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AlloSync reconstruction wedges are anatomically contoured grafts made from 100% allograft bone for Cotton and Evans procedures.
Eight profiles are available for Cotton procedures (plantar flexion opening wedge osteotomy of the medial cuneiform). The convex medial and concave lateral shape maximizes bone contact and does not violate the intercuneiform joint. The 12 profiles available for Evans procedures provide reliable and precise correction.

AlloSync™ Anatomic &nbsp;Reconstruction Wedge

Orthobiologics

Eric W. Tan, MD (Los Angeles, CA) demonstrates Cotton and Evans osteotomies using AlloSync™ allograft anatomic reconstruction wedges.

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Evans Calcaneal and Cotton Osteotomy

Foot and Ankle

Thomas G. Harris, MD, (Pasadena, CA) presents a flatfoot procedure where he used AlloSync™ bone wedges for an Evans and Cotton osteotomy. Dr. Harris implanted a DynaNite® compression staple for additional stability and compression across the Evans osteotomy.

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Flatfoot Reconstruction With AlloSync™ Wedges

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AlloSync™ Anatomic Reconstruction Wedge Surgical Technique I AlloSync™ Anatomic Reconstruction Wedge02 AlloSync™ – Reconstruction Wedge AlloSync reconstruction wedges are anatomically contoured grafts made from 100% allograft bone for Cotton and Evans procedures. Eight profiles are available for Cotton procedures (plantar flexion opening wedge osteotomy of the medial cuneiform). The convex medial and concave lateral shape maximizes bone contact and does not violate the intercuneiform joint. The 12 profiles available for Evans procedures provide reliable and precise correction. The AlloSync Reconstruction Wedge Advantage: n Made with dense cancellous bone for increased strength n Grafts come prehydrated n Sterile to device-grade standards n Grafts can be soaked in biologic fluids such as PRP or BMC prior to implantation n Ambient temperature storage AlloSync reconstruction wedges can be used in conjunction with the BioSync® reconstruction instrument set (AR-8948S). This set includes wedge trials that correspond with each of the available AlloSync wedges. Additionally, the BioSync wedge tamp can be used for AlloSync wedge insertion and positioning. BioSync Reconstruction Instrument Set AR-8948S Anatomic Cotton AlloSync Wedge AlloSync™ Anatomic Reconstruction Wedge I 03 Anatomic Evans Wedge Surgical Technique Carefully reflect the extensor digitorum brevis muscle belly superiorly and retract the peroneal tendons, along with the sural nerve, inferiorly to expose the anterior process of the calcaneus and the calcaneocuboid joint. Make a longitudinal incision just below the sinus tarsi to expose approximately 3 cm of the calcaneus proximal to the calcaneocubiod joint. Beginning 10 mm to 15 mm proximal to the calcaneocuboid joint, perform an osteotomy with an oscillating saw parallel to the joint. Leave the medial cortex intact. Place 2.4 mm or 1.6 mm guidewires on each side of the osteotomy and use a pin-style distractor to provide controlled distraction and unobstructed access to the osteotomy site. A provisional guidewire may be placed across the calcaneocuboid joint to prevent subluxation of the joint during distraction. 21 3 4 I AlloSync™ Anatomic Reconstruction Wedge04 Anatomic correction is performed by carefully distracting the osteotomy site while preserving the medial cortical hinge. This distraction typically measures between 6.5 mm and 12 mm. Trialing should begin with the small trials and progress as the patient’s size and correction require. Assess whether the desired correction of the talonavicular joint occurs with the trial wedge both clinically and fluoroscopically. Seat the AlloSync graft in the osteotomy until flush with bone. A tamp may be utilized as needed. After removal of the distractor, adequate correction and graft position should be confirmed both clinically and radiographically; if additional implant positioning is required, use the tamp to make adjustments. Ancillary fixation can be added when using AlloSync reconstruction wedges. Refer to the Comprehensive Foot System brochure (LB1-0437-EN) to see the various plates that can be used over the AlloSync reconstruction wedges. Commonly used plates for Evans osteotomy include the flat L-plate, medium X-plate, or large X-plate. Plate selection is based on the AlloSync reconstruction wedge used and patient anatomy. Anatomic Evans Wedge Surgical Technique Depth Width Thickness Open the selected size wedge. the surgeon’s discretion, AlloSync wedges may be soaked in biologic fluids such as PRP or BMC prior to insertion. AlloSync™ Reconstruction Evans Wedge Trial Sizing Footprint Image Implant Part no. Width (mm) Depth (mm) Thick- ness (mm) Thickness Image ABS-2810-1806 ABS-2810-1808 ABS-2810-1810 ABS-2810-1812 18 18 6.5 8 10 12 ABS-2810-2006 ABS-2810-2008 ABS-2810-2010 ABS-2810-2012 20 20 6.5 8 10 12 ABS-2810-2206 ABS-2810-2208 ABS-2810-2210 ABS-2810-2212 22 22 6.5 8 10 12 5 6 7 AlloSync™ Anatomic Reconstruction Wedge I 05 Make an incision dorsally over the medial cuneiform. Retract the extensor hallucis longus, and dissect the soft tissues down to the surface of the medial cuneiform. Make a transverse osteotomy in the center of the medial cuneiform parallel to the first tarsometatarsal joint. Take care to preserve the plantar cortex of the cuneiform. Gently open the osteotomy using a single or stacked osteotome technique; maintain distraction with a heart- or pin-style distractor. Distract the osteotomy site to the surgeon’s desired reconstruction between 4.5 mm and 7.5 mm. Start with the smaller trials first and proceed to exchange the colored trial inserters with thicker/larger trials. Assess whether the desired anatomic correction occurs with the trial wedge both clinically and fluoroscopically (shape and size). Correction is verified under fluoroscopy by assessing the declination of the first metatarsal. Once the correct footprint and thickness of the wedge are determined, record the trial’s size. Anatomic Cotton Wedge Surgical Technique The anatomic design of the AlloSync™ Cotton wedge’s helps prevent prominence and violation of the intercuneiform joint (as seen with triangle-shaped wedges). The following surgical technique describes the use of the anatomic AlloSync Cotton reconstruction wedges in an opening wedge cuneiform osteotomy. This technique can also be applied to other opening wedge osteotomies of the foot that require wedges of similar size. 1 2 3 I AlloSync™ Anatomic Reconstruction Wedge06 Seat the AlloSync graft in the osteotomy until flush with bone. Check final position fluoroscopically, using a tamp if needed. After removal of distraction, adequate correction and graft position should be confirmed both clinically and radiographically. 4 Ancillary fixation can be used with AlloSync reconstruction wedges. Refer to the Comprehensive Foot System brochure (LB1-0437-EN) to see the various plates that can be used over the AlloSync reconstruction wedges. The flat Cotton plate or the 2-hole straight plate can be used for Cotton osteotomy. Plate selection is based on the AlloSync reconstruction wedge used and patient anatomy. 5 Anatomic Cotton Wedge Surgical Technique Open the selected size wedge (box has sticker with corresponding color). Prior to inserting the wedge, the graft may be soaked with a biologic fluid such as PRP or BMC per surgeon preference. Thickness Depth AlloSync™ Reconstruction Cotton Wedge Trial Sizing Footprint Image Implant Part no. Depth (mm) Thickness (mm) Thickness Image ABS-2800-1645 ABS-2800-1655 ABS-2800-1665 ABS-2800-1675 16 4.5 5.5 6.5 7.5 ABS-2800-2045 ABS-2800-2055 ABS-2800-2065 ABS-2800-2075 20 4.5 5.5 6.5 7.5 AlloSync™ Anatomic Reconstruction Wedge I 07 Ordering Information AlloSync™ Reconstruction Wedge Product Description Item Number AlloSync Cotton Wedge, 16 x 4.5 mm ABS-2800-1645 AlloSync Cotton Wedge, 16 x 5.5 mm ABS-2800-1655 AlloSync Cotton Wedge, 16 x 6.5 mm ABS-2800-1665 AlloSync Cotton Wedge, 16 x 7.5 mm ABS-2800-1675 AlloSync Cotton Wedge, 20 x 4.5 mm ABS-2800-2045 AlloSync Cotton Wedge, 20 x 5.5 mm ABS-2800-2055 AlloSync Cotton Wedge, 20 x 6.5 mm ABS-2800-2065 AlloSync Cotton Wedge, 20 x 7.5 mm ABS-2800-2075 AlloSync Evans Wedge, 18 x 18 x 6.5 mm ABS-2810-1806 AlloSync Evans Wedge, 18 x 18 x 8 mm ABS-2810-1808 AlloSync Evans Wedge, 18 x 18 x 10 mm ABS-2810-1810 AlloSync Evans Wedge, 18 x 18 x 12 mm ABS-2810-1812 AlloSync Evans Wedge, 20 x 20 x 6.5 mm ABS-2810-2006 AlloSync Evans Wedge, 20 x 20 x 8 mm ABS-2810-2008 AlloSync Evans Wedge, 20 x 20 x 10 mm ABS-2810-2010 AlloSync Evans Wedge, 20 x 20 x 12 mm ABS-2810-2012 AlloSync Evans Wedge, 22 x 22 x 6.5 mm ABS-2810-2206 AlloSync Evans Wedge, 22 x 22 x 8 mm ABS-2810-2208 AlloSync Evans Wedge, 22 x 22 x 10 mm ABS-2810-2210 AlloSync Evans Wedge, 22 x 22 x 12 mm ABS-2810-2212 BioSync® Reconstruction Instrument Set Product Description Item Number BioSync Reconstruction Instrument Set AR-8948S Set includes the following: Wedge Inserter AR-8948-01 Osteotomy Distractor AR-13225 Distractor, medium AR-8948CD Mallet AR-8826M BioSync Reconstruction Wedge Instrument Case AR-8948C Cotton Wedge Trial, 16 x 4.5 mm AR-8948T-1645 Cotton Wedge Trial, 16 x 5.5 mm AR-8948T-1655 Cotton Wedge Trial, 16 x 6.5 mm AR-8948T-1665 Cotton Wedge Trial, 16 x 7.5 mm AR-8948T-1675 Cotton Wedge Trial, 20 x 4.5 mm AR-8948T-2045 Cotton Wedge Trial, 20 x 5.5 mm AR-8948T-2055 Cotton Wedge Trial, 20 x 6.5 mm AR-8948T-2065 Cotton Wedge Trial, 20 x 7.5 mm AR-8948T-2075 Evans Wedge Trial, 18 x 18 x 6.5 mm AR-8942T-1806 Evans Wedge Trial, 18 x 18 x 8 mm AR-8942T-1808 Evans Wedge Trial, 18 x 18 x 10 mm AR-8942T-1810 Evans Wedge Trial, 18 x 18 x 12 mm AR-8942T-1812 Evans Wedge Trial, 20 x 20 x 6.5 mm AR-8942T-2006 Evans Wedge Trial, 20 x 20 x 8 mm AR-8942T-2008 Evans Wedge Trial, 20 x 20 x 10 mm AR-8942T-2010 Evans Wedge Trial, 20 x 20 x 12 mm AR-8942T-2012 Evans Wedge Trial, 22 x 22 x 6.5 mm AR-8942T-2206 Evans Wedge Trial, 22 x 22 x 8 mm AR-8942T-2208 Evans Wedge Trial, 22 x 22 x 10 mm AR-8942T-2210 Evans Wedge Trial, 22 x 22 x 12 mm AR-8942T-2212 Depth Guide AR-13120G-2 Driver, T-8 hexalobe, self-retaining AR-8916-27 Handle, small, w/ AO connection AR-2001AOT Holding sleeve, for 2.0 and 2.4 mm screws AR-8920H Drill Guide, 1.7 mm, Evans wedge AR-8942-03 BioSync Wedge Tamp AR-8942-01 Screwholding Forceps, self-retaining AR-8941F Osteotome, low profile, short, 5 mm AR-13203-05 Osteotome, low profile, short, 10 mm AR-13203-10 Osteotome, low profile, short, 12 mm AR-13203-12 Products may not be available in all markets because product availability is subject to the regulatory approvals and medical practices in individual markets. Please contact Arthrex if you have questions about the availability of products in your area. This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level or outcomes. View U.S. patent information at www.arthrex.com/corporate/virtual-patent-marking © 2018 Arthrex, Inc. All rights reserved. | www.arthrex.com | LT1-00135-EN_A

AlloSync™ Anatomic Reconstruction Wedge

A document containing information about Arthrex products and product lines.

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AlloSync™ Bone Grafting Solutions

View U.S. Patent information at www.Arthrex.com/virtual-patent-marking © 2018 Arthrex, Inc. All rights reserved. LB1-00155-EN_A Allograft Anatomic Reconstruction Wedges for Cotton and Evans Procedures AlloSync™ Allograft Anatomic Recontruction Wedges Features and Benefits • 100% allograft bone • Possible shorter OR time vs autograft bone • Sterile to device-grade standards Sterility assurance level (10-6) • Ambient temperature storage AlloSync allograft anatomic reconstruction wedges can be used in conjunction with the BioSync® reconstruction instrument set (AR-8948S). This set includes wedge trials that correspond with each of the available AlloSync wedges. Additionally, the BioSync wedge tamp can be used for AlloSync wedge insertion and positioning. AlloSync allograft reconstruction wedges are anatomically contoured grafts for Cotton and Evans procedures. The AlloSync allograft reconstruction wedges provide an alternative to autograft bone, which research suggests is equivalent to structural allografts in fusion rates for osteotomies and fusions of the foot.¹ Eight anatomically derived profiles are available for Cotton procedures and 12 profiles for Evans procedures providing reliable and precise correction. BioSync Wedge Tamp AR-8942-01 BioSync Reconstruction Instrument Set AR-8948S Allograft demineralized bone matrix is optimal for containment of additional biologically active products. In order to provide a composite graft and enhance the biologic nature of the graft, combine osteogenic, autologous bone marrow and/or autologous PRP. The Arthrex Angel® cPRP System The Arthrex Angel cPRP system uses a proprietary platelet sensor and 1-button automation to deliver customized PRP concentrate. The Angel cPRP system is the only device that can provide cPRP with adjustable cellular levels. Customization of cellular levels in cPRP is necessary to reduce the number of neutrophils, which can be detrimental to bone healing. ACP Double Syringe With Cap ABS-10010S Combining AlloSync™ Wedges With Autologous Products References: 1. Müller MA, Frank A, Briel M, et al. Substitutes of structural and non-structural autologous bone grafts in hindfoot arthrodeses and osteotomies: a systematic review. BMC Musculoskelet Disord. 2013;14:59. doi: 10.1186/1471- 2474-14-59. 2. Grøgaard B, Gerdin B, Reikerås O. The polymorphonuclear leukocyte: has it a role in fracture healing? Arch Orthop Trauma Surg. 1990;109(5):268-271. 3. Voggenreiter G, Assenmacher S, Kreuzfelder E, et al. Immunosuppression with FK506 increases bone induction in demineralized isogeneic and xenogeneic bone matrix in the rat. J Bone Miner Res. 2000;15(9):1825-1834. doi:10.1359/jbmr.2000.15.9.1825. 4. Gallo l, Sáenz A, Artiñano E,, Esquide J. Autologous platelet- rich plasma: effect on sternal healing in the sheep model. Interact Cardiovasc Thorac Surg. 2010;11(3):223-225. doi:10.1510/icvts.2010.237776. Product and Ordering Information Product Type Part Number Product Type Part Number AlloSync Evans Wedges 18 mm x 18 mm x 6.5 mm ABS-2810-1806 18 mm x 18 mm x 8 mm ABS-2810-1808 18 mm x 18 mm x 10 mm ABS-2810-1810 18 mm x 18 mm x 12 mm ABS-2810-1812 20 mm x 20 mm x 6.5 mm ABS-2810-2006 20 mm x 20 mm x 8 mm ABS-2810-2008 20 mm x 20 mm x 10 mm ABS-2810-2010 20 mm x 20 mm x 12 mm ABS-2810-2012 22 mm x 22 mm x 6.5 mm ABS-2810-2206 22 mm x 22 mm x 8 mm ABS-2810-2208 22 mm x 22 mm x 10 mm ABS-2810-2210 22 mm x 22 mm x 12 mm ABS-2810-2212 AlloSync Cotton Wedges 16 mm x 4.5 mm ABS-2800-1645 16 mm x 5.5 mm ABS-2800-1655 16 mm x 6.5 mm ABS-2800-1665 16 mm x 7.5 mm ABS-2800-1675 20 mm x 4.5 mm ABS-2800-2045 20 mm x 5.5 mm ABS-2800-2055 20 mm x 6.5 mm ABS-2800-2065 20 mm x 7.5 mm ABS-2800-2075 To order, please call Arthrex Customer Service at 1-800-934-4404 or email your order to: cstissue@arthrex.com. Autologous Conditioned Plasma (ACP) The Arthrex ACP® double-syringe system allows for rapid and efficient concentration of platelets and growth factors within a plasma-based PRP. White blood cells are NOT concentrated within the Arthrex ACP system. Concentrated white blood cells, specifically neutrophils, have been shown to suppress bone formation and bone healing. PRP has been found to improve bone regeneration.2-4 Arthrex Angel System ABS-10060 View U.S. Patent information at www.Arthrex.com/virtual-patent-marking © 2018 Arthrex, Inc. All rights reserved. LB1-00155-EN_A AlloSync™ bone product is indicated for orthopedic applications as filler for gaps or voids that are not intrinsic to the stability of the bony structure. AlloSync bone product is indicated to be packed gently into bony gaps in the skeletal system as a bone graft extender (extremities, spine, and pelvis) and as bony void filler of the extremities and pelvis. These defects may be surgically created or from the result of traumatic injury to the bone. This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level or outcomes.

AlloSync™ Anatomic Reconstruction Wedge

AlloSync™ Anatomic Reconstruction Wedge

Evans Calcaneal and Cotton Osteotomy

Flatfoot Reconstruction With AlloSync™ Wedges

AlloSync™ Anatomic Reconstruction Wedge

AlloSync™ Bone Grafting Solutions

AlloSync™ Allograft Anatomic Reconstruction Wedges for Cotton and Evans Procedures