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Andrew L. Clavenna, MD (Dallas, TX), discusses the surgical use of the GraftNet™ XL bone collection device for spine procedures.

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GraftNet™ XL Device for Spine Procedures

I'm Andrew Clavenna from Dallas, Texas, here to demonstrate the Graphnet XL. This is a case standard mis-tlif type case important when collecting bone dust that use different suction lines so that we don't put soft tissue into the bone dust collector. So here we are. Tube retractor facet joint cephalad caudal. And I'm just going to clean off some of the soft tissue from this facet joint as we would standard in any case. Here's where simply having the multi-port allows us to switch over to the suction tubing to collect our bone graft. Obviously, a three millimeter matchstick two fluted device is better, as studies have shown flute size does make a difference. Definitely don't want to use like a diamond bit, bur as our cell viability would be much less benefit of that. Graphnet XL is that the mesh collector allows us to irrigate without worry that we're diluting our bone graft. Clean. Classically, all this bone would be thrown away and wasted and allowing us to harvest this and use it for our fusion has shown that this bone has mesenchymal cells. And osteogenic potential to facilitate our fusion during our tlif. So I've removed most of the inferior articular process of L4, and now going through the superior articular process of L5. One of the advantages of the graphnet XL is that it does have a three foot suction tubing attachment to get your hand away from the collection device, decreasing weight on your hand to minimally change how you normally operate, as well as allowing the scrub tech direct visualization of your collected bone grafts so they can notify you if you're filling up. The device does allow for a large volume of collection. It also has a clip attached so that the scrub tech can clip it to the mayo, or hang it from the mayo so that it's out of the way and you don't have to worry about it falling onto the floor and contaminating the sterility and using the drill to remove this bone. It allows us to get down to that cortical edge and overall minimize the use of the kerosene. Less kerosene. Use less fatigue you have to worry about in your hands. It's important after you're done collecting your bone dust, your suction tubing attachment, especially if you're using the three foot adapter, has extra dust in it, and you'll want to collect that by simply irrigating through the suction device. As you can see, all that extra irrigation is suctioned out and we've got our bone graft in the mesh bag. So after you're done harvesting your bone graft and you've irrigated your suction tubing, make sure and turn off your suction to decrease the vacuum on the container. And then simply counterclockwise turn of the lid allows the lid to be disengaged. This gives you access to the mesh bag in the center. Your bone graft still will be somewhat hydrated, so you can simply squeeze that mesh bag to get further liquid off of your bone graft. Once you're ready to get the bone graft out of the mesh bag, simply invert the mesh bag to expel your bone graft. You can put your fingers inside to tint up the mesh bag to allow you to scrape off any residual bone graft. There's a fair bit of bone graft here, and this is from just taking out a unilateral facet joint. Graphnet Excel not only allows you to collect a large amount of bone graft, but the handling characteristics allow for mobility. Obviously this then can be added to a substrate to increase your overall graft volume, such as PRP or DBM. So to illustrate how much bone graft you can get. Again, this is just from a unilateral facet harvest in a five cc syringe. We are able to decrease the overall cost and potentially less use of extenders.

GraftNet™ XL Device for Spine Procedures

DynaNite® CT nitinol staples deliver active compression for secure sternal closure, applying proven orthopedic fixation principles to cardiothoracic surgery. With two low- profile staple size options, the system offers flexibility to accommodate patient anatomy and surgical technique. Engineered to ensure consistent sternal stability throughout postoperative recovery, DynaNite CT staples work in combination with FiberTape® cerclage to deliver a comprehensive solution for sternotomy repair.

DynaNite® CT for Sternotomy Closure

DynaNite® CT for Sternotomy Closure

Raymond J. Gardocki, MD (Nashville, TN), provides an in-depth overview of the anatomical orientation through an endoscope lens during an endoscopic transforaminal approach for discectomy.

Voyage Into Kambin’s Prism

Voyage Into Kambin’s Prism

Asheesh Bedi, MD (Ann Arbor, MI), demonstrates a comprehensive cam resection of the femoral neck using the Hip DiamondCut™ burr.

Femoral Neck Cam Resection Using the Hip DiamondCut™ Burr

Femoral Neck Cam Resection Using the Hip DiamondCut™ Burr

Peter Borden, MD (Torrance, CA), demonstrates repairing a small rotator cuff tear using Self-Punching Double-Loaded Knotless 2.6 FiberTak® soft anchors.

Small Rotator Cuff Repair Using Double-Loaded Knotless 2.6 FiberTak® Soft Anchors

Hi, this is Peter Borden from Los Angeles, California. I'm going to demonstrate with you today the use of the 2.6 FiberTak anchor. Using two anchors for a simple rotator cuff repair. This is a left shoulder, and we have a small laterally based tear. We are going to plan to put one anchor here and one anchor here, right on the edge of the greater tuberosity here. We are going to repair that in a single row fashion. For this case we're utilizing the NanoScope. We've got this ultra wide NanoScope view currently of the greater tuberosity and the small cuff tear. You can see the extent of the cuff tear, but you can see the entire greater tuberosity from front to back in this one view. I can show you with a press of a button that we can cycle through a 70 degree view, so we can look at it from the side standpoint. I can also cycle away from that and do a standard 30 degree view as well. But notice how when we go to the Pano view, we just get a much more global view of the greater tuberosity. Here we've added an ASL portal for suture management. I would like to be able to put both anchors. One anchor here and one anchor here. We're going to go ahead and retrieve our working sutures one at a time, out our lateral portal, and then we'll take the Scorpion. I'm going to add the working stitch to the side loader as we come in. So I'm going to go ahead and take a feel and see how much cuff tissue I want to grab. And I want to pull and reduce. I'm going to go into the anterior extent of the tear. That looks good. I'm going to do one there and let's go ahead and pull that. So we got the first pass done. I'm going to move that out of our working portal for suture management. So now we'll retrieve our blue white working stitch. We will add the second working stitch to the Scorpion. We're going to hold our suture and do our second pass, making sure we stay on the correct side of all the sutures. And we're going to come in and we're going to make an analogous pass. And I'm going to take all these and for suture management purposes, and we're going to take everything out of our ASL portal. There's our passes. So now we're localizing our posterior anchor placement here. So I want to be right off the edge. Kind of similar to my other anchor. And then I'll check the anchor again and make sure I can lift the arm up and I can. So we placed our anchor. We're going to retrieve the black and blue working suture. Now we're going to load a Scorpion passer. We will take a look at our spread. So I don't want to hit the other suture from the first anchor. So I'm going to keep an eye on everything. I'm going to go in, go above it, look and see where my other pass was. There's my other pass. I'm going to go just adjacent to that. So we're going to come in and we're going to go ahead and take our second pass. We will fire it, retrieve it. So we got two sutures there. We're ready to convert. So I'm going to go in I'm going to retrieve this guy. We have the loop suture for conversion of the anchor. At this point I'm going to go ahead and take this. Put it through the loop. And we're we'll make sure that it's where the purple mark is. That's the purple mark. Both sutures are through the shuttle loop, and I've got this ready to go. So I will go ahead and convert this. We will utilize the shuttle suture in order to put a little tension on the loop on the working repair sutures so that we have a little counter tension and this little counter tension that we're doing on here. It just helps us keep this from getting all twisted up. And as I bring it in, look how nice and straight it kept my repair sutures on that tissue. And now that I've got this scenario here, I could remove this suture that was helping me maintain the orientation of the sutures. And now we're going to take both of these sutures, and we will go ahead and seal that down to bone. We will go ahead and use the Mega loader to load our repair sutures in the cutter, and we'll come in and we'll go down to the anchor, give another little gentle tug. Now we'll do the same thing with the other sutures. So that's perfect. We will cut this suture and get out of here. We've got this single row, lateral row repair of the rotator cuff. We've got great fixation of the cuff tissue to the greater tuberosity.

Small Rotator Cuff Repair Using Double-Loaded Knotless 2.6 FiberTak® Soft Anchors

Peter J. Millett, MD (Vail, CO), uses the Knotless 1.8 FiberTak® implant system in a cadaveric demonstration of a knotless Bankart repair. Dr. Millett reviews a range of tips and pearls from portal placement to sequential repair tensioning. Tensionable Knotless FiberTak implants of varying colors provide multiple points of fixation to restore anatomic tension to the glenohumeral soft tissue.

Tensionable Knotless Bankart Repair Using the Knotless 1.8 FiberTak® Implant System

Tensionable Knotless Bankart Repair Using the Knotless 1.8 FiberTak® Implant System

At the Spine Evolutions course,&nbsp;Peter Derman, MD&nbsp;(Dallas, TX), discusses the importance of ultra-minimally invasive endoscopic spine surgery in relation to cervical pathology.

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Endoscopic Posterior Cervical Foraminotomy

OrthoPedia: Endoscopic Posterior Cervical Foraminotomy

The combined use of CeMend™ molds and spacers allows for complete customization to create a mono block spacer for complex revision cases.

CeMend™ Spacer Molds With Arthrex Bone Cement for Two-Stage Revision

The arthritic cement shoulder spacer system, including molds and arthritis. Bone cement provides customized spacer solutions for complex revision cases. The external frame is used to securely hold the selected mold. Two humeral head size options provide a smooth articular surface. Six insert options are available for varying mold sizes. The customizable molds allow for 46 different configurations between four stem diameters. Nine stem lengths. And two head diameters. The metal core is standard and available in all sizes. The optional extension may be added if additional reinforced length is desired. Using the Arthrex Virtual Implant Positioning System, bone defects found in complex revision cases with existing metal can be visualized using metal segmentation and revision planning. To maximize efficiency. Assembly of the spacer mold and mixing of the cement by an assistant may take place during the removal of the preexisting prosthesis, at the surgeon's discretion. To begin building the spacer. Place the selected insert into the external frame. The accompanying mold is placed into the insert. At this time, an optional metal core extension can be placed under the existing metal core, followed by the selected head diameter. The set screws are then used to close the external frame, which is now ready for cement. The Arthrex bone cement kits include the necessary materials to mix and inject cement into the assembled mold. To begin mixing the cement, place the funnel on the mixer. Empty the first ampoule into the mixer. Both cement packets are poured on top of the liquid. The second ampoule of liquid is added last. Using the plunger, mix the cement for about 45 seconds. Once proper consistency is reached, remove the plunger cap and bass from the mixer to assemble the gun plunger. Inject the cement into the prepared mold to the desired length of the spacer. Wait for cement to harden completely. After the cement has polymerized, remove the prepared mold and remove any excess residue with a rasp or Roger. The final spacer is ready to be inserted into the humeral canal. If infected bone voids exist in the glenoid side, the calcium sulfate bio beads can be used as a bone void filler that is resorbed and replaced with bone during the healing process.

CeMend™ Spacer Molds With Arthrex Bone Cement for Two-Stage Revision

John M. Tokish, MD (Scottsdale, AZ), demonstrates the CuffMend™ technique using a biceps tendon autograft prepared with the Autograft Tissue Compression System and fixated with FiberStitch™ RC and Self-Punching PushLock® anchors. View the graft preparation video <a href="https://www.arthrex.com/resources/VID1-006270-en-US/graft-preparation-for-auto-cuffmend-augmented-rotator-cuff-repair">here</a>.

CuffMend™ Augmentation Technique Using a Biceps Tendon Autograft

My name is J.T. Tokich from the Mayo Clinic in Scottsdale, Arizona. And today we're going to be demonstrating for you an augmentation technique using the patient's own autograft biceps smash using the Arthrex autograph compression device. So you can see that we've been able to harvest about 40mm of tendon. This gives us plenty of length for our biceps to smash, because what we want is about 27mm of tendon for the patch. Once that you're happy that the graft is nicely centered within the tissue plate, we simply cover it. And then we're going to load it on top of the biceps smash press. Once that's done, then we will start with putting the tension down. We're then going to leave that at the max point for four minutes, and the graph then will stay compressed. Once we've given it that four minutes, we're going to loosen it up and the patch is ready to go. The patch is beautifully formed. Now we have to just load it onto the introducer with the graph now prepared and we're back inside, you can easily see the repair that we did viewing from the From the back side portal. One of the things we've learned is that it's better to come in fairly low and parallel. So for the standard placement of the biceps smash autographed patch, we will generally make in addition to this standard lateral working portal, one additional anterolateral portal that you can see is placed by the passport cannula here. This will allow the graft spreader with the patch to sit on top, so viewing from the outside you can see the graft and the graft spreader is prepared nicely. And then all we have to do to insert it is simply slide the wheel back. And this allows us then to enter into the passport. Once it's inside the shoulder, we're going to bring it directly into the top and center it upon the place that we want to be. We can then open the graft here and set it exactly where we want the graph to go. So oftentimes the medial row can be fixed by using standard anterior cannula which we're demonstrating here. I prefer to use simple stitches so that it puts a little bit of tension on the graft. So my first stitch is going to be to come inside of the purple line. I'm going to come in and cheat just inside that, and then we're going to insert the FiberStitch RC until it goes down to the depth stop. Once it's there, I will rotate backwards outside. You can see this until I get a very satisfying click. I then simply go forward and then my second arm of this is ready to be deployed. I back this out. I'm going to come and use this guy over the top of the front side. That guy drops in and I send my FiberStitch wheel back again. And this deploys the second pledget and then we all we have to do is remove the FiberStitch. This gives us a loop and a double mattress. I'll turn my attention to the free end of the suture as shown here on the outside. I then simply have to pull this guy down. It's the second limb of our mattress stitch, and it will allow us to come in and compress. This gives us an excellent first anchor stitch medially on the patch. We then bring the tensioner cutter and this will give us a FlushCut down against the patch. We're now going to repeat that step for our second FiberStitch I back this guy out, I'm going to just simply come over the top of the patch again. Again, coming just over the top so I can secure with a medial stitch right over the top on the other end of this. Once I feel like I've got that patch down, I simply bring the other limb of the mattress suture in place and it will cinch that down completely. Once I've gotten that, we're going to cut the excess edge. Additional stitching is quite easy. One could remove the tissue passer, which is what I generally do now. We can bring the spreader completely out and now we have our patch in place. Two stitches we found is plenty to do this, but if you want to really spread out the graft or if you want additional fixation, we found that this technique of throwing in some of the extra stitches has been an excellent way to really spread out the graft over the top. Now I've got a fourth stitch, one on the outside corner. There's our third stitch symmetrically on the anterolateral aspect for the lateral row. We want to be able to be just slightly distal and lateral to where the patch will naturally step down. You're now getting into pretty hard cortical bone. So we felt that that was best done through the traditional lateral portal. And so I'm going to have to retrieve our stitch through this passport. We're now simply going to load it on our PushLock. You can see we have the Self-punching PushLock for our lateral row. Now one thing that's important is that we leave some slack in this lateral row so as not to over tension it on the patch. So what we like to do is pass point quite a ways to leave this slack in place and then come back. And we can always take up slack. Then this guy can be punched in directly. This nicely restores the patch directly on top of the tendon. We then cut the excess suture off the graft and our posterior lateral row is complete. The self-punching PushLock can then again be introduced into the portal. We then decide where we want this PushLock to go, and then we're going to just tap it in. And then an open cutter comes in and finishes up the edge of this. This completes the patch laterally and medially. And you can see that we have now SpeedBridge repair. And it is now augmented by an autographed biceps tendon. It has my favorite configuration of two stitches medial that are simple to spread the patch out one suture anteromedial and one suture posteromedial again, which does a beautiful job of spreading the graft out. And then we've got the critical portion of the rotator cuff repair covered. This is where the tenocytes need to be. And so we want to be in that position. And we've got our posterior lateral PushLock in place and our anterior lateral PushLock in place as well. And this completes the construct and the repair.

CuffMend™ Augmentation Technique Using a Biceps Tendon Autograft

The Synergy exoscope is an autoclavable and reusable 0° 4K scope used to provide real-time visible light and near-infrared (NIR) fluorescence imaging during open surgical procedures.

Synergy Exoscope Imaging

Synergy Exoscope Imaging

John Xerogeanes, MD (Atlanta, GA), demonstrates how to use reusable sliding GraftClamp instruments with the GraftPro® system during a quad tendon ACL reconstruction using FiberTag® TightRope® SB implants. The reusable GraftClamp instruments simplify graft preparation by allowing single-user graft preparation.

Quad Tendon Graft Preparation Using Sliding GraftClamp Instruments

Quad Tendon Graft Preparation Using Sliding GraftClamp Instruments

The Arthrex ultra-minimally invasive endoscopic spine portfolio is a comprehensive solution that includes enhanced visualization with the Synergy camera system and operative endoscope, ergonomic WishBone™ and ring-handled instrument options, a steerable electrosurgery probe, and an endoscopic instrumentation system.

Arthrex Ultra-Minimally Invasive Spine Portfolio Overview

Arthrex Ultra-Minimally Invasive Spine Portfolio Overview

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>

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

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

G. Russell Huffman, MD (Orlando, FL), reviews key literature supporting biologic rotator cuff augmentation in addition to discussing how graft choice may affect retear and reoperation rates.&nbsp;

Rotator Cuff Tears: Literature Review on Graft Options for Rotator Cuff Augmentation

OrthoPedia: Rotator Cuff Tears: Literature Review on Graft Options for Rotator Cuff Augmentation

What's NewJAN 30

GraftNet™ XL Device for Spine Procedures

What’s New This Week and Prior

JAN 29

DynaNite® CT for Sternotomy Closure

JAN 28

Voyage Into Kambin’s Prism

JAN 27

Femoral Neck Cam Resection Using the Hip DiamondCut™ Burr

JAN 26

Small Rotator Cuff Repair Using Double-Loaded Knotless 2.6 FiberTak® Soft Anchors

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