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INFORMATIONSMATERIALIEN FÜR KUNDEN

Steven J. Lee, MD (New York, NY), demonstrates the use of the lateral biplanar plate from the Arthrex Elbow Plating System. The plate provides direct lateral fixation on the epicondyle and posterolateral fixation along the shaft, and a removable tab facilitates capitellum fixation. Dr. Lee uses the lateral positioner from the ElbowLOC® arm positioning system.

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Distal Humerus Fracture Fixation With the Arthrex Distal Humerus Lateral Biplanar Plate

Hi, I'm Steven Lee from Lenox Hill Hospital in New York City. I'm going to talk about arthrex cool new contoured plates for the distal humerus. And this particular plate is the Biplanar lateral plate system. A couple of cool features about these plates is the one, of course, the anatomic contouring of the plate to the bone, but also the addition of special different tabs that are added to the distal aspect of the plate, which allows for more screw fixation abilities, especially for those hard to treat distal humerus comminuted fractures. Each one of these screw holes can take either a 2.7 or 3.5 locking screw, and the crew lock screws are a variable pitch locking screw, so it gives some mild compression and at the same time can also lock into the plate at the same time. A couple more features that I really like about this plate are that the distal end of the plate has scallops to it, which allows us to bend the plate a little bit more easily to help contour it, just in case it doesn't perfectly fit the bone. There are also suture holes to allow for you to put sutures to repair your ligament and or tendon, and you can also add suture underneath the tab as well. Some of the features that I really love about this set are that it's been very well thought out, especially the instrumentation. So there's a bunch of different reduction clamps that you're probably used to using, but also this one reduction clamp called the tooth choker. Especially like this because of the fact that it has sharp ends on the on the tip, sort of like your pointed reduction clamps, and yet is not bowed out so that when you are dealing with fractures and trying to reduce them, the Kocher clamp tooth choker would will hug the bone and it doesn't get caught up in soft tissue or the nerve here or whatever. And so it holds things very, very nicely. There are instrumentation, thoughtful features for which there are each. Most of the instruments are double sided. So I do like to use different sized freezer freezers. So there's a wide area on one side that you can use to help scrape the soft tissue off. It's appropriately sharp and soft and dull enough, and then you can flip it around and use the smaller end or the thinner end for your regular, freer application. Same thing for the other cool tool, which is the curette on one side, and the dental toothpick for reducing your fractures at the same time. And it's wonderfully balanced. You can spin it in your in your hands very easily. Also the screws in the set are all stadium seating screws, which means that they don't need to be measured by your surgical tech. Only if it sits flush on the set, then that only that screw can fit in there. So they don't. You don't have to wait for each screw to be measured, which is a very time saving feature. Often we'll put in a tack first, and I'm going to go ahead and put in my first screw in the oblong hole. This is going to be a 3.5 screw cortical screw. So that's going to be a 22. So this does come with a torque limiter. And of course to if you want to go ahead and tighten by hand as well. So I'm going to put in a 2.7 non-locking screw in distally. Again you can put either locking or non-locking screw in each one of these holes. This is a variable angle locking drill guide. So it does give you a 24 degree arc of variability. I do like reading my screw lengths directly off of the drill guide. But to note, there's two different lines on the drill. There's a single black line that you read for up to 50mm of length of the screw, and anything over that you would read off of the double black line that's on the drill. So. Hopefully you can just start seeing the double black line coming into view. So again we're going to put a non-locking screw in first. Okay. So I'm going to go ahead and put in a 2.7 non-locking screw into one of these tabs. This is a 2.7 non-locking screw going into one of the tab holes. It looks like that's conforming really nice onto the bone as well. This is our screw in locking tower guide. You can use this tower to also bend the tab. If for whatever reason, the tab is not conforming perfectly down onto the bone. So this is a 2.7 locking screw going into the tab hole distally. I'm going to put in a 2.7 distal locking screw using the screw in locking guide. So this is the distal most screw. This is going to be a 2.7mm locking screw. There is a torque limiter on the drill. This is a AP with some of our screws in. You can see the plate sits really nicely on the bone. And very importantly the screws that are put in distally are missing the olecranon fossa and providing extra fixation distally, which is my usual biggest concern with these type of injuries. This is a lateral provisional x ray. I think it looks unbelievable how well it sits on the humerus. It's very well contoured and screw positioning of where they go is optimal. This is the final AP x ray for the biplanar lateral plate. The cool thing to note here is that we have a total of five screws that are distal to the olecranon fossa, just the angle of where those screws go. Just I think are perfect. They miss the olecranon fossa and gives us extra fixation for those really difficult distal humerus comminuted fractures. So very happy with the way that looks on the bone. This is the final lateral x ray for the biplanar lateral plate. Again getting five separate screws distal to the olecranon fossa is absolutely amazing. The plate is very skinny. It's low profile, it's smoothened on the ends and the ability to take both locking and non-locking screws either 2.7 or 3.5 and any of the holes gives us so much flexibility on treating what is often very difficult fractures to treat.

Distal Humerus Fracture Fixation With the Arthrex Distal Humerus Lateral Biplanar Plate

James McWilliam, MD, (White Plains, NY), demonstrates the correction of a type III tailor’s bunion, characterized by a widened 4th-5th intermetatarsal angle, using a more proximal osteotomy on the 5th metatarsal, access at the 5th metatarsal styloid, and fixation with a bevel screw. This approach allows for a greater reduction of the intermetatarsal angle while providing a large surface area for fixation.

Minimally Invasive Correction of a Type 3 Tailor’s Bunion Using a Beveled Screw

Hello, I'm Jim McWilliam from White Plains, New York, and I'm going to talk about minimally invasive surgery on the foot with regards to bunion deformity. So if there's a large intermetatarsal four five angle or if there's significant lateral bowing of the fifth metatarsal, you might want to perform your correction via a more proximal osteotomy. And I'll show you how that's done. And I'll show you an alternative fixation method. Now here we've marked the trajectory of the fifth metatarsal in both the lateral plane and the AP plane. And I'm going to use that sort of as a rough guide for where I'm going to do my fixation. So this is going to be the trajectory of my screw. You can see that instead of being in the high and inside position of a traditional Jones screw, it's going to be going right through the fifth metatarsal Styloid. And I'm going to make my osteotomy where the wire crosses the medial cortex of the fifth metatarsal. So my osteotomy is going to be roughly here more proximal. I might even shift it a little more proximal in that x ray that. So right about there, before the watershed zone of a zone three proximal fifth metatarsal. But we're going to be proximal enough that we're going to get a good level of correction. All right. So we're going to make our incision. I will typically make the incision directly lateral. And that will kind of allow me to do a long oblique osteotomy. I'll use my little elevator. Remember this has the ideal curve to minimally elevate the periosteum dorsally and planoly. To kind of minimize soft tissue disruption but allow enough exposure. All right. So once again I'm going to go straight across just like I have with the other osteotomy. All right. X ray. So I've gone across the I've gone across the entirety of the bone. Now remember there's a declination of the fifth metatarsal. So if I just rotate my hand approximately, I'm going to be cutting distally. And the dorsal cortex. Then I've gone through there. Now, similarly, if I rotate my hand approximately and maybe direct it down just a little bit, I'm going to be cutting approximately. And the planter cortex, you can see I've got my shift there. So this guidewire is a little bit easier to work with. It's the 1.6mm guidewire for the four millimeter beveled screw. And because it's 1.6mm, it's going to be a lot easier to get my direction that I want. So I'm literally starting at the fifth metatarsal Styloid. And I'm going to drive it into the osteotomy line, kind of ideally hugging that medial cortex when I get to the osteotomy. And then we'll check on the lateral and make sure we're in the appropriate orientation there as well. We're pretty good there. So now it's simply going to be a function of moving the metatarsal over and driving the guidewire across the osteotomy and an intramedullary position. So I've got my metatarsal shifted. I've got my guidewire in the right position. So now we're just going to drive the guidewire across. You see how just putting the guidewire in this trajectory across the osteotomy site actually forces the fifth metatarsal medially, affecting your correction. So we've got good correction. We've got good position of the wire in this plane. Let's check the lateral. We've got good correction. You can see I actually cracked the dorsal cortex a little bit with my osteotomy. But we should get good adequate fixation distally without any problem. So now I'm going to use this wire as a guide for my incision. And it just minimizes trauma to the skin and it enhances cosmesis. So I'm going to take the back end of the blade and just push it down. This is an 11 blade. I'm just going to push it down along the guidewire to the fifth metatarsal. So I'm good there. Now we'll take our measuring device. It's beveled to allow us to more closely measure the appropriate depth. We're going to check that the bevel is facing in the right direction. And everything's lined up well. And we still have maintained our medial shift of the distal metatarsal. I'm going to drive this wire out the tip because not only is it our guide for the screw, but it's our provisional fixation and it's just not worth having to do everything over again. We're going to drill over this under fluoro. Not necessarily wanting to go through the medial cortex. All right. We're pretty good there. So if we line up the laser line on the drill with the laser line on the screw, we know what side the bevel is going to be on. Once the screw is buried in the soft tissue, it's just a little visual guide. It only works as long as you keep the driver engaged on the screw. So once the driver is no longer engaged, you're going to have to do it with fluoro. So there's our final fixation our final correction in the AP plane. And there's the lateral.

Minimally Invasive Correction of a Type 3 Tailor’s Bunion Using a Beveled Screw

Elizabeth G. Matzkin, MD (Boston, MA), demonstrates an ACL reconstruction using a GraftLink® construct with RT TightRope® SB implant with FiberTape® suture for the InternalBrace™ technique.
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.

GraftLink® ACL Reconstruction Using the TightRope® SB Implant for the InternalBrace™ Technique

Hello, I'm Elizabeth Matzkin from Boston, Massachusetts, and today we will be demonstrating an ACL graft reconstruction with internal brace technique and the new tightrope SB. As you can see here, we have our graft out on the table on our Graph Pro ready to go. We have a hamstring semitendinosus that's been quadrupled using a standard grafting technique. And we have our new tightrope SB on both sides of the graft you can see the yellow suture which is the soft button. This is just like our tightropes we've been using for the last ten years, but there's no metal. So for patients that may have metal adversity or a metal allergy, this is going to be perfect. There's also some other advantages to using the soft button, which you will see in our demonstration on our tightrope SB. You can see our blue passing sutures, our white tensioning sutures, our internal brace sutures, and these sutures which are used for elongating, which you will see as we pass the button into the knee for our ACL reconstruction. On the tibial side of our graft, we can see our blue passing sutures. These suture tapes here in the middle are from our graft prep. So there are saved sutures. We can see our white tensioning sutures. And then again, we can see the suture that we're going to use for elongating the suture button when we pass it into the knee. So we have about a 30 millimeter femoral tunnel. So we've marked 30mm from the end of this soft button. I also like to mark my graft around 15 to 20mm. It's often where we have these sutures wrapped around the graft itself. But that will help us as we pull the graft into our tunnel. And we'll mark it also on our tibial side. So here we are. We're in our right knee. We've already prepped our femoral and tibial tunnels. We have sutures passed through them so we can get ready to pass our graph with the new tightrope SB. So we're going to pass this through our suture here on the outside. And then we're going to shuttle our white tensioning sutures and our blue passing sutures through the knee here. As you're doing this, you're going to have one hand pulling through the sutures through the femoral tunnel and your other hand holding on to the the graft. And the extra suture in order to feel the tension as the graft is passing, as we're getting ready to pass our tightrope, SB, we have one hand holding our tensioning and passing sutures and our other hand holding the trailing sutures. This allows us to keep the tightrope sb lengthened as we pass this through. We've also switched our scope to the 70 degree so we can watch this go up our femoral tunnel. So again we're holding both ends of the tightrope. We're watching it up the tunnel. We can see it just passed through and we could feel it flip right there. And the other thing we can look at is we can see our mark that we made. On the sutures, which is also a second way to check that we're at the same length to flip that tightrope. Sb now, to deploy our tightrope SB we can either pull on the implant or pull on the internal brace, as you can see here and now, if I go to pull on my graft, you can see that tightrope is flipped and it's not going anywhere. One nice advantage of the tightrope SB is that once we've flipped it, if we're not happy, or for some reason, we've flipped it on the outside of the Iliotibial band, we can actually elongate it and flip it by pulling tension on both sides of the suture, and we can watch it unfold and we can see we can pull it back down our tunnel and we can start all over. So this is a very nice advantage, which we can't do with our metal tightropes. And you can watch this go flip one more time again, holding both sides of the tightrope. Now that our tightrope SB is flipped on our lateral femoral cortex, we're going to shuttle our graft up into the knee. We'll watch it kind of go up into our femoral tunnel. And here comes our beautiful hamstring. Quadrupled graft link. And see our internal brace here. So graph going into our femoral tunnel we have marked it at 15 to 20mm. So we know how far to pull it in okay. So we have our graph passing to our femoral tunnel. Now we're going to pass it into our tibial tunnel. As you can see here. We're going to keep our tiger trailing sutures outside of the passing suture. We're going to send these down our tibial tunnel. We'll pull some of the slack out of our internal brace suture. And again, we've left behind our trailing suture because that's what allows us to pass our soft button in an elongated fashion. We can remove our femoral trailing suture at this point, because that side has already been docked, and we will hold some tension on our tibial trailing suture as we reduce the graft into the tibial tunnel. Now that our tightrope SB is outside of our tibia, we can remove our tiger trailing suture and our blue passing suture. Now we're ready to tension this inner tibial tunnel. So I have a small hemostat here to take some of the tension off our tightrope, SB, as we provisionally take some of the slack out of it so it doesn't bunch up too much. It'll allow it to lay a little bit more flat when we get down to our tibial bone. Now you can actually put a little pressure on that button and kind of flatten it or pancake it out on the tibial bone. So it lays a little bit flatter as we completely deploy it. And our final tensioning. So now we are going to fix our save sutures from our graph prep, along with the internal brace in our 4.75mm swivel lock anchor. So we have our swivel lock in that has fixed our saved sutures from our graft as well as our internal brace, and we can cut those and then we can still retension our tightrope SB on both the tibial and femoral sides to complete the procedure. So here's our final construct. We have our graph link ACL with tightrope SBS on both our femoral and tibial side with an internal brace technique.

GraftLink® ACL Reconstruction Using the TightRope® SB Implant for the InternalBrace™ Technique

During Spine Evolutions, Wade K. Jensen, MD (Afton, Wyoming), reviews surgical tips and targeting techniques for the transforaminal approach to endoscopic discectomy.

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Surgical Technique and Tips for Endoscopic Transforaminal Approach During Discectomy

OrthoPedia: Surgical Technique and Tips for Endoscopic Transforaminal Approach During Discectomy

Misty Suri, MD (New Orleans, LA), presents a case of rotator cable reinforcement with biologic tuberoplasty for the treatment of a massive irreparable rotator cuff tear in a 72-year-old male. Dr. Suri discusses his patient selection criteria, simplified technique for combined rotator cable reinforcement and biologic tuberoplasty, accelerated postoperative rehab protocol, and perceived benefits of this procedure.

Biologic Tuberoplasty With Cable Reinforcement for Massive Irreparable Rotator Cuff Tears

Hi, I'm doctor Misty Suri from New Orleans, Louisiana. I'm very excited to share a case with you of a massive, irreparable rotator cuff tear that I treated with a biologic tuboplasty combined with a cable reinforcement. So our patient is a 72 year old, retired, right hand dominant male. He fell while playing catch with his grandson. He fell on his outstretched arm and his pain was worse at night with attempted forward head activities. He had pain and he wasn't getting better with conservative management. His prior medical history was diabetes, glaucoma and hypertension. His range of motion was pretty good. He did have painful forward elevation. His subscap was intact. His strength was four out of five to his supraspinatus and infraspinatus. His AC joint was tender and his Vas score was 5.5 out of ten, and his pain score was 20 out of 100 on x ray. He did not have significant glenohumeral arthritis. He was a Hamada type one. On our coronal cuts for the MRI, we can see the significant atrophy to the rotator cuff. This would not be amenable to a rotator cuff repair. On our sagittal view here we can see the positive tangent sign with the significant atrophy to the rotator cuff as well. So what are the options for this type of patient? Debridement. Partial repair. Subacromial. Spacer. Superior capsular reconstruction var biologic Tuboplasty plus cable reinforcement or a reverse shoulder arthroplasty due to the patient's preserved joint space. For me, the procedure of choice would be biologic tuboplasty plus cable reinforcement. Combining the biologic Tuboplasty with cable reinforcement allows mean coverage of the greater tuberosity with a cushion, thereby preventing bone to bone contact, and also reinforcing the cable insertion points has been shown to improve shoulder biomechanics. Let's take a quick look at the surgical steps for this technique. Here we are viewing from the posterior portal with our grasper from the lateral portal pulling on a rotator cuff tissue. We can see the rotator cuff tissue is thin. It's friable. It's not of great quality. Not a very substantive in nature, and would be a significant risk for rotator cuff retear in the event of an attempted repair. Now we're debriding and preparing the bony bed of the greater tuberosity, and then measuring the size of the defect and graft to reinforce the cable. We'll use a two millimetres fibertape in a baseball stitch configuration moving from anterior to posterior. The appropriate tension for me is where I can place the fiber tape to exit the cuff in close proximity to the swivel lock anchor site in the greater tuberosity, to secure the fiber tapes at the anterior and posterior margins. We will use the tangible knotless swivel lock anchor. As you can see here, this is viewing from the lateral portal. This is the posterior insertion point right next to the native rotator cuff. There tensioning down that rotator cuff but not over tensioning it. Using the knotless mechanism of the swivel lock, we shuttle the four millimeter thick, pre-cut Arthur Flex graft to the prepared site, and we can see in a ratcheting type motion the graft moving nicely into the defect. Here are some other views. This is a lateral view. And now looking from the posterior aspect we can see the tuboplasty in combination with the cable reinforcement post-operatively. It's an aggressive rehab protocol. We start therapy at about one week after surgery. At three weeks. We're doing active assisted motion, and at six weeks we're doing full active motion and strengthening. And the goal is by three months to be moving the shoulder with a pain free range of motion. Here's our patient six weeks out of surgery, his Vas score has decreased to one. His pain score has increased to 40 and he's quite happy. So my experience so far is I've done 25 patients, have 12 month follow up on average for these patients, with the longest being two years out. We've had significant improvements in pain function and strength. The right patient for me in my hands is a painful shoulder that's non-arthritic non pseudo paralytic, has good range of motion with no advanced arthritis, with an intact or repairable subscap tear. In my practice, the biologic tuboplasty with cable reinforcement has enabled me to manage the challenging problem of a non-arthritic massive, irreparable rotator cuff tear with a cushion using a simple, fast and reproducible technique. As most of these procedures are performed at a surgery center, they're pre-cut. Four millimeter graft makes this a cost effective solution. Last but not least, my patients have experienced significant pain relief, allowing them to progress through my expedited rehab protocol. Thank you.

Biologic Tuberoplasty With Cable Reinforcement for Massive Irreparable Rotator Cuff Tears

Benton A. Emblom, MD (Birmingham, AL), repairs a gluteus medius tendon using a double-row tendon compression bridge.

Endoscopic Double-Row Gluteus Medius Repair Using the Gluteus Medius Repair System

I'm Benton emblem. I'm an orthopedic sports medicine surgeon in Birmingham, Alabama at Andrews Sports Medicine and Orthopedic Center. What we're going to demonstrate today is a partial thickness gluteus medius tendon repair. I see a good bit of these in middle aged women between 50 and 60 that have lateral hip pain, that often complain of discomfort for a year at least, that are treated empirically for gluteus medius tendinitis and or trochanteric bursitis. An MRI typically is obtained and shows a partial thickness gluteus medius tendon tear. These can be easily repaired endoscopically with a 30 or a 70 degree scope from the trochanteric space utilizing knotless suture anchors. We're going to demonstrate the repair of a partial thickness gluteus medius tendon tear, utilizing the 2.6 Knotless gluteus medius Tendon repair Kit. In this kit includes the drill guide and drill. The two anchors knotless 2.6mm the Millimeters the cutter. And in this instance we're going to utilize two additional anchors to create a two row or double row configuration repair. So we're established in the trochanteric space of the hip. This is a right hip proximal distal. Our two portals that we've created so far are a mid lateral portal. This is approximately four centimeters or a finger four fingerbreadths distal to the kind of the mid greater trochanter. And this is our standard anterolateral portal. So what we've done up to this point is we've prepared the trochanteric space by doing a complete bursectomy. We've identified the gluteus Maximus sling right here, which is our distal posterior landmark. And then this is our gluteus medius gluteus minimus muscle tendon complex. And this is the vastus lateralis. If you note the vastus lateralis has a very distinct sheen to it. And it's typically what I call the lighthouse of the trochanteric space. So in some in some cases of partial gluteus medius tendon tears, if the tendon length is pretty short, we'll typically do a single row knotless compression bridge construct and others where the tendon length is more substantial. We'll do a two row where we'll utilize four anchors. In that case, we'll typically develop an X footprint configuration by putting two anterior anchors and two posterior anchors. In that case, we'll take our anterior superior anchor and feed it and couple it with the posterior inferior anchor. And then once that's converted, we'll take our anterior inferior anchor here and convert it and couple it with the posterior superior anchor. So we'll put our first anchor in here. Oftentimes you have to manipulate the leg so that the trajectory of the drill is appropriate to prevent from skiving. So in this case you can notice that this drill guide is aiming somewhat tangentially to the proximal aspect of the femur. So we're going to have our have our assistant internally rotate the femur so that it'll bring the proximal femur a little bit more internally positioned. So we'll put our first anchor in right here which is going to be our anterior superior anchor. This is going to be the knotless 2.6mm FiberTak. So we're going to drill here. And when we insert this anchor we will by hand ensure that we have the anchor started into the pilot hole. And then we'll gently tap it with a mallet. So the backside of the guide will go flush with the handle of the inserter. And you just pull straight back after you've. Gotten the suture undone. And I just do a gentle pull not to try and deform the anchor, but just to make sure that we're well seated in the bone. So now we've established our are proximal posterolateral portal to insert our posterior anchors. So we've placed our most superior anterior anchor and our most inferior posterior anchor. And now we will convert these anchors creating a compression bridge configuration. So we'll take a loop grasper. And what we have to do here is we're trying to take this stitch here and take it to that anchor and that blue stitch there and bring it to this anchor. So what I like to do is I'll take the loop Grasper push the suture somewhat into the field. I'll grab the round stitch here and I'll run over. And I will basically grab the blue stitch here. And pull these out through the anterior lateral portal. And then we'll come back in through our posterior portal, grab our round stitch here and move forward. And grab our blue stitch. Carefully watching the SutureTape down here to make sure that the conversion stitch doesn't unload itself. And now we're going to convert our posterior stitch by converting it through the looped shuttle. We're finishing the conversion. We're sequentially tensioning each limb of the compression. Suturebridge. So we now have a nice tensioned bridge from anterior to posterior. And this is one limb of our x. So now we've placed our other two anchors to create the create the second limb of the X of the two row compression construct. We'll come in with our loop Grasper. And just like we did the first time, we'll grab our round suture and come posteriorly and grab our blue repair stitch. And we'll come back in our posterior portal and grab our posterior round conversion stitch. And then come to the anterior inferior anchor and grab its appropriate repair suture. And then just like in the first limb, we'll convert the knotless mechanism and convert loosely so that we don't over tension one limb of the compression bridge and then sequentially tension that creating a two row compression bridge in an X configuration. So this is our final construct. After we've converted two pairs of the 2.6 Knotless FiberTak creating a x shaped two row compression bridge. You can see here we've got our anterior superior anchor, our anterior inferior anchor with our posterior superior anchor and our posterior inferior anchor. And as our assistant externally rotates the leg, you can see as the gluteus medius minimus complex comes under tension, you can see this configuration remains taut and provides excellent compression of the partial thickness gluteus medius tendon tear.

Endoscopic Double-Row Gluteus Medius Repair Using the Gluteus Medius Repair System

Sanj Kakar, MD (Rochester, MN), shares a surgical pearl for using the NanoNeedle™ scope 2.0 to access the thumb CMC joint.

SpeedPearl: Accessing the Thumb CMC Joint With the NanoNeedle™ Scope 2.0

Speaker  Accurate diagnosis and assessment of the articular surface of the thumb CMC joint is particularly important, for example, in fractures and when managing thumb CMC arthritis. However, this joint is tight. Given its complex anatomy, and so this is perfect for the nanoneedle scope given its lightweight, small and flexible design. The Nanoneedle allows for safe entry into the thumb CMC joint. I typically create the one new portal first and to provide greater working space, the portal is created next.

SpeedPearl: Accessing the Thumb CMC Joint With the NanoNeedle™ Scope 2.0

Seth I. Gasser, MD (Tampa, FL), shares his firsthand experience with the Synergy Power™ system—highlighting how it streamlines workflow within a facility and why it is his preferred powered instrument solution in the OR.

Dr. Seth I. Gasser Surgeon Testimonial: Synergy Power™ System

Speaker  Energy. Power has really changed the way our team works and functions. It's streamlined the work process, including setup times and surgical times with just two hand pieces. It covers our broad range of needs throughout any procedure. It's reliable. Powerful. Versatile. The frequent changes required often during surgery are quick and easy, with a unique design of the hand pieces. It's very easy for the scrub tech to make a quick change. I don't worry about them having difficulty, and my focus is really on the surgery and the patient because I'm confident that the equipment will work as it's supposed to. It provides a balance of comfort and performance. It has a lighter feel. And it's the kind of comfort that really adds up over the course of long, difficult cases. Arthrex has been a leader and innovator as long as I've been in practice over the past 33 years. They've answered all of our questions, guided our setups, trained the staff, and really made sure everything ran smoothly before we started. And this is just another example of how Arthrex has made it easier for me as a surgeon to treat my patients better.

Dr. Seth I. Gasser Surgeon Testimonial: Synergy Power™ System

John Zvijac, MD (Miami, FL), demonstrates the use of the NanoNeedle™ scope 2.0 and the PassPort Button™ cannula with auxiliary lumen for Nano shoulder arthroscopy labral repairs.

Labral Repair Using the NanoNeedle™ Scope 2.0 and the PassPort Button™ Cannula With Auxiliary Lumen

Speaker  Hi, I'm John from Miami, Florida, and today we're showcasing a label repair technique using the Nanoneedle scope 2.0 and the accessory Lumen Passport. This setup allows for ultra minimally invasive access and enhanced maneuverability. We've already established our portals, and the accessory Lumen Passport is positioned to facilitate suture management and instrument passage. You'll see how this design improves efficiency and flexibility during the repair. Here is what the accessory Lumen Passport looks like. We have a center hole for instrumentation, and then there is an accessory lumen, which allows for passage of a multitude of micro instruments for suture management. Here we see the nanoneedle scope in the posterior shoulder portal and the accessory passport lumen anteriorly in a rotator cuff interval. A little pro tip the accessory portal. If you can leave this inferiorly or posteriorly, it makes it a little bit easier for suture management. It's not that big of a deal. You can always put it in any position, but that's a little pro tip to help as you're moving this along. You can see the soft tissue bankart lesion that's occurred. This is the labrum all the way down. And we're well past the 6:00 position to allow for bringing the capsule both superiorly and laterally onto the articular surface. The labrum often falls not only medially but inferiorly while you're doing these type of surgeries. Speaker  So it's important to free all of this up for proper mobilization and tensioning. We'll be repairing this labral tear with the 1.8mm knotless fiber tack anchor. This is being done through the central lumen of our passport. And now we're going to pass the suture retriever through the accessory portal in our passport. You can see it coming through, and we can easily pass our stitch with the use of a scorpion through our central portal. And now we're going to just easily shuttle our loop stitch through our center portal. And now we're ready for shuttling a repair stitch. Keeping very nice suture management, preventing entanglement of the stitches intra articularly. We're going to take this stitch out through our center hole to allow for final cutting of the stitch. Here we're using the flush cutter, and we can just bring this down to central portal. And we can cut our stitch flush. And we're ready for the next stitch. The repair is completed with precise suture placement and minimal disruption to the surrounding tissue. The accessory Lumen Passport enhances suture management and expands our instrument options for suture passing during a label repair. Combined with the Nanoneedle scope 2.0, we're moving closer to an ideal solution for the ultra minimally invasive arthroscopy.

Labral Repair Using the NanoNeedle™ Scope 2.0 and the PassPort Button™ Cannula With Auxiliary Lumen

Sanj Kakar, MD (Rochester, MN), shares how the NanoNeedle™ scope 2.0 can aid in visualization during wrist arthroscopy procedures.

SpeedPearl: DRUJ Arthroscopy Using the NanoNeedle™ Scope 2.0

Speaker  The trampoline hook and suction test provide an indirect assessment to the foveal insertion of the Tfcc, which is the most important static stabilizer of the Druj. Given how tight the DJ is, the Nanoneedle provides an ideal indication for its use to examine this space and the Foveal insertion of the Tfcc. Using the percutaneous kit, you can access the DJ in a safe and efficient manner.

SpeedPearl: DRUJ Arthroscopy Using the NanoNeedle™ Scope 2.0

At the Orthopedic Technology and Innovation Forum, John J. Christoforetti, MD (Bethesda, MD), and Benjamin G. Domb, MD (Chicago, IL), review the evolution and application of knotless all-suture anchor technology in hip arthroscopy, highlighting its advantages in reproducibility, safety, and adaptability to the anatomical constraints of the hip joint.

Femoroacetabular Impingement (FAI) and Labral Tears: Literature Review on All-Suture Anchor Outcomes in Hip Arthroscopy

OrthoPedia: Femoroacetabular Impingement (FAI) and Labral Tears: Literature Review on All-Suture Anchor Outcomes in Hip Arthroscopy

The Arthrex ElbowLOC® positioner is a modular, upper extremity positioner that gives the surgeon the choice of supine, lateral, or supine-suspended positioning for elbow surgery, as well as a wrist traction device for wrist and hand arthroscopy. The ElbowLOC positioner is easy to use and set up, and housed in a space-saving single autoclavable tray.

The Arthrex ElbowLOC® Elbow and Wrist Positioner

The Arthrex ElbowLOC® Elbow and Wrist Positioner

The Arthrex Graft Gun features an optimized design for enhanced visualization of graft delivery during minimally invasive and tubular spine surgeries. It is validated to deliver 100% autograft chips.1
Reference
1. Arthrex, Inc. Data on file (APT-1022220). Naples, FL; 2025.

Arthrex Graft Gun

Arthrex Graft Gun

The MaxForce™ MTP fusion system features a unique gear mechanism along the plate, allowing for controlled, dialed-in compression across the joint. Featuring 18 different plate options of varying sizes and curvatures for primary and revision cases and multiple Arthrex plating-screw and cross-screw options to best address patient needs and anatomy, the MaxForce MTP fusion system provides a comprehensive solution for 1st MTP arthrodesis.

MaxForce™ MTP Plating System Features and Benefits Animation

MaxForce™ MTP Plating System Features and Benefits Animation

What's NewMAY 19

Distal Humerus Fracture Fixation With the Arthrex Distal Humerus Lateral Biplanar Plate

What’s New This Week and Prior

MAY 18

Minimally Invasive Correction of a Type 3 Tailor’s Bunion Using a Beveled Screw

MAY 17

GraftLink® ACL Reconstruction Using the TightRope® SB Implant for the InternalBrace™ Technique

MAY 16

OrthoPedia: Surgical Technique and Tips for Endoscopic Transforaminal Approach During Discectomy

MAY 15

Biologic Tuberoplasty With Cable Reinforcement for Massive Irreparable Rotator Cuff Tears

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