Name: Tips and Pearls for the FiberTag® TightRope® SB Implant With the InternalBrace™ Technique
Uploaded: 2025-06-25T00:00:00Z
Duration: 8 min 25 s
Channel: Arthrex

Knee

Justin Boyle (Arthrex Group Product Manager) demonstrates tips and pearls for properly attaching and fixating FiberTag® TightRope® SB implants using a quadriceps tendon graft.
 
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-tobone fixation.

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VID1-007982-en-US | A | Tips and Pearls for the FiberTag® TightRope® SB Implant With the InternalBrace™ Technique

Justin Boyle

Human

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Tips and Pearls for the FiberTag® TightRope® SB Implant With the InternalBrace™ Technique

Hi, I'm Justin Boyle, group product manager for the knee ligament team. And today I'm going to show you some tips and pearls for using the new fiber tag tightrope SBM plant doing a quad link all inside ACL technique. So you can see the packaging is very similar to the existing fiber tag. Tightrope two. The main difference here is that it uses a new soft button implant instead of the standard titanium implant. You can see the yellow color here is actually a radiopaque yarn that allows the surgeon to see the button deployed on the cortex. We're also going to show the new sliding clamps designed for the fiber tag tightrope, and then a new soft tissue version. So we're going to load the new implant card very similar to how we load the existing tenaculum. So we're going to slide the card until it has a hard stop on the actual instrument. And then we're going to pre pierce our fiber tag here. So once we clamp down we've got a nice hold of the graft. I'm going to take the thumb screw here. Turn that to make sure it's nice and tight. Once I've got a good hold on it. Now I can go ahead and load it onto the sliding post. And then I can just put it under some initial tension. All right. So you can see here we've got the board. We've rotated it so it's perpendicular to us. We've got our soft tissue clamp closest to us. We've got the fiber tag tightrope card and clamp away from us. I found this is just much easier, much more efficient to do the suturing of the graft. So now we're going to do our initial needle pass through the graft. This is going to lay down the tag nice and flat. If you pinch down on the tag and then pull one limb through at a time, it'll help it from getting twisted up as you're popping it through the graft. So you can see there it lays down the fiber tag nice and flat. And then now to use the sliding mechanism on the clamp we're going to come from the bottom. We're going to grab our suture go up through the slot, bring it over to the other side and then come back out the bottom. One limb on each side. So we'll do our initial needle pass through the tag. Get that nice and tight. And then now we can use our sliding mechanism again to go deliver a suture back to the other side. So again, from the bottom up. Slide over. Back out the bottom. Now we'll do our second pass. Now I'm going to come up through the slot in the card. I'm going to work back down. So do another pass here. And then for extra reinforcement you can come back through the slot in the card. Just go on the other side of the tenaculum. Once we get our passes through now we can use our sliding mechanism again. I like to kick the the clamp over to one side, so I'm always entering and exiting from the same side. So up through the bottom slide over, back down. Now I'll do a couple more passes on the tag, and you can see once you get a hang of this it makes the graph prep so much more efficient, much faster. They don't need another set of hands to help hold it. Hold the instrument, the tenaculum instrument. Just a much better way of doing the graph prep. Then at this point, we can tie a knot and then move on to the other side of the graft. All right. So now we've prepped our graft. We've got our femoral implant here with our internal brace. And we've got our tibial implant. The construct is very similar. So now we're going to walk through all the different components of the construct. So we've got a blue fiberwire suture. That's going to be our leading suture. Just like normal. We've got our white tensioning strands for the tightrope. The main difference here technique wise, is that we're going to have this tiger wire suture that's going to stay behind out of our Am portal. And by pulling on the blue and the tiger in opposite directions, that's going to allow you to elongate the implant, elongate that ring shape implant. So it's nice and thin as it passes through the tunnel. You can see our internal brace here. And then moving to the tibial side of the construct. We've got the same blue leading suture, our white tensioning strands for the tightrope and then our tiger wire trailing suture that stays behind. So now we're going to show some tips and pearls when we go to implant the graft. So to lengthen the graft we've got our tibial side of our implant here. We're just going to show the lengthening process. You're going to want to grab the passing suture from the opposite side of the loop that you're going to lengthen. So if I want to lengthen the left side here I'm going to grab the blue and then pull the suture lengthen. And then I'll repeat that same process for the other side of the tightrope. Grab the tiger. Find out which side of the loop is the spliced end. And now pull to lengthen that. And then now we'll do the tibial side. Same process holding the tiger and then pulling on the right side of the implant. Now we're ready to go implant the device on the femur. You can see we've got our white tensioning strands, our blue passing suture. We've got our trailing tiger wire suture and then our internal brace. The key here before you implant is to pull the blue and the tiger in opposite directions. Make sure the implant is nice and skinny so we can go and plant it. So we're going to load up our blues and whites like we normally would. We're going to pass the blues and the whites. Take some of the slack out of the tightrope. So we've got the slack out of the tightrope. We've got our blues under tension. We've got our trailing tiger wire. Suture under tension. That's going to keep the implant nice and skinny. And now we're just going to keep pulling. Pulling. Pulling some resistance buttons pulling through. So now the button's starting to come through. Once we think the buttons all the way through the tunnel. Now we'll pull back on our fibertape. The key here is to not pull back on the tiger suture. If you pull back on the tiger suture, that's going to pull the implant back down the tunnel. So we're going to pull in our internal brace and we'll see the implant bunch up really nicely on the femur here. If you've pulled the implant through the IT band, if you want to unclip the implant, this new soft button has the technology where I can now extend the implant. And now I can bring it back down the tunnel. So it gives you a second chance at flipping the button on the cortex. So remember the key here is to hold the blue and the tiger in opposite directions. That'll allow us to pass the implant through. So now to deploy the implant, we're going to either pull back on the internal brace or on the graft itself that's going to deploy the implant on the femur. If we're happy with that, then we can go ahead and start our tensioning process. Now we're ready to start tensioning our graft. After you've deployed the implant on the cortex, you can now remove this trailing suture. And now we'll go ahead and tension our graft up. All right. So now we're ready to implant the graft in the tibia. Or to make sure you grab your internal brace tails, the blue passing suture and then the white tightrope tensioning strands. If you're going to grab all those pull them through our loop then. Now we're ready to settle down. We're leaving our tiger wire trailing suture that's going to stay behind. That's going to allow us to keep the implant nice and elongated. You can see here. Pull some of the slack out of the internal brace. Now we're ready to bring our implant down through the tibia. Once it's down, we can get rid of our trailing suture and go ahead and pull the slack out. Doc? Our graft. So now we're going to fixate our internal brace in full extension. Now we can cut our fibertape that's been used for the internal brace. So now we can do our final tensioning on the soft button implant. I've removed the blue passing suture and the white trailing suture has been removed. Now we're just going to walk the implant down to the tibia. The nice thing about this new soft button implant is you can conform it to whatever bone that it's sitting on, and then we can go ahead and pull some more tension. So you can deform the implant just by pushing on it. You can see it lays nice and flat. That's our final construct.