TightRope II RT, with FiberTape for InternalBrace Technique

ACL TightRope II RT, mit InternalBrace-Bandaugmentation

TightRope II RT, Reconstruction with InternalBrace Ligament Augmentation Repair

TightRope II, ACL, RT,con aumento de ligamento InternalBrace

Finished Product

AR-1588RT-IB

Human

Orthobiologics

Knee

Procedure

Harnessing the power of biologics to provide all necessary components of healing, the BioACL™ technique uses the patient’s own bone collected using the GraftNet™ device and mixed with autologous bioactive fluid.&nbsp;
Using the Angel® system or Arthrex ACP® double-syringe system, concentrated platelet-rich plasma (cPRP) is obtained from bone marrow aspirate (BMA) or whole blood. The autologous mixture is then delivered into the bone tunnels created during an ACL reconstruction. In conjunction with the QuadLink™ technique, the BioACL technique provides the ultimate anatomic, minimally invasive, and reproducible approach for biologically augmented ACL reconstructions.

BioACL™ Technique

Child (D)

Product

As the first adjustable-loop cortical suspensory fixation implant to use a flat SutureTape design, the ACL TightRope II implant offers better handling characteristics and is more resistant to graft abrasion or tissue pull-through than traditional round sutures.1&nbsp;
Engineered for precise graft tensioning, the adjustable-loop mechanism allows for incremental retensioning of the graft construct after the implants have been secured on the cortex. The redesigned cortical button now incorporates a proprietary knotless fifth locking mechanism, increasing strength and resistance to cyclic displacement.2 To accommodate various graft types and techniques, TightRope II implants are available in RT and BTB configurations loaded with an additional flipping suture or preloaded with a FiberTape® suture for the InternalBrace™ technique. Available options for the ABS implant include standard or open.
References
1. Arthrex, Inc. LA1-00038-EN_B. Naples, FL; 2017.
2. Arthrex, Inc. Data on file (APT-G01155). Munich, Germany; 2020.
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.

ACL TightRope® II Implant

Once the minimally invasive or open incision is made and proper soft-tissue windows are established, use the fibular, tibial, and/or femoral collateral marking hooks for anatomic precision and osseous measurements when drilling the appropriate reconstruction tunnels. Using the femoral collateral marking hook with the parallel drill guide will increase anatomic femoral drilling efficiency by significantly reducing convergent tunnels and allowing for accurate guide pin placement at multiple incremental distances. During tunnel creation, use the spooned ends of the collateral ligament retractor to retract the neurovascular structures and the collateral ligament rasp to chamfer the aperture of the completed reconstruction tunnels. Then use FiberWire® or FiberStick™ suture to pass the prepared grafts and tension to the desired position prior to graft fixation.

Anatomic Collateral Ligament Reconstruction

Many products are available to assist the surgeon with bone-tendon-bone (BTB) graft harvesting and preparation. 

 
 
The parallel graft knife—with parallel blades to create a precise cut in a single pass—is designed for harvesting the patellar or quadriceps tendon during an ACL or a PCL reconstruction. 
 

 
Graft harvesting cutting guides and saw blades can harvest an ideal trapezoidal-shaped bone plug with predrilled suture holes from both the patella and the tibia; the cutting guides provide consistent, reproducible 
results during tendon harvest. 
 

 
Additional instrumentation for BTB graft preparation, including a graft harvesting osteotome and ACL graft shaper, are also available.&nbsp;

BTB Graft Harvest and Preparation Instruments

Multiple collateral ligament reconstruction techniques, from aperture fixation using the BioComposite SwiveLock® tenodesis system with biocomposite interference screws to suspensory fixation using TightRope® technology, are available.
FiberTak® soft anchors and biocomposite suture anchors, which come preloaded with needles, are part of a comprehensive line of anchor fixation devices supporting primary or hybrid collateral ligament repair and reconstruction techniques.

Collateral Ligament Graft Fixation

Arthrex offers the most advanced techniques and instruments for hamstring harvesting and preparation for ACL reconstruction. A reproducible harvest can be performed through a traditional anterior or posterior approach using the minimally invasive hamstring harvest technique and specialized tendon strippers.
The GraftLink®&nbsp;technique provides an anatomic, minimally invasive, and reproducible ACL reconstruction procedure. When used in combination with anatomic guides, the FlipCutter® III drill allows independent femoral and tibial "retrodrilling" to create sockets while maintaining the cortices to maximize fixation. Femoral and tibial TightRope® II implants, with a proprietary 5-point locking system, make the GraftLink technique the most reproducible ACL reconstruction available.
Anatomic: Independent tibial and femoral socket preparation with FlipCutter III reamer and/or low-profile reamers facilitate unconstrained placement of the ACL graft.
Minimally Invasive: Socket preparation with the FlipCutter III reamer limits soft-tissue dissection and helps preserve bone and periosteum.
Reproducible: The GraftPro® graft prep system simplifies graft preparation; the tapered graft and adjustable ACL TightRope II buttons facilitate graft passing, fine tuning of graft depth, and graft tensioning from the femoral and tibial sides.

Hamstring Autograft ACL Reconstruction

Arthrex offers the most advanced techniques and instruments for hamstring harvesting and preparation. Harvesting can be accomplished safely and reproducibly both from the traditional anterior approach or through a posterior approach using the minimally invasive hamstring harvest technique and specialized tendon strippers. 
 

The Arthrex Graft Prep Station offers a variety of interchangeable clamps and posts to facilitate graft tensioning and suturing. 
 

Graft preparation has been revolutionized with the FiberLoop® line of suture and SpeedWhip™ technique. The continuous loops of #2 or #0 suture and free-floating straight or curved needles allow reproducible graft suturing in half the time of traditional straight sutures.

Hamstring Graft Harvest and Preparation Instruments

MCL reconstruction is typically performed when the MCL is severely injured or in cases of chronic MCL laxity. During an MCL reconstruction, autograft or allograft tissue is used to reconstruct the injured ligament. Graft-fixation technology for MCL reconstruction has evolved from staples, posts and washers, and interference screws to less invasive and easier-to-use suspensory fixation, including the TightRope® implant, and 
all-suture anchor technology, such as the Knee FiberTak® anchor.&nbsp;
Adding the InternalBrace™ technique to an MCL repair may result in lower failure rates and less residual laxity post-op as well as shorter immobilization times and faster return to play.1 Additionally, FiberTape® suture has been used for more than 15 years in more than 4 million cases, including tendon and ligament-bridging repairs.
The InternalBrace surgical technique is intended only to support the primary repair and is not intended as a replacement for the standard of care using biologic augmentation in a primary repair.&nbsp;The InternalBrace surgical technique is intended only for soft-tissue-to-bone fixation and is not cleared for bone-to-bone fixation.
Reference
 
1. van Eck CF, Nakamura T, Price T, Linde M, Smolinski P. Suture tape augmentation improves laxity of MCL repair in the ACL reconstructed knee.&nbsp;Knee Surg Sports Traumatol Arthrosc. 2021;29(8):2545-2552. doi:10.1007/s00167-020-06386-7

Medial Collateral Ligament (MCL) Reconstruction

Ruptures of the quadriceps and patellar tendons are common in elite and recreational athletes. Most surgeons treat these injuries surgically to lessen the risk of long-term disability and morbidity.&nbsp;
Historically, open techniques have been used for rupture repairs, but these techniques may be complicated by wound-healing issues and infection. The minimally invasive Percutaneous Achilles Repair System (PARS) technique can be used to treat quadriceps, patellar, and Achilles tendon ruptures.

Patellar Tendon Repair

PCL injuries occur during sports-related activities or high-velocity, traumatic accidents. Indications for operative treatment of PCL tears include acute injuries, active young patients, and either isolated grade 3 tears or combined injuries, such as a grade 2 injury with posterolateral corner instability. 

Arthrex developed several techniques for isolated PCL injuries—including PCL inlay reconstruction, double-bundle PCL reconstruction, and the transtibial PCL RetroConstruction™ procedure—that can be combined with multiligament or posterolateral corner reconstruction.
Additionally, a comprehensive line of PCL reconstruction instrumentation is available for a variety of PCL reconstruction techniques, as well as autografts and allografts and single- or double-bundle options.

Posterior Cruciate Ligament (PCL) Reconstruction

Ruptures of the quadriceps and patellar tendons are common in elite and recreational athletes. Most surgeons treat these injuries surgically to lessen the risk of long-term disability and morbidity. Historically, open techniques have been used for rupture repairs but may be complicated by wound-healing issues and infection. The minimally invasive Percutaneous Achilles Repair System (PARS) technique can be used to treat quadriceps, patellar, and Achilles tendon ruptures.
The PARS technique helps facilitate consistent capture of the distal aspect of the quadriceps tendon and includes color-coded FiberWire® and FiberTape® sutures. The anatomically contoured guide is reusable, while the suture and passing needles come packaged in a convenient kit. Choose transverse suture, locking suture, or both. The colored FiberWire sutures offer a more organized approach to identifying and securing matched pairs.

Quadriceps Tendon Repair 

The next evolution in adjustable cortical suspensory fixation, the ACL TightRope II implant includes a flat-tape TightRope loop for improved graft interface and handling characteristics during graft tensioning and greater resistance to graft abrasion.1 Engineered to enable precise graft tensioning and incremental retensioning of the construct after cortical button fixation, this implant features a proprietary 5-point locking design that resists cyclic displacement and offers excellent pull-out strength.2
 
 
An ideal choice for all inside ACL reconstruction, the ACL TightRope II RT implant can be used for femoral fixation and combined with an ACL TightRope II ABS implant and concave ABS button for tibial fixation to facilitate incremental graft advancement and tensioning of both the femoral and tibial ends of the graft.
References
1. Arthrex, Inc. Data on file (LA1-00038-EN_B). Naples, FL; 2017.
2. Arthrex, Inc. Data on file (APT-G01155). Munich, Germany; 2020.

TightRope II RT, with FiberTape for InternalBrace Technique

AR-1588RT-IB

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