Name: Collateral Ligament Reconstruction With the InternalBrace™ Ligament Augmentation Procedure
Uploaded: 2019-09-24T00:00:00Z
Channel: Arthrex

Michael Garcia, MD (Tampa, FL), presents collateral ligament reconstruction with InternalBrace™ ligament augmentation fixation using two 2.5 mm × 6 mm Nano tenodesis screws and SutureTape.
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.

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VID1-000589-en-US | C | Collateral Ligament Reconstruction With the InternalBrace™ Ligament Augmentation Procedure

Michael J. Garcia

Human

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

Surgical Technique Videos

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

Collateral Ligament Reconstruction With the InternalBrace™ Ligament Augmentation Procedure

Hello, my name is Michael Garcia. I'm a hand and upper extremity surgeon from Florida Orthopedic Institute in Tampa, Florida. And today we're going to demonstrate the use of the 2.5 Bio-Tenodesis screw in collateral ligament reconstruction in the hand, particularly for the proximal interphalangeal joint utilizing internal brace technology. These are the contents of the kit. This is a graph sizer which allows us to appropriately size our graft in between 2.0 and 2.5 millimeters. It is important that the graph not be too large for this technique. This is a graft and suture passing device. These are 2.5 and 2.7mm drill bits, the 2.5mm drill bit being used in soft or osteoporotic bone, the 2.7mm drill bit being used in hard bone. These are the guidewires for the above mentioned drill bits. And this is the implant itself, which is a 2.5mm peak tenodesis screw, which is 2.5mm in width and six millimeters in Kilometers in length. We begin the procedure with exposure of the proximal interphalangeal joint. This is a lateral approach of the proximal interphalangeal joint in between the neurovascular bundle bundle and the extensor mechanism dorsally. We have removed the collateral ligament in this case so as to demonstrate a reconstruction. I have already harvested a graft from the palmaris longus. This is a slip of the pulmonary longus and not the entire palmaris longus. We will now use a graft sizer to assure that the graft is the appropriate size, but it will fit through the 2.5mm side easily. After whip stitching the ends of the graft. We are now prepared to perform the reconstruction. The first step is to place two K-wires parallel to the joint and the near isometric points of the proximal interphalangeal joint. I begin with the proximal phalanx. This is a bicortical K-wires. The next key wire is placed in the middle phalanx in and near the insertion of the collateral ligament. Again, this is a bicortical K-wires. Once confirming the position of the K-wires under fluoroscopy, the K-wires are then advanced to tend the skin on the ulnar side of the digit. Once this is done, separate counter incisions are made on the ulnar side of the digit for graft passing. Once this portion of the case is completed, attention can be then turned to drilling the bicortical holes, which will transmit the graft and the tenodesis screw. Once the holes are drilled, we can begin the reconstruction. The proximal phalanx is approached first. The suture passer is passed into the bicortical drill hole and it is passed out to counter incision on the opposite side of the digit, using the whip stitch portion of the graft, and incorporating a SutureTape for an internal brace to assist with immediate stability of the joint. The suture and graft are passed across the digit. This is an advanced until the graft inserts into the hole and is brought out the contralateral side. It is important to take an appropriate length graft so that you can do this for appropriate tensioning. Once this is done, have an assistant hold the suture at the other side of the digit by pulling the suture to one side of the hole. You can insert the screw into the hole and turn clockwise to advance the screw. It is important to maintain tension on the graft during this time period, so that you ensure appropriate fixation of the graft within the hole. This screw should be advanced until it is at the cortical margin. Once this is completed, the proximal segment of our graft VersaGraft has been secured. We can complete the reconstruction using the same suture passing device is introduced across the Bicortical hole and again out the second counter incision that we made. The sutures, including the internal brace and the whipstitch sutures, are placed into this nitinol loop, again pulling across the digit and pulling out the contralateral side. The graft is then passed into the drill hole, and then the internal brace is tightened as well. So now we can see our reconstruction in place prior to tenodesis, and we can assess this geometry of the graft by holding tension on the graft and taking the digit to a range of motion. You can see that this is fairly isometric to a full range of motion in the proximal interphalangeal joint. Once this is done, the joint can be reduced. A mild radial directed force can be applied. Have your assistant hold the the internal brace and the graft, and then the screw is introduced again into its hole. Again advancing to the cortical margin. Securing the distal graft. Once this is completed, the residual graft and suture from the ContourLock side of the digit can be amputated at the skin edge. Now you can see the graft and InternalBrace reconstruction through a full range of motion in an isometric position. The patient is placed into a postoperative dressing and splint to immobilize the digit in extension for a period of 3 to 4 days. The patient is then placed in a removable finger gutter splint in therapy, and allowed for gentle range of motion beginning on postoperative day 4 to 5. There is no forceful pinching or gripping allowed against the graft for a period of 6 to 8 weeks, and only active active assisted range of motion is allowed for the first month.

Collateral Ligament Reconstruction With the InternalBrace™ Ligament Augmentation Procedure

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