. And then we can adjust the angle a little bit. But it can rotate a little bit to make sure it sits perfectly. So here you can see it's going in just percutaneously. You can see how it sits right in the base of the coracoid here. You can adjust how far you are medial by adjusting the amount of the see here. Now we're going to drill our pin. Now it should start to see it come out. There it is. And then we'll take the guide out. And we'll double check and make sure we like it. Good. So it looks like we're in the center of the coracoid. There. We There's our suture. We'll grab it and retrieve it here. We'll do is we'll thread our button in. So I'll just make a loop in the bottom one. I use the dog bone, which is a button specifically designed for fixation on the inferior surface of the coracoid. We've loaded the dog bone here with two strands of FiberTape, so it's very strong, and we've colored the ends of one of the strands so we can tell which strand is which. So we'll pull this through. All right. So now what I usually do is just take the button and put a KingFisher grasper on it to help guide it into place. Okay. So there it's going into place. There it's seated so you can see it's right on the bottom of the coracoid there. And now we're going to add a graft because it's more of a chronic situation. So I'll just clear up this subcoracoid space here so we can see. Well, what I've been using is a switching stick to pass the graft and some cannula dilators. So we'll come posteriorly to rebuild the conoid ligament. So you can see the switching stick coming in. We can just clear out some of the periosteum by the pectoralis minor. So the next step then is going to be to put an eight millimeter cannula dilator over that. So this actually serves as a soft tissue dilator so that the graft can pass easily. So I'll put a KingFisher grasper in through this low anterior portal here. So we'll put a FiberStick in from superior. We just leave the little inserter on. It makes it a little bit more rigid so it's easy to pass. And there we have our suture pass medial to the coracoid. That's the most difficult part. Once that's done, we'll just put a loop to put our graft around. Okay. And now we'll take our switching stick back. And this time we'll come in here to the clavicle and lateral to the coracoid, as you see here. And again we'll dilate it with a cannula dilator. So we make a soft tissue tunnel. We'll come in with our other FiberStick. This time it'll be a TigerStick so we can tell them apart. There we go. Again. Retrieve that out our anterior portal. So we're ready for our graft now. We've got our sutures all passed. We've created soft tissue tunnels, and now we can come through with our graft. And we usually use an eight millimeter graft. You can see it's a robust graft. When we used to drill holes in the clavicle, we were limited in our graft size because the graft had to fit through one of the bone tunnels. But now using this technique, just going around the clavicle, we can use a larger graft. And we don't have any risk of fracturing the clavicle from our tunnels. As it comes around Arthroscopically, you'll be able to see the graph come in here. And we don't have any any trouble passing it because we've already dilated it. And then we'll pull it out through that anterior cannula and then back up. And now laterally around the coracoid process you can see here it's going to come up lateral. Good. Now it's around everything. And it's right in that area that we bird the bone a little bit. So hopefully that will heal to the bone. And now it's just a matter of reducing the clavicle and fixing the graft. So we can take our scope out at this point. And all our work now is going to be on the top. So this is a cortical button contoured to fit on the top of the clavicle. We put the two strands that are together that are one pair through one side. And then we'll thread the other two through. Good. And now we'll reduce it. You can see here where the button is. And now what we'll do is we'll secure the button to itself. First step is to tie it down. So we've got one half hitch in it. My assistant will push down on the clavicle. Someone will push up on the humerus a little bit. The arm holder really helps with that. Feels reduced. We'll put two half hitches in it. Now we'll come in with floral and just check. Make sure that it's reduced fully. That looks like it's down. Knife, please. So now at this point we'll make sure our graph doesn't have any slack in it. And then we'll tie our graft to itself. Okay. Wonderful. So we can cut off the residual graft. You could potentially take these limbs and bring them over to the acromion if you wanted to. I don't typically do that. The graft sits on top of the not stacked, so it helps to protect it a little bit. So I'll take the fascia which I elevated off before, and I'll sew the graft into that to add some horizontal stability to the construct. As I close the fascia. So this is our final incision. It's about three to 3.5cm.

Augustus D. Mazzocca, MD, (Farmington, CT) discusses anterior/posterior stability as it relates to acromioclavicular (AC) injuries. He shows the latest techniques, including AC InternalBrace™ ligament augmentation, and presents biomechanical testing results for each technique.

A video of a live presentation reviewing Arthrex products or techniques.

Video einer Live-Präsentation, die Arthrex Produkte oder Techniken überprüft.

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Anterior/Posterior Stabilization of the AC Joint

They're showing a lot of instability. So the yellow clavicle's going around and forget it. We're going to move on. We don't have any time. This is a study we did in 2011, which shows what the native AC joint did both anterior and posterior. And then when you just cut the inferior capsule, then what it was with five millimeters, ten millimeters and the whole thing torn. And the idea we're showing here is that the AC joint, just by its bony congruity, has some stability. So this is one of the main arguments that we always had. If you're doing an operation for instability, then we try to keep that. There are many, many ways to stabilize the AC joint. This was a paper that was published in 2014 where this was using the excess graft from the ECR. This was an Intramedullary AC reconstruction that had tested Trans acromion AC by Grutter and Peterson. The eight turn AC recon. So these are all kind of variations on the same theme, which is to try to do something besides at the AC to the AC. And what we found was most of them did a very good job taking care of anterior posterior superior, definitely, but also anterior posteriorly has always been a problem. And with that being said, there was more stuff. So these are some videos of what the intact AC joint looks like. And then this is a video. Showing just the superior. So you can see that the anterior and posterior are still intact, but you can see the amount of motion that you get there exposed especially posteriorly rotation and posterior translation. So there's been a lot of good work that's been done with other types of procedures. This would be the AC brace that Doctor Millett was talking about. We have a 3.5 swivel lock on the acromion and a 4.75 on the clavicle. There was a posterior brace where this was done posteriorly to try to eliminate the fact that we had posterior translation and posterior rotation. There is a SpeedFix where you use the the acromion back to the clavicle with a SpeedFix type of procedure. Then there was a no anchor, which is a type of box where you can see drill holes are made through the acromion and the clavicle and tied in the front. Then the kind of. We call it the Munich brace. But this is what they do. Arthroscopically with a kind of X pattern. And we have a fellow from Tokyo, Japan who was part of this study looking at the superior capsule. And then they went and tried to recreate that using FiberTape. And those are both the Tokyo repair and anatomic repair. This is our biomechanical setup, which allowed us to test both anterior and posterior translation on the left, as well as posterior rotation in the same specimen without moving the specimen. So this was a new advance for us to try to test and try to understand the posterior rotation component of this. This shows how much force it takes to posteriorly translate ten millimeters. The higher the force, the stronger repair. And you can see that this group to the left is just a repair repair with the cut and the repair with the dogbone repair of the CC ligaments. And then how much torque it takes to really rotate. And you can see that from the native that most of these really aren't doing a great job with posterior rotation. So that's really still the frontier that we're still working on. I think we're doing a much better job at stabilizing anterior and posterior. And just to summarize, tremendous motion at the AC joint, irrespective of damage to the conventional CC, horizontal and stability is really felt to be the major factor in clinical failure I believe. Anterior posterior rotation at the AC joint is significant. And really, all the reconstructions that we've looked at so far are still pretty weak in this. The internal brace suture reconstruction without a distal clavicle excision, I think, is doing a very good job of taking care of that horizontal instability, but not the rotation.

Anatomic Coracoclavicular Ligament Reconstruction for the Treatment of Chronic AC Joint Separations Featuring the Bio-Tenodesis™ System

This is the AnaToemic coracoclavicular ligament reconstruction for chronic unstable acromioclavicular joint or AC separations. Well, here at the University of Connecticut, we've been able to do perhaps some landmark evaluation of AC joint reconstructions. One of the things that's happened is a more definitive anatomic relationship of the conoid and trapezoid ligaments. And then what we've done today is we've applied this basic science research in an attempt to improve the surgical results in the treatment of AC joint instability. If you want to focus on the important aspects of this procedure, first there needs to be a very meticulous exposure of the distal clavicle when you go through the deltoid trapezium interval and creating a very robust fascial capsular layer, if you will, or fascia periosteal layer that you can repair at the end. I think that's very, very critical. The second thing is the manner in which the distal clavicle is resected. I think we don't have to take the traditional two or 2.5cm, but in fact maybe 8 to 10 millimeter resection and then beveling posterior to prevent posterior impingement of the distal clavicle. That's another important surgical caveat. The next one is to expose the coracoid. And I think that that needs to be done inside that reflected deltoid muscle and fascial layer. Getting deep to that and exposing circumferentially around the coracoid for easier graft placement. The next caveat is perhaps the most important anatomically and perhaps biomechanically, and that is through the anatomic work to make sure that using a guidewire that you get as close to the tunnel orientation of the normal conoid and trapezoid ligaments. So if you notice how Gus did that with measuring 35mm medial from his distal clavicle resection and then angling superior posterior to anterior inferior, trying to reproduce the direction and alignment of that ligament and then correspondingly 15mm more medially, doing the same for the trapezoid ligament. The next caveat that's very important is pre tapping and those holes, and being sure that you can deliver or introduce the bio screws without difficulty so that you can get the screws to pass easier and still have a good fit. Today we have a chronic grade three in a 27 year old male. One of the reasons why there is so much force at the AC joint, and it stays persistently painful in some people, is because there's a constant load applied to it. The most important bony landmark that we'll see here is really the coracoid process. You can see his disrupted AC joint here and although not confirmed on the x rays, he has significant amount of trapezius pain, especially with forward elevation. Since we know from osteological measurements that the conoid and trapezoid ligaments are roughly 45mm medial to the lateral aspect of the clavicle. One thing to be aware of is that the coronoid ligament, or the more medial ligament, really is a posterior attachment, and the trapezoid ligament or the anterior more anterior ligament is more of a midline. So we will make a incision and Langer's lines from the coracoid process to the posterior aspect of the clavicle. Here is the anterior deltoid musculature and fascia. Here is the posterior aspect of our clavicle and the trapezius fascia and musculature. What we'll now do is do is make a horizontal incision, splitting this clavicle into two exact pieces and retract in its entirety, the deltoid and its fascia anteriorly, and the trapezius and its fascia posteriorly. There's the meniscal remnant that's in the AC joint. You can see the damage, how damage it is. This whole clavicle here is not the joint. The joint is just this part right here. So one centimeter over is to here. And then we want to cut this so that it doesn't posteriorly impinge into the spine of the scapula. Most people will try to cut this off. We do not recommend that at this time because this is the area that's involved with the joint. And then we posteriorly modify that. So now we'll take a rasp here and just smooth this off making sure there's no sharp edges. So remember, you want to be about 45mm medial or directly in line with the coracoid process right here to make our conoid and trapezoid. We're now exposing the underside of the clavicle for our placement of our tunnels and access to the coracoid process. What I'm doing now is tagging the undersurface of the deltoid, deltoid fascia, so that we can then repair this in a nice thick flap. So here is conoid going medial. And here's trapezoid going laterally. Laterally. More anteriorly. Conoid very posterior ligament. They're both coming from the base which is right down here. You can see that that's the base of the coracoid process right there. This device you can see it can either go from lateral to medial and up Or if you'd like, you can come down and go medial to the lateral. But we're going to go lateral to medial. We come in around the base and all we do is bring our wire through. And I'll take a fiber wire please. We take one and put it through straight. And then we take the other doubled over one of these ends. This will be our non-biologic fixation. We then take a loop of fiber wire and place that as well. And that's going to be to pass our graft. And now we will just extract the device and we'll pass our sutures around. The next step now will be to prepare our bone tunnels. Remember that we wanted to have our bone tunnels approximately 45mm away from the distal or the lateral edge of the clavicle, or 35mm away from the edge of our clavicle after excision. And as you as you can see, we are in the correct position. What we want to do then is drill our medial tunnel, medial to this to recreate the conoid and trapezoid, and then roughly 15mm away in the mid portion of our clavicle. Drill the trapezoid to drill more medial. And drill this conoid. You want to be in a more medial position. Occasionally, the head will get in your way so that you can move the patient's head to gain more medial access. We like to go at approximately a 45 degree angle pointed towards the coronoid process. Once again roughly 45 to 30 degrees. And we'll drill down. We try to parallel our bone tunnels. Our graft preparation. Right now you can use either allograft or autograft. We use Allograft. In this patient, you need to pretension a frozen allograft to eliminate the creep in the collagen bundles. We tubular ize it to make it stronger, and also so that it's easier to handle. We then will ream our bone tunnels according to its size. This graft measures 6.0mm. So we will start with a six millimeter tunnel. There you go. We do not ream out, we pull it out. One important thing to mention is the taper on the screws is significant. So if you feel as you do this procedure that you're getting a good bite on the first 1 or 2 screws of your tenodesis screw, you need to back it out and ream up by five millimeters. This set has five millimeter cannulated reamers to accommodate that. We put two passing sutures to ease our transition of our graph. And from the beginning you'll remember that we passed a loop as well. So now what we'll do is we'll take one end of our graph that we're going to take our loop that we passed earlier and put our one end of our graph through that. And now we'll pass this around the base of the coracoid process. We tap a hole for the interference screw fit. And we repeat the process for the trapezoid tunnel. Now we'll take two more sutures, please, to put down the bone tunnels for passing. Pull the graph through the tunnel and its non-biological counterpart. That's nice. So here's the Odysseus driver. Our 5.5mm screw. Make sure the thumb pads all the way back. We take our non-biological suture, put that in the nitinol wire, and you can hold that for me. And then we'll put that through the center portion of the screw, so that we have the ability to tie this over the cantellated portion of the screw. Once we're in, we need the tendon and the posterior aspect because we want the tendon as posterior as possible. We have our non-biological fixation through the screw itself, and now we will just insert the screw over the top of itself. We go all the way down till it's flush with the top of the clavicle, which looks good right there. Okay, now coming out. Because of the internal friction, oftentimes you have to mallet it out. Now, what we will do in one motion we're going to raise up the arm. Two we will reduce the clavicle onto the base of the coracoid. Tightening up the graft in a over reduction type maneuver. So once again we will repeat. We've created the conoid and trapezoid ligaments which are the ligaments. And as you can see from the position of our tunnels we tried to place those as posterior as possible, eliminating the ability of the clavicle to move posteriorly, impacting onto the base of the spine of the scapula, causing pain. Now we are reduced and you can see that you have the conoid and the trapezoid limbs recreating your bundles. So now we're tying down our non-biological portion that will help it heal. Then what we can do is sew these sideways to one another. Now we sew the two ends of the graph together. Now what we're going to do is our previously tagged suture on the deep portion of the deltoid fascia. As you can see here, will now be sewed or reattached to the trapezius fascia, which is right here with non-absorbable polyester polyethylene suture and then standard wound closure after that. Post-operatively. Again we have to have to allow for soft tissue healing in a tunnel. The patient will be placed into a shoulder immobilizer supporting the upper extremity for about six weeks, allowing gentle codman's and elbow and wrist exercises. Then we try to regain his range of motion and begin general cuff strengthening. Scapular muscle stabilizer strengthening program. After that, probably don't allow these guys to return to full sports activity or labor for about four months. For information on the Arthrex Surgical Skills Training program, contact Arthrex at one 800 933 7001 or visit the Arthrex website at arthrex.com. This program was sponsored by an educational grant from Arthrex incorporated.

A step-by-step demonstration of how a product would (or could) be used in a surgical technique.

Eine schrittweise Demonstration, wie ein Produkt in einer Operationsanleitung verwendet werden würde (oder könnte).

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Demonstração passo a passo de como um produto seria utilizado em uma técnica cirúrgica.

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Anatomic Coracoclavicular Reconstruction - For Treatment of Chronic Acromioclavicular (AC) Instabilities

Tenodesis Screw, PEEK, 5.5 mm x 8 mm

PEEK Tenodesis Schraube, 5.5 x 8.0 mm, steril, IM

Tornillo Tenodesis de PEEK, Ø 5.5 mm x 8 mm

Parafuso de interferência em PEEK, 5,5 x 8mm

Bio-Tenodesis Screw, 5.5 mm x 15 mm

Bio-Tenodesis Schraube, 5.5 x 15 mm, steril, IM

Tornillo Bio-Tenodesis, Ø 5.5 mm x 15 mm

BROCA CIRURGICA DE 4.0MM CANULADA EM 2.4MM

Long Driver for 15 mm Bio-Tenodesis Screw

Schraubendreher für 15.0 mm Bio-Tenodesis Schraube (AR-1547B, AR-1555B,AR-1562B, AR-1350-55/-475, AR-1655PS)

Destornillador para tornillo Bio-Tenodesis de Ø 15 mm

CHAVE PARA PARAFUSO BIO-TENODESIS DE 15 MM

Driver for 10 mm Bio-Tenodesis Screw

Schraubendreher für 10.0 mm Bio-Tenodesis Schraube (AR-1540B)

Destornillador para tornillo Bio-Tenodesis de Ø 10 mm

CHAVE PARA PARAFUSO BIO-TENODESIS DE 10 MM

Driver for 23 mm Bio-Tenodesis Screw

Schraubendreher für 23.0 mm Bio-Tenodesis Schraube (AR-1570B, AR-1580Bund AR-1590B)

Destornillador para tornillo Bio-Tenodesis de 23 mm

CHAVE PARA PARAFUSO BIO-TENODESIS DE 23 MM

Schraubendreher für 12.0 mm Bio-Tenodesis Schraube (AR-1670B, AR-1680B)

Destornillador para tornillo Bio-Tenodesis de 12 mm

CHAVE PARA PARAFUSO BIO-TENODESIS DE 12 MM

Tenodesis Screw Instrumentation Case

Sterilisationscontainer für Tenodesis Schrauben (Obere Extremitäten)

Estuche de esterilización de tornillos Bio-Tenodesis

CAIXA PARA SET INSTRUMENTAL BIO-TENODESIS

Schraubendreher Handgriff mit Fadenverklemmung, Tropfenform

Mango en forma de lágrima con sujeción de sutura

Tenodesis Screw Instrumentation Set

Bio-Tenodesis Instrumentation Set, master set

Flexibler Obturator für chronische AC Gelenksrekonstruktion

Técnica de reconstrução da articulação AC crônica

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Apresentação vídeos (1)

Anterior/Posterior Stabilization of the AC Joint

Catálogos (1)

Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

Guias de técnicas cirúrgicas (1)

Anatomic Coracoclavicular Reconstruction - For Treatment of Chronic Acromioclavicular (AC) Instabilities

Vídeos de técnicas cirúrgicas (3)

Knotless Acromioclavicular Repair

Arthroscopic Subacute AC Joint Reconstruction Using the Dog Bone™ Button and Allograft

Anatomic Coracoclavicular Ligament Reconstruction for the Treatment of Chronic AC Joint Separations Featuring the Bio-Tenodesis™ System

Implantes (2)

AR-1655PS

AR-1555B

Instrumentação Necessária (1)

AR-1675S

Instrumentação Opcional (2)

AR-2252

AR-2275