#2 FiberSnare suture, 26" length with 2” closed loop (White/Blue)

#2 FiberSnare with #2 FiberWire Braided Polyblend Suture, White/Blue with Closed Loop, 26 inches, One End Stiffened, 12 inches

Finished Product

AR-7209SNL

Human

Knee

Procedure

Arthrex offers a comprehensive selection of fixation devices for a variety of bone-patellar tendon-bone (BTB) graft techniques. These options include adjustable, continuous-loop suspensory fixation, and interference screws in a variety of materials. The TightRope® implant, which has been used in 2 million procedures globally,1 was designed to simplify ACL reconstruction and facilitate advanced techniques, such as the GraftLink® technique. BioComposite FastThread™ interference screws, which are composed of time-tested material with more than a decade of clinical success and implantation, allow for faster screw insertion and better graft protection.2
References
1. Arthrex, Inc. Data on file (sales data as of September 18, 2018). Naples, FL; 2018.
2. Arthrex, Inc. LA1-0199-EN_E. Naples, FL; 2018.
Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA.

BTB Autograft ACL Reconstruction 

Child (D)

There has been a renewed interest in ACL primary repairs as the treatment for Sherman type I and type II ACL ruptures. Careful analysis of historical data has revealed that certain ACL tear subgroups, especially proximal tears with good tissue quality, have positive clinical outcomes with primary ACL repair.1
Studies reporting outcomes of remnant-preserving ACL surgeries have shown encouraging results and a greater potential for early healing and better functional outcomes compared with remnant-resecting surgeries.2 Preservation of the native ACL using the primary repair technique can achieve short-term clinical success and result in good clinical outcomes at 3-year follow-up in this carefully selected patient population.3
Arthroscopic primary repair is minimally invasive because no grafts need to be harvested, no graft tunnels or sockets need to be drilled, and revision surgery, if necessary, is more analogous to primary reconstructions.4 The goal of the procedure is to preserve the remnant native ligament. By doing this, the native nerve endings and blood supply are preserved.5
References
1. van der List JP, DiFelice GS. Role of tear location on outcomes of open primary repair of the anterior cruciate ligament: a systematic review of historical studies. Knee. 2017;24(5):898-908. doi:10.1016/j.knee.2017.05.009
2. van der List JP, DiFelice GS. Successful arthroscopic primary repair of a chronic anterior cruciate ligament tear 11 years following injury. HSS J. 2017;13(1):90-95. doi:10.1007/s11420-016-9530-8
3. Jonkergouw A, van der List JP, DiFelice GS. Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):21-28. doi:10.1007/s00167-018-5338-z
4. DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy. 2015;31(11):2162-2171. doi:10.1016/j.arthro.2015.08.010
5. DiFelice GS, van der List JP. Arthroscopic primary repair of proximal anterior cruciate ligament tears. Arthrosc Tech. 2016;5(5):e1057-e1061. doi:10.1016/j.eats.2016.05.009

ACL Repair

Product

An innovative approach to ACL preservation, the ACL Repair TightRope implant enables precise, incremental repair tensioning and retensioning. Additionally, the FiberRing suture allows for simplified and reproducible suture passing and implant loading. Careful analysis of historical data has revealed that certain ACL tear subgroups, especially proximal tears with good tissue quality, have positive clinical outcomes with primary ACL repair.1
Reference
1. Arthrex, Inc. Data on file (DOC1-000178-en-US_B). &nbsp;Naples, FL; 2020.

ACL Repair TightRope® Implant With FiberRing™ Sutures

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

Collateral Ligament Reconstruction Set

Orthobiologics

The BioACL technique harnesses the power of next-generation biologics to provide the ultimate anatomic, minimally invasive, reproducible approach for taking patient outcomes to the next level.
By prefilling ACL bone tunnels with a powerful composite of concentrated platelet-rich plasma (cPRP) from bone marrow aspirate (BMA) or whole blood processed with the Angel® system, the patient’s own bone collected with the GraftNet™ device, and AlloSync® Pure demineralized bone matrix, the BioACL technique provides all the necessary healing components for an ACL reconstruction procedure.
In conjunction with the QuadLink™ with InternalBrace™ technique, the BioACL technique has been shown to result in earlier range of motion, improved limb symmetry, less bone-tunnel widening, and improved patient-reported outcomes as compared to nonaugmented ACL procedures.1&nbsp;
 
 
Reference
1. Lavender CD, Schaver AL, Taylor S, et al. Anterior cruciate ligament reconstruction augmentation with bone marrow aspirate concentrate, demineralized bone matrix, and suture tape shows no difference in outcomes—but faster functional recovery—versus non-augmented anterior cruciate ligament reconstruction. Arthroscopy. Published online July 22, 2024.&nbsp;<a href="https://doi.org/10.1016/j.arthro.2024.06.042">https://doi.org/10.1016/j.arthro.2024.06.042</a>
 
The&nbsp;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&nbsp;InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.

BioACL™ Technique

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

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

Collateral Ligament Reconstruction Set

For meniscal allograft transplant, the double bone plug technique involves medially implanting the meniscal allograft with rigid fixation at both horn attachments. The technique can also correct meniscal deficiency using bone plugs and minimally invasive suspensory fixation and allows the meniscal allograft to maintain functional hoop stress.

Double Bone Plug

The Double Bone Plug technique for meniscal tear/deficiency utilizes bone plugs that can either be prepared freehand or by using a coring reamer. The freehand technique is performed using rongeurs and a high speed burr. For detailed information about this technique and/or Arthrex products utilized in this technique, visit the educational resources tab or products tab below. The double bone plug technique for meniscal allograft reconstruction provides a method for implanting the meniscal allograft medially with rigid fixation at both horn attachments. It has been demonstrated that bony fixation and bony healing at the attachment site allows for the maintenance of functional hoop stress by the meniscal allograft.

Double Bone Plug Meniscal Transplant

The new larger loop FiberSnare suture was specifically engineered for convenience and ease of use when shuttling sutures during ligament reconstruction and repair procedures. The FiberSnare suture has an overall working length of 26” in and the construct consists of a #2 FiberWire® suture with a 2 in loop on one end while the opposite end is stiffened 12 in. FiberSnare sutures can be used for both retrograde (outside-in) or antegrade (inside-out) drilling techniques as a shuttling suture. The new unique color patterns (black/white and white/blue striped suture) also allow for easier suture identification and management.

FiberSnare® Suture

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

The goal of lateral extra-articular augmentation or reconstruction is to eliminate residual laxity and reduce the risk of ACL graft rupture. Two common techniques include iliotibial band (ITB) tenodesis and anterolateral ligament (ALL) reconstruction. These procedures play a role in augmenting rotational stability in the ACL-reconstructed knee. Patients who see the benefits, include hyperlax patients, revision cases, pivoting athletes, and those with IKDC grade III pivot shifts.
There are several distinct advantages of using adjustable, tensionable implant technology, such as the Knotless FiberTak® anchor or FiberTag® TightRope® implant, when compared to traditional techniques using staples or interference screws:
<ul>
 <li>Simple: Quick, easy, and reproducible techniques</li>
 <li>Safe: Knotless FiberTak anchor sets just below the cortex, reducing the risk of femoral tunnel convergence of the ACL; the self-punching anchor technique is designed to reduce the risk of damaging the ACL graft as with traditional techniques that require drilling; no risk of graft laceration as described with interference-screw techniques1</li>
 <li>Low profile: Techniques using additional hardware, such as staples, may lead to pain or discomfort, warranting removal; no prominent hardware is part of the Knotless FiberTak anchor or TightRope implant1</li>
 <li>Preserves anatomy: No socket drilling involved in the Knotless FiberTak onlay technique&nbsp;</li>
 <li>Titratable graft tensioning: Using these techniques, a surgeon can provisionally tension and incrementally retension the graft after checking for isometry and overconstraint</li>
</ul>
Reference
1. Muller B, Willinge GJA, Zijl JAC. Minimally invasive modified Lemaire tenodesis. Arthrosc Tech. 2020;10(1):e29- e36. doi:10.1016/j.eats.2020.09.006

Lateral Extra-Articular Tenodesis

For over a decade, Arthrex has offered multiple collateral ligament reconstruction techniques, ranging from socket and tunnel based aperture fixation with FastThread™ interference screws to suspensory fixation using TightRope® technology.
In cases of avulsion type injuries, a primary LCL/PLC repair may be performed to restore stability while preserving native anatomy. The versatile line of Knee FiberTak® anchors offers various onlay fixation options, utilizing both knotted and knotless SutureTape technology in addition to 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.&nbsp;

Lateral Collateral Ligament (LCL) and Posterolateral Corner (PLC) Repair

FiberLoop® and TigerLoop™ sutures are a continuous loop of FiberWire® suture with multiple needle options. The needles are easy to handle and move freely on the suture to recenter themselves after passing through tissue and facilitating even tension. Graft preparation using the SpeedWhip™ technique drastically reduces time spent preparing the graft, uniformly compresses the graft, improves strength,1 and allows for last minute adjustments in graft length.
&nbsp;
The SpeedWhip rip-stop technique eliminates the weak link in graft preparation by reinforcing the suture/tissue interface with a FiberTag® scaffold. A FiberTag suture is incorporated into the end of the FiberLoop construct to allow each needle pass to include both the graft and the FiberTag scaffold. This construct has been shown to increase the strength over standard stitching alone.1
&nbsp;1. Arthrex, Inc. LA1-00005-EN_A. Naples, FL; 2015.&nbsp;

Looped Suture With Needles

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

The anatomic double-bundle technique replicates the native shape of the medial patellofemoral ligament (MPFL), provides stability in both flexion and extension, and effectively limits rotation throughout ROM, helping minimize postoperative instability. The technique, if accomplished directly and anatomically, can also allow for more aggressive rehabilitation protocols and earlier return to activity.1
Successful MPFL reconstruction is dependent on anatomic placement of the graft. The technique incorporates the use of a femoral template to ensure proper placement of the graft in the femur. This position provides a static fixation point that equalizes the tension across the graft in flexion and extension, thus helping minimize stress across the patellofemoral joint.
Other options include Knee FiberTak® anchors for onlay MPFL techniques as well as 4 MPFL convenience packs to address each patient's unique needs and each surgeon's fixation preference. The newest kits use 3.9 mm BioComposite SwiveLock® anchors for patellar fixation and either a 6 mm × 20 mm BioComposite FastThread™ interference screw or an ACL TightRope® implant for femoral fixation.
Reference
1. Schöttle PB, Hensler D, Imhoff AB. Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):147-151. doi:10.1007/s00167-009-0868-z

MPFL 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

A technique gaining popularity, PCL repair is generally indicated for bony avulsions that can occur on either the femur or tibia.&nbsp;
PCL injuries can happen during sports-related activities or high-velocity, traumatic accidents. Applications for operative treatment of PCL tears include acute injuries, tears in active young patients, and either isolated grade 3 tears or a combined injury, such as grade 2 tears with posterolateral corner instability.
PCL tears can be treated with innovative, minimally invasive procedures using the PCL Repair TightRope® implant and FiberRing™ sutures.

Posterior Cruciate Ligament (PCL) Repair 

The streamlined PCL ToolBox contains all the necessary instruments for performing a variety of modern PCL reconstruction techniques. The set includes the RetroConstruction™ Drill Guide System with drill sleeves for use with the FlipCutter® reamer, RetroDrill® reamer, and standard 2.4 mm guide pins.
 
 
Femoral and tibial RetroConstruction marking hooks allow safe, reproducible placement of pins and drills into the anatomic footprints. Also included in the set are double-bundle femoral drill guides, curved instruments for tibial preparation, a knee obturator for safe and easy posterior portal placement, tunnel plugs, drills, screwdrivers, notchers, and other accessories. This toolbox facilitates standard transtibial PCL reconstruction as well as modern techniques such as the arthroscopic inlay and GraftLink® all-inside PCL technique.

PCL ToolBox

Quadriceps tendon grafts offer unique benefits for cruciate ligament reconstruction, such as a predictably large diameter, low morbidity,1 and a preferable stiffness profile for knee ligament reconstruction.
The QuadPro™ tendon harvester is designed to harvest a quadriceps or patellar tendon graft using a minimally invasive technique.2-4 The sharp tip cores out an approximate cylindrical graft. The harvester's ergonomically designed handle features graduations on the clear shaft to allow visualization of approximate graft length during harvesting. Available in four sizes (8 mm to 11 mm), the QuadPro tendon harvester can accommodate each patient’s unique needs as well as the surgeon’s preference for graft diameter.
The FiberTag® TightRope® implant facilitates attachment of single-ended grafts, such as quadriceps tendon grafts, to the ACL TightRope RT and ABS implants. FiberTag suture is integrated into the TightRope implant for a strong, consistent connection between the suture and TightRope loop. A simplified suturing technique, along with innovative packaging and the GraftClamp graft preparation instrument, make preparing quadriceps tendon grafts faster and more reproducible than ever.
References
1. Arthrex, Inc. LA1-00100-EN_K. Naples, FL; 2021.
2. Xerogeanes JW, Mitchell PM, Karasev PA, Kolesov IA, Romine SE. Anatomic and morphological evaluation of the quadriceps tendon using 3-dimensional magnetic resonance imaging reconstruction: applications for anterior cruciate ligament autograft choice and procurement. Am J Sports Med. 2013;41(10):2392-2399. doi:10.1177/0363546513496626
3. Hadjicostas PT, Soucacos PN, Berger I, Koleganova N, Paessler HH. Comparative analysis of the morphologic structure of quadriceps and patellar tendon: a descriptive laboratory study. Arthroscopy. 2007;23(7):744-750. doi:10.1016/j.arthro.2007.01.032
4. Krebs N, Yaish A, O’Neill N. Anatomic evaluation of the quadriceps tendon in cadaveric specimens: application for anterior cruciate ligament reconstruction graft choice. SMRJ. 2019;4(1):7961. doi:10.51894/001c.7961

Quad Tendon Autograft ACL 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 

Relatively uncommon knee injuries, tibial spine avulsion fractures typically occur in children and adolescents.1 Despite the low incidence of tibial spine avulsion fractures, they deserve ample attention to ensure knee function and stability are correctly restored.
Innovative FiberRing™ sutures provide a simple and reproducible technique for securing the distal remnant to achieve anatomic reduction. The ACL Repair TightRope® implant offers titratable knotless fixation to ensure ACL length is appropriately restored and maintained.
Finally, the ACL InternalBrace™ ligament augmentation button accommodates the InternalBrace technique to help prevent excess range of motion during the healing phase and potentially reduce the chances of secondary injury.2,3
References
1. Williams NR, Yin S, Guzman AJ, et al. Tibial spine avulsion repair with FiberRing suture and anterior cruciate ligament repair TightRope.&nbsp;Arthrosc Tech. 2023;12(12):e2381-e2385. doi:10.1016/j.eats.2023.08.008
2. Mackay GM, Blyth MJ, Anthony I, Hopper GP, Ribbans WJ. A review of ligament augmentation with the InternalBrace™ the surgical principle is described for the lateral ankle ligament and ACL repair in particular, and a comprehensive review of other surgical applications and techniques is presented. Surg Technol Int. 2015;26:239-255.
3. Smith PA, Bley JA. Allograft anterior cruciate ligament reconstruction utilizing internal Brace augmentation. Arthrosc Tech. 2016;5(5):e1143-e1147. doi:10.1016/j.eats.2016.06.007

#2 FiberSnare suture, 26" length with 2” closed loop (White/Blue)

AR-7209SNL

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