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FiberTak SpeedBridge Rotator Cuff Repair ® ™ Surgical Technique FiberTak® SpeedBridge™ Repair As the next evolution of knotless rotator cuff repair, the FiberTak SpeedBridge technique is completed with 2.6 FiberTak RC soft anchors on the medial row and FiberTape® sutures fixated laterally with trusted SwiveLock® anchors. This knotless repair creates a quick, secure construct in as few as three suturepassing steps. The small size of the 2.6 FiberTak RC anchors allows for three points of medial-row fixation where previously only two fixation points could be achieved. Advantages Biomechanical repair strength is comparable to traditional SpeedBridge repair1 Multiple fixation points and additional FiberTape sutures increase tendon-to-bone compression2 Contact area of the tendon-to-footprint interface increased 14% compared to traditional hard-bodied anchors2 Secure lateral fixation with trusted SwiveLock anchors Enhancements Knotless 2.6 FiberTak RC anchors are adaptable and can conform to traditional repair techniques while providing the additional benefits of tensionable knotless technology for incorporating biologics or increasing medial-row compression. Double-Pulley Rip-Stop With ArthroFLEX® Dermal Allograft Augmentation Canopy Augmentation With ArthroFLEX Dermal Allograft Independent Mattress Rip-Stops Independent Mattress Stitches ArthroFLEX is a registered trademark of LifeNet Health. 02 I FiberTak® SpeedBridge™ Repair 2.6 FiberTak® RC Soft Anchors These anchors are available with fixed 1.7 mm FiberTape® suture—with joined tails for simplified suture-passing— and the option of a sliding SutureTape or tensionable knotless mechanism. 2.6 FiberTak RC Soft Anchors Knotless 2.6 FiberTak RC Soft Anchors Sliding 1.3 SutureTape Incorporate sliding SutureTape for knotted medial-row compression variations or remove if it is not needed for the repair. Tensionable Knotless Mechanism With the tensionable knotless mechanism, complete a variety of medial-row compression variations and easily incorporate biologics. Self-Punching Inserters All 2.6 FiberTak anchors are loaded on self-punching inserters, which eliminate the need to predrill or prepunch a socket for anchor insertion, reducing surgical steps. Use these inserters with or without a guide; drills and punches are available for hard bone. SwiveLock® Lateral-Row Anchors Trusted fixation with more than 10 million anchors used since 20063 Joined FiberTape Suture Tails Simplified suture-passing Shuttle both limbs of FiberTape suture with one pass Available with #2 suture for tensionable knotless dogear or cable fixation FiberTak® SpeedBridge™ Repair I 03 FiberTak SpeedBridge Technique: Medial Row ® ™ FiberTak® SpeedBridge™ Technique: Medial Row 1 While viewing through a posterolateral portal, prepare the rotator cuff footprint and identify the posteromedial anchor insertion point. Using a mallet, insert and advance the 2.6 FiberTak RC anchor into bone; stop at the insertion zone laser line. If hard bone is encountered, use a punch or drill to create a socket to ease anchor insertion. 3 Load the single end of FiberTape® suture onto a Scorpion™ suture passer and advance through the rotator cuff. Pull the suture to smoothly lead both FiberTape suture limbs through the tissue. 2 Once the anchor is fully inserted, remove the suture retention ring and inserter. Grasp all limbs of the suture and pull slowly to set the anchor. Repeat steps 1 and 2 for middle and anterior medial-row anchors. Once the anchors are inserted, remove the sliding SutureTape. 4 Cut off the joined suture tail, allowing each suture limb to be separated for lateral fixation. Tension each suture limb independently to remove any potential slack beneath the tendon. Note: Drilling in very hard bone may require cycling the drill while maintaining consistent alignment of the drill guide. Increased size, hard bone drills are also available for use. FiberTak® SpeedBridge™ Technique: Medial Row I 05 FiberTak SpeedBridge Technique: Lateral Row ® ™ FiberTak® SpeedBridge™ Technique: Lateral Row 1 2 Retrieve one FiberTape® suture tail from each medial anchor and preload them through the SwiveLock® anchor eyelet. Using a punch, prepare a bone socket about 5-10 mm lateral to the edge of the tuberosity. Bring the eyelet of the implant to the edge of the bone socket and remove slack from each of the FiberTape suture limbs individually. Apply tension to the FiberTape sutures so that the tissue is reduced and compressed to the bone. Note: Use a hemostat to secure sutures in place while preparing a bone socket. 3 Completely advance the driver into the bone socket, beyond the first laser line and until the anchor body contacts bone. Evaluate suture tension. If tension is not adequate, back the driver out and readjust the tension. 4 5 Make sure the tip of the anchor body is in contact with bone. Hold the thumb pad steady and rotate the driver handle in a clockwise direction to insert the anchor body until it is flush with the bone. Cut the FiberTape suture tails with a FiberTape cutter. Repeat these steps for the second lateral anchor. Note: Do not attempt to apply tension to the sutures with the eyelet in the bone socket. FiberTak® SpeedBridge™ Technique: Lateral Row I 07 FiberTak SpeedBridge Technique: Lateral-Row SP Fixation ® ™ FiberTak® SpeedBridge™ Technique: Lateral Row With SP SwiveLock® Anchors 1 2 Retrieve one FiberTape® suture tail from each medial anchor and preload them through the self-punching SwiveLock anchor eyelet using the MegaLoader. With the eyelet of the implant above bone, remove slack and tension each suture to reduce the tissue and compress it to bone. Note: If hard bone is encountered, use a punch to break the cortex before inserting the anchor. Be sure the eyelet and driver are perpendicular to the bone prior to malleting. 3 With the eyelet perpendicular to the bone, completely advance the driver into the bone socket, beyond the first laser line and until the anchor body contacts bone. Evaluate suture tension. If tension is not adequate, back the driver out and readjust the tension. 4 5 Make sure the tip of the anchor body is in contact with bone. Hold the thumb pad steady and rotate the driver handle in a clockwise direction to insert the anchor body until it is flush with the bone. Cut the FiberTape suture tails with a FiberTape cutter. Repeat these steps for the second lateral anchor. Note: Do not attempt to apply tension to the sutures with the eyelet in the bone socket. FiberTak® SpeedBridge™ Technique: Lateral-Row SP Fixation I 09 FiberTak SpeedBridge Technique: Knotless Double-Pulley Rip-Stop ® ™ FiberTak® SpeedBridge™ Technique: Knotless Double-Pulley Rip-stop Tendon reduction under direct visualization and tensionable knotless medial fixation can be achieved with the knotless double-pulley. Shuttle the tensionable knotless sutures through the cuff with a separate pass to help prevent the construct from twisting beneath the rotator cuff. 1 2 Once the FiberTape® sutures are passed, use a FiberLink™ shuttle suture to pass the knotless sutures. Using the Scorpion™ suture passer, load the single end of a FiberLink suture and pass it lateral and outside of the anterior and posterior 2.6 FiberTak RC anchors to form the double-pulley rip-stop. Retrieve the tail of the FiberLink suture from a superior portal to improve the shuttling angle through the tissue. Retrieve the sutures of the knotless mechanism, load them into the loop of the FiberLink shuttle suture, and pass the FiberLink suture through the rotator cuff. Repeat the same steps for the posterior anchor. Note: For this technique, cut out the middle anchor’s knotless mechanism; the tensionable knotless mechanisms of the anterior and posterior anchors will be linked together in steps 4 and 5. (d) (c) (b) (a) (g) (f) (e) 3 Posterior Anchor Middle Anchor Anterior Anchor a. TigerLink™ shuttle stitch d. 1.7 mm FiberTape sutures e. FiberLink shuttle stitch b. Blue repair stitch f. Blue/black repair stitch c. 1.7 mm TigerTape™ sutures g. 1.7 mm black FiberTape sutures FiberTak® SpeedBridge™ Technique: Knotless Double-Pulley Rip-Stop I 11 (b) (e) 4 Retrieve the posterior blue repair suture (b) and the anterior looped end of the white/blue shuttle suture (e) from the lateral cannula. Feed the end of the repair suture through the shuttle suture loop and fold it at the ink-mark indicator. Pull the tape suture tail of the white/blue shuttle suture (e) to shuttle the repair suture into the knotless mechanism. Note: Tension the repair suture, but do not tighten it completely until the second repair suture is shuttled. (a) (f) 5 Repeat the previous steps using the anterior blue/black repair suture (f) and the posterior looped end of the white/ black shuttle suture (a). 12 I FiberTak® SpeedBridge™ Technique: Knotless Double-Pulley Rip-Stop 6 Tension the two repair sutures, reducing and fixating the tendon to the bone. Tension the FiberTape® suture limbs independently to remove any potential slack beneath the tendon. Cut the repair sutures flush once adequate fixation is achieved. Note: Refer back to the lateral-row fixation technique to complete repair. FiberTak® SpeedBridge™ Technique: Knotless Double-Pulley Rip-Stop I 13 FiberTak SpeedBridge Technique: Dog-Ear or Cable Fixation ® ™ FiberTak® SpeedBridge™ Technique: Dog-Ear Reduction Suture Achieve anterior and posterior lateral tissue fixation with the repair stitches from Knotless SwiveLock® anchors. 1 Retrieve the knotless sutures from the lateral cannula. Load the blue repair suture onto a Scorpion™ suture passer and advance through tissue. 3 Tension the repair suture, reducing and fixating the tendon to the bone. A suture cutter can be used to hold the anchor steady during tensioning. Cut the repair suture once adequate fixation is achieved. 2 Feed the end of the repair suture through the shuttle suture loop and fold it at the ink-mark indicator. Pull the tape shuttle suture tail to shuttle the repair suture into the tensionable knotless mechanism. 4 Double-Pulley Rip-stop With Dog-Ear or Cable Fixation Note: If using Knotless SwiveLock anchors and additional lateral fixation is not required, pull one end of the shuttle stitch to remove and cut the repair stitch and FiberTape® sutures with a FiberTape suture cutter. FiberTak® SpeedBridge™ Technique: Dog-Ear or Cable Fixation I 15 Ordering Information Biocomposite Product Description Item Number Knotless, 4.75 mm × 24.5 mm w/ #2 suture (blue), SP PEEK eyelet AR-2324KBCSP 4.75 mm × 24.5 mm w/ 1.3 mm SutureTape (white/blue), SP PEEK eyelet AR-2324BCSP 4.75 mm × 24.5 mm, SP titanium eyelet AR-2324BCM Knotless, 5.5 mm × 24.5 mm w/ #2 suture (blue), SP PEEK eyelet AR-2323KBCSP 5.5 mm × 24.5 mm w/ 1.3 mm SutureTape (white/blue), SP PEEK eyelet AR-2323BCSP 5.5 mm × 24.5 mm, SP titanium eyelet AR-2323BCM PEEK Product Description Item Number Knotless, 4.75 mm × 24.5 mm w/ #2 suture (blue), SP PEEK eyelet AR-2324KPSP 4.75 mm × 24.5 mm w/ 1.3 mm SutureTape (white/blue), SP PEEK eyelet AR-2324PSP 4.75 mm × 24.5 mm, SP titanium eyelet AR-2324PSLM Knotless, 5.5 mm × 24.5 mm w/ #2 suture (blue), SP PEEK eyelet AR-2323KPSP 5.5 mm × 24.5 mm w/ 1.3 mm SutureTape (white/blue), SP PEEK eyelet AR-2323PSP 5.5 mm × 24.5 mm, SP titanium eyelet AR-2323PSLM Titanium Product Description Item Number 4.75 mm × 19.1 mm, SP titanium eyelet AR-2324SLM 5.5 mm × 19.1 mm, SP titanium eyelet AR-2323SLM Product Description Item Number Recommended FiberTape® Suture Options for SwiveLock® C and SP Anchors 36 in (blue) tape, w/ each end tapered to #2 FiberWire® suture, 54 in AR-7237 7 in (blue) tape, w/ each end tapered to #2 FiberWire suture, 30 in AR-7237-7 7 in (blue) tape, w/ each end tapered to #2 FiberWire suture, collagen-coated AR-7237-7B 7 in (white/black) tape, w/ each end tapered to #2 TigerWire® suture, 30 in AR-7237-7T 17 in (blue) tape, w/ each end tapered to #2 FiberWire suture w/ tapered needle, 26.5 mm, ½ circle AR-7237-17N 16 I Ordering Information FiberTape® Suture Instruments Mini FiberTape suture retriever w/ self-release (SR) handle AR-12974SR Mini FiberTape suture retriever w/ nonratcheting (NR) handle AR-12974NR Mini FiberTape suture retriever w/ WishBone™ handle AR-12974W FiberTape suture retriever w/ SR handle AR-13974SR FiberTape suture retriever w/ NR handle AR-13974NR FiberTape suture retriever w/ WishBone handle AR-13974W KingFisher® FiberTape suture retriever/grasper w/ SR handle AR-13971SR KingFisher FiberTape suture retriever/grasper w/ NR handle AR-13971NR KingFisher FiberTape suture retriever/grasper w/ WishBone handle AR-13971W Penetrator™ FiberTape suture retriever, 15˚ up curved AR-2167-3 Penetrator FiberTape suture retriever, straight AR-2167ST-3 Penetrator FiberTape suture retriever w/ WishBone handle, 15˚ up curved AR-2167W-3 Penetrator FiberTape suture retriever w/ WishBone handle, straight AR-2167STW-3 FiberTape suture cutter AR-13250 FiberTape suture cutter w/ WishBone handle AR-13250W 2.6 FiberTak RC Soft Anchor Product Description Item Number With 1.7 mm TigerTape™ Loop (white/black) and 1.3 mm SutureTape (white/blue), self-punching, qty 5 AR-3652SP With 1.7 mm FiberTape Loop (blue) and 1.3 mm SutureTape (white/black), self-punching, qty 5 AR-3652TSP With 1.7 mm FiberTape Loop (black/blue) and 1.3 mm SutureTape (blue), self-punching, qty 5 AR-3652TTSP Knotless with 1.7 mm TigerTape Loop (white/black) and #2 Suture (blue), self-punching, qty 5 AR-3653SP Knotless with 1.7 mm FiberTape Loop (blue) and #2 Suture (white/black), self-punching, qty 5 AR-3653TSP Knotless with 1.7 mm FiberTape Loop (black/blue) and #2 Suture (blue/black), self-punching, qty 5 AR-3653TTSP 2.6 FiberTak Soft Anchor Product Description Item Number Knotless w/ #5 suture, self-punching, qty. 5 AR-3641SP Knotless w/ #5 suture, qty. 5 AR-3641 With two 1.3 mm SutureTapes (white/blue, white/black), self-punching, qty. 5 AR-3632SP With three 1.3 mm SutureTapes (white/blue, black/white, blue), self-punching, qty. 5 AR-3633SP Ordering Information I 17 Product Description Item Number Disposables for 2.6 FiberTak® Anchors Disposable kit Includes angled circumferential teeth spear, sharp obturator, and drill AR-3650DS Instruments for 2.6 FiberTak Anchors Angled spear w/ circumferential teeth AR-3655 Blunt obturator for AR-3655 AR-3658B Sharp obturator for AR-3655 AR-3658T Circumferential teeth spear w/ sharp obturator AR-1941CT Fishmouth spear w/ sharp obturator AR-1941DGF Drill, 2.6 mm AR-3657 2.6 mm shaver drill AR-3657SD Punch AR-3656 SpeedBridge™ Implant Systems Product Description Item Number FiberTak SpeedBridge Implant System Three 2.6 FiberTak RC Self-Punching anchors w/1.7 FiberTape® loop and 1.3 mm SutureTape (1 white/black, white/blue, 1 blue, white/black, and 1 black/blue, blue), two 4.75 Knotless BioComposite SwiveLock® SP anchors, SCORPION-multifire needle, and MegaLoader AR-2600FSB-1 Knotless FiberTak SpeedBridge Implant System Three 2.6 Knotless FiberTak RC Self-Punching anchors w/ 1.7 mm FiberTape loop and #2 suture (1 white/black, blue, 1 blue, white/black, and 1 black/blue, blue/black), two 4.75 Knotless BioComposite SwiveLock SP anchors, SCORPION-multifire needle, and MegaLoader AR-2600FSB-2 FiberTak SpeedBridge Implant System Three 2.6 FiberTak RC Self-Punching anchors w/1.7 FiberTape loop and 1.3 mm SutureTape (1 white/black, white/blue, 1 blue, white/black, and 1 black/blue, blue), two 5.5 Knotless BioComposite SwiveLock SP anchors, SCORPION-multifire needle, and MegaLoader AR-2600FSB-3 Knotless FiberTak SpeedBridge Implant System Three 2.6 Knotless FiberTak RC Self-Punching anchors w/ 1.7 mm FiberTape loop and #2 Suture (1 white/black, blue, 1 blue, white/black, and 1 black/blue, blue/black), two 5.5 Knotless BioComposite SwiveLock SP anchors, SCORPION-multifire needle, and MegaLoader AR-2600FSB-4 18 I References References 1. Arthrex, Inc. Data on file (APT-05242). Naples, FL; 2021. 2. Arthrex, Inc. Data on file (APT-05350). Naples, FL; 2021. 3. Arthrex, Inc. Sales Data. Naples, FL; 2024. 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. 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. arthrex.com © 2024-01 Arthrex Inc. All rights reserved. LT1-000204-en-US_D Arthrex manufacturer, authorized representative, and importer information (Arthrex eIFUs) US patent information

FiberTak® SpeedBridge™ Rotator Cuff Repair

The Knotless FiberTak® biceps implant system offers a knotless, all-suture anchor solution to perform an onlay proximal biceps tenodesis at any location. The implant uniquely integrates two individual tensionable knotless mechanisms within a single FiberTak sheath. The blue FiberWire® repair suture passes around the biceps tendon, while the white suture loop is retrieved through the tendon. The blue repair suture is retrieved through the loop, and both are tensioned to complete the tenodesis.

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A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

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Knotless FiberTak® Biceps Implant System for Proximal Biceps Tenodesis

Arthroplasty Shoulder

Elbow

Imaging and Resection

A comprehensive overview of a product team’s portfolio.

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

This animation provides an overview of the features and benefits of the Knotless 1.8 FiberTak® soft anchor for the treatment of shoulder instability.

Knotless 1.8 FiberTak® Soft Anchor for Shoulder Instability Repair

Orthobiologics

The CuffMend™ system provides a fast and efficient technique for augmenting partial- and full- thickness rotator cuff tears with ArthroFlex dermal allograft. The graft is securely fixated to tendon and bone using FiberStitch™ RC implants and Knotless PushLock® anchors.
ArthroFLEX® is a registered trademark of LifeNet Health.

CuffMend™ Rotator Cuff Repair Augmentation System

This animation illustrates how the FiberTape® cerclage system is used to repair an oblique proximal humerus fracture.

FiberTape® Cerclage System

CuffMend™ Rotator Cuff Augmentation System

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A document containing information about Arthrex products and product lines.

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FiberWire® High-Strength Orthopedic Sutures

Knotless 1.8 FiberTak Soft Anchor for Glenoid Labrum Repair ® Surgical Technique Knotless 1.8 FiberTak® Soft Anchor for Glenoid Labrum Repair This tensionable knotless suture anchor combines the benefits of soft anchors with knotless soft-tissue fixation. Use the curved spear and 1.8 mm drill to precisely create a pilot hole on the glenoid rim. Insert the suture anchor through the spear, maintaining the same portal and drill trajectory. Once the suture is passed and shuttled into the locking mechanism, tension can be controlled and adjusted under direct visualization. Advantages Knotless Simple Stitch 52 lb of secure, low-profile knotless suture fixation1 No risk of knot impingement or loosening 1.8 mm drill to minimize bone removal Premium instrumentation with additional stability, available in curved and straight options for full access around the glenoid. Simple, reproducible insertion and passing techniques similar to knot-tying anchors Tension and retension until repair is complete Infinite Tissue-Tensioning Variability Knotless 1.8 FiberTak Soft Anchor With Self-Locking Technology Just pass it, cinch it, cut it 02 I Knotless 1.8 FiberTak® Soft Anchor for Glenoid Labrum Repair Knotless Mattress Stitch Knotless 1.8 FiberTak® Soft Anchor The Knotless 1.8 FiberTak® Soft Anchor is the latest in knotless technology for instability. This design combines trusted knotless technology with the latest in suture innovation. The implant and instrument design is optimized for consistent and reliable fixation. Implant Features The implant handle features a centering, stability sleeve, which increases insertion consistency by eliminating extra movement that can occur during impaction. The vivid, all-blue repair suture has a tapered tail. Instrument Features Curved guide handles have a scallop at the proximal end for identifying the convex curve direction of the distal tip Flexible drill has a tri-flat design for drill hub connection, a positive stop for consistent drill depth, and a centering stability sleeve for accuracy while using the drill guide Laser line on the distal tip of the spear indicates the convex curve direction Knotless 1.8 FiberTak® Soft Anchor I 03 1 Mobilize the labrum and create a bleeding bed to enhance tissue healing to bone. Pass the spear and place it on the glenoid rim. Fully advance the drill through the spear until the drill laser line or collar contacts the spear’s handle. Note: Drilling in very hard bone may require cycling the drill while maintaining consistent alignment of the drill guide. Increased size, hard bone drills are also available for use. 3 Remove the inserter handle and spear, then pull on all 3 suture tails to confirm the anchor is set in the cortical bone. Note: A slow, steady pull is recommended to allow the anchor to properly deploy. A fast, aggressive pull could lead to improperly setting the anchor. 04 I Knotless 1.8 FiberTak® Soft Anchor for Glenoid Labrum Repair 2 Insert the anchor through the spear and into bone by gentle impaction until the inserter handle is flush with the back of the spear. Note: If insertion resistance is encountered, do not impact harder. Replace the implant and repeat the drilling/insertion process. Avoid excessive impaction as this could lead to inserter damage and/ or breakage. See warning note on back page for additional information. 4 Retrieve the blue repair suture through the anterosuperior portal using a suture retriever. Insert a curved SutureLasso™ suture passer into the anteroinferior cannula and pass it through the capsulolabral tissue inferior to the anchor. Advance the nitinol wire loop into the joint. Retrieve the wire loop through the anterosuperior portal using the KingFisher® retriever. 5 Load the blue repair suture tail through the nitinol wire loop. Retract the wire loop through the SutureLasso™ suture passer to pull the suture to the distal end of the suture passer inside the joint. Remove the suture passer and wire loop together to shuttle the repair suture through the labral tissue. 7 Pull the SutureTape side of the white/black shuttle suture to transfer the repair suture back into the anchor through the same portal where it was inserted. Advance the shuttle suture with repeated light tugs until the repair suture is passed through the suture splice locking mechanism and back out of the cannula. 6 Retrieve the blue repair suture and round-looped side of the white/black shuttle suture through the anterosuperior portal. Load the repair suture through the loop of the shuttle suture. Fold the repair suture tail at the purple mark and crease the suture with your fingers. 8 Pull the free end of the repair suture until the desired repair tension is achieved. A tissue grasper can be used to position the labrum in its desired location while applying tension on the repair. Cut the suture flush using a mini suture cutter. Knotless 1.8 FiberTak® Soft Anchor for Glenoid Labrum Repair I 05 Ordering Information Implant Product Description Item Number Knotless 1.8 FiberTak® Soft Anchor, #2 Suture AR-3636 Disposable Instruments Product Description Item Number Percutaneous Instrument Kit for Knotless FiberTak Soft Anchor, w/ 1.8 mm rigid drill AR-3610PK-3 Knotless FiberTak Disposable Kit, w/ tapered curved spear, 1.8 mm flexible drill, and blunt obturator AR-3610DC-3 Knotless FiberTak Disposable Kit, w/ curved spear, 1.8 mm flexible drill, and blunt obturator AR-3638DC Knotless FiberTak Disposable Kit, w/ straight spear, 1.8 mm rigid drill, and blunt obturator AR-3638DS 1.8 mm Flexible drill w/ hub, trocar obturator, sterile AR-3610ND-2 1.9 mm Flexible drill w/ hub, trocar obturator, sterile, hard bone AR-3610ND-4 1.8 mm rigid drill, sterile AR-3600D-2 1.8 mm flexible ShaverDrill™ device AR-3610NSD-2 Reusable Curved Spear Options Product Description Item Number Curved Spear for FiberTak soft anchor, w/ trocar obturator AR-3610CTC Tight Curved Spear for FiberTak soft anchor, w/ trocar obturator AR-3610CTC-2 Reusable Straight Spear Options Product Description Item Number Fishmouth spear AR-3610F Spear w/ circumferential teeth AR-3610CT Slotted spear AR-3610ST Fishmouth Spear AR-3610F Spear w/ Circumferential Teeth AR-3610CT 06 I Knotless 1.8 FiberTak® Soft Anchor for Glenoid Labrum Repair Slotted Spear AR-3610ST Ordering Information (Cont) Knotless 2.6 FiberTak® Soft Anchor With the same tensionable knotless technology as the smaller Knotless 1.8 FiberTak soft anchor, the Knotless 2.6 FiberTak soft anchor includes a #5 repair suture. This anchor option combines the benefits of a soft anchor with a broader soft-tissue repair option. Using a drill guide and 2.6 mm drill, create a pilot hole and insert the anchor through the drill guide. Once the repair suture is passed through tissue, shuttle it into the knotless suture mechanism. Suture repair tension can be controlled and adjusted under direct visualization. Implant Product Description Item Number Knotless 2.6 FiberTak soft anchor, w/ #5 suture AR-3641 Disposable Instruments Product Description Item Number Disposables Kit, w/ spear, obturator, and 2.6 mm drill AR-3650DS 2.6 mm drill AR-3657 2.6 mm ShaverDrill™ device AR-3657SD Reusable Instruments Product Description Item Number Punch for Knotless 2.6 FiberTak soft anchor AR-3656 Blunt-Tip Obturator for Spear AR-3658B Trocar-Tip Obturator for Spear AR-3658T Angled Spear w/ circumferential teeth AR-3655 Circumferential teeth Spear, 2.6 FiberTak soft anchor AR-1941CT Fishmouth Spear, 2.6 FiberTak soft anchor AR-1941DGF Punch for Knotless 2.6 FiberTak Soft Anchor AR-3656 Blunt-Tip Obturator AR-3658B Trocar-Tip Obturator AR-3658T Angled Spear w/ Circumferential Teeth AR-3655 Spear w/ Circumferential Teeth AR-1941CT Fishmouth Spear AR-1941DGF Knotless 1.8 FiberTak® Soft Anchor for Glenoid Labrum Repair I 07 Reference 1. Arthrex, Inc. Data on file (APT 3531). Naples, FL; 2017. WARNING! TO HELP AVOID INSERTER BREAKAGE AND POTENTIAL PATIENT INJURY: Avoid excessive impaction as this could lead to inserter damage and/or breakage. If insertion resistance is encountered, do not impact harder. Replace the implant and repeat the drilling/insertion process. Visually inspect the inserter for potential breakage after each implantation. See image below for reference (a). (a) 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 and/or outcomes. arthrex.com © 2023-09 Arthrex Inc. All rights reserved. LT1-000002-en-US_F Arthrex Manufacturer, Authorized Representative and Importer information: elFU - Arthrex View U.S. patent information

Knotless 1.8 FiberTak® Soft Anchor for Glenoid Labrum Repair

Biologic Tuberoplasty Surgical Technique Table of Contents Tensionable Knotless Biologic Tuberoplasty Technique............... 04 ArthroFLEX® Dermal Allograft............................................................... 04 Tensionable Knotless Anchor Technology......................................... 05 Self-Punching Inserters........................................................................... 05 Tuberosity Preparation and Footprint Measurement...................... 06 Graft Preparation....................................................................................... 07 Medial Anchor Placement....................................................................... 08 Graft Delivery and Fixation..................................................................... 09 Optional: Partial Rotator Cuff Repair.................................................... 14 Ordering Information................................................................................ 15 References.................................................................................................. 16 Table of Contents I 03 Tensionable Knotless Biologic Tuberoplasty Technique Tensionable knotless biologic tuberoplasty technique harnesses the power of the ArthroFlex dermal allograft to provide a biologic cushion between the acromion and the tuberosity that can prevent bone-on-bone contact due to an irreparable rotator cuff tear. Selfpunching tensionable knotless anchor technology allows the ArthroFlex graft to be placed in a quick, effective, and reproducible technique preventing shoulder impingement syndrome, often associated with shoulder pain.1 ArthroFLEX® Dermal Allograft ArthroFlex dermal allograft is a biohospitable acellular dermal allograft intended for supplemental support and covering for soft-tissue repair.2 LifeNet Health’s patented and validated Matracell decellularization process renders the ArthroFlex dermal allograft acellular without compromising its biomechanical or biochemical properties. Matracell technology removes ≥97% of the donor DNA from the dermal matrix, ensuring a biocompatible scaffold that retains its growth factors, native collagen scaffold, and elastin.3 Biomechanical testing has shown that ArthroFlex dermal allograft provides high ultimate load and suture retention strength.4 ArthroFlex dermal allograft has demonstrated the ability to remodel and integrate with host tissue after implantation.5 ArthroFlex is treated with Preservon®, a proprietary and patented preservation technology that allows the graft to be fully hydrated at room temperature while avoiding the water-mediated lysis of the natural collagen and elastin scaffold.2 04 I Tensionable Knotless Biologic Tuberoplasty Technique ≥97% DNA and Cellular Content Removed Removing cells and immunogenetic components allow host cells to readily infiltrate and proliferate3,5 Intact Acellular Extracellular Matrix Provides a strong, biohospitable collagen scaffold for host cellular and vascular ingrowth1 Convenience Excellent handling; ready to use;® room temperature storage (15˚C-30˚C)6 Supports Rapid Healing Retains growth factors, elastin, matrikines, cytokines, and collagens7 Tensionable Knotless Anchor Technology Tensionable knotless anchor technology was first introduced in 2015 and has since been trusted by surgeons worldwide with well over 1 million anchor implantations. The tensionable and retensionable capability of these anchors allows for easy introduction and final fixation of ArthroFlex onto the tuberosity. Self-Punching Inserters Self-punching inserters efficiently eliminate the need to predrill or prepunch a bone socket prior to anchor insertion. With direct visualization of the inserter tip, the self-punching feature lets users precisely insert the anchor into bone. Tensionable Knotless Anchor Technology I 05 Tuberosity Preparation and Footprint Measurement 1 Prepare the greater tuberosity by performing a mild decortication using an arthroscopic burr or power rasp. Note: Be sure to leave some cortical bone at the articular margin where the medial anchors will be placed. 06 I Tuberosity Preparation and Measurement 2 Use an arthroscopic measuring probe to measure the anterior-posterior and medial-lateral footprint of the tuberosity. Graft Preparation 1 2 Cut the ArthroFlex human dermal allograft according to the footprint measurements, taking care to undersize the graft by 15%-20%. Use a Scorpion™ suture passer to create luggage tags on the lateral corners with 1.3 mm FiberLink™ and TigerLink™ SutureTapes. 3 4 Pass FiberLink and TigerLink sutures in a simple stitch configuration through the medial corners of the graft; ensure the loops are under the graft. Graft Preparation I 07 Medial Anchor Placement 1 2 Through percutaneous portals, insert self-punching, Knotless 2.6 FiberTak® soft anchors on the anteromedial and posteromedial corners of the greater tuberosity. Establish a lateral portal using a 12 mm PassPort Button™ cannula. A PassPort divider can be inserted to aid in later suture management. Note: A 2.6 FiberTak drill guide may be used to aid in anchor placement. Medial Anchor Placement (Optional) 3 4 Alternatively, insert Knotless 4.75 mm SwiveLock® anchors into prepunched holes on the anteromedial and posteromedial positions of the tuberosity. Establish a lateral portal using a 12 mm PassPort Button cannula. A PassPort divider can be inserted to aid in later suture management. 08 I Medial Anchor Placement Graft Delivery and Fixation 1 Retrieve the repair suture and the round shuttle link looped suture from each medial anchor. 2 Graft Delivery and Fixation I 09 3 4 Use the medial FiberLink™ and TigerLink™ sutures to pass the repair sutures through the medial corners of the graft. Note: Knotless mechanism is not yet converted. 5 10 I Graft Delivery and Fixation 6 Load the repair suture into the loop of the shuttle stitch and fold it over at the purple mark. Pull the suture tape limb of the shuttle stitch to convert the knotless mechanism of each anchor. 7 Repeat the steps for the other medial corner. Upon completion of converting the knotless mechanisms, carefully remove the Passport divider. Graft Delivery and Fixation I 11 8 Alternate pulling tension on each repair suture to shuttle the graft through the 12 mm PassPort Button™ cannula and onto the tuberosity. It is important to hold slight counter tension on the lateral sutures to aid in easier graft passage. 9 12 I Graft Delivery and Fixation 10 Insert two self-punching 4.75 mm SwiveLock® SP anchors to secure the lateral luggage tag suture tails into the tuberosity. Alternatively, self-punching 3.5 mm PushLock® Anchors can be used. Graft Delivery and Fixation I 13 Optional: Partial Rotator Cuff Repair Inverted Mattress Stitch Repair Inverted mattress stitch FiberTape® suture secured in the eyelet of the posteromedial Knotless SwiveLock® anchor Simple Stitch Repair Simple stitch repair secured in the eyelet of the posteromedial Knotless SwiveLock anchor Side-to-Side Repair Side-to-side repair between the graft and remaining rotator cuff tendon 14 I Optional Partial Repair Ordering Information Product Description Item Number Implants - Medial Row Knotless 2.6 FiberTak® anchor w/ #5 suture, self-punching AR-3641SP Knotless BioComposite SwiveLock® anchor, 4.75 mm × 19.1 mm, w/ #2 suture (blue) and SutureTape link (white/blue) AR-2324KBCC Knotless PEEK SwiveLock anchor, 4.75 mm × 19.1 mm, w/ #2 suture (blue) and SutureTape link (white/blue) AR-2324KPSLC Implants - Lateral Row BioComposite SwiveLock SP anchor, 4.75 mm × 24.5 mm, w/ 1.3 mm SutureTape (white/blue), self-punching PEEK eyelet AR-2324BCSP PEEK SwiveLock SP anchor, 4.75 mm x 24.5 mm, w/ 1.3 mm SutureTape (white/blue), self-punching PEEK eyelet AR-2324PSP Graft ArthroFLEX® 20 mm x 30 mm × 3 mm, w/ MatraACELL® decellularized dermis AFLEX352 Bone Preparation PoweRasp™ instrument, 5.5 mm × 13 cm AR-8550PR PowerPick™ instrument, 45°, 6 mm drill depth AR-8150PX-45 Other Arthroscopic measurement probe, 60°, 220 mm AR-4070-01 SCR guide AR-16950SR Back grasper w/ SR handle AR-12531SR PassPort Button™ cannula, 12 mm ID × 3 cm AR-6592-12-30 PassPort Button cannula, 12 mm ID × 4 cm AR-6592-12-40 PassPort Button cannula, 12 mm ID × 5 cm AR-6592-12-50 12 mm PassPort inserter AR-6592-12PI PassPort divider, 12 mm AR-6592-12D FiberLink™ SutureTape, 1.3 mm, w/ loop (white/blue) AR-7535 TigerLink™ SutureTape, 1.3 mm, w/ loop (white/black) AR-7535T Ordering Information I 15 References 1. Mirzayan R, Bouz G. Biologic tuberoplasty with an acellular dermal allograft for massive rotator cuff tears. Arthrosc Tech. 2021;10(7):e1743-e1749. doi:10.1016/j. eats.2021.03.016 5. Hartzler RU, Softic D, Qin X, Dorfman A, Adams CR, Burkhart SS. The histology of a healed superior capsular reconstruction dermal allograft: a case report. Arthroscopy. 2019;35(10):2950-2958. doi:10.1016/j.arthro.2019.06.024 2. Moore MA, Samsell B, Wallis G, et al. Decellularization of human dermis using non-denaturing anionic detergent and endonuclease: a review. Cell Tissue Bank. 2015;16(2):249-259. doi:10.1007/s10561-014-9467-4 6. LifeNet Health. Sterile decellularized dermis instructions for use [63-0050-01]. Virginia Beach, VA; 2019. 3. LifeNet Health. Memo DD-0206. Virginia Beach, VA; 2023. 7. LifeNet Health. Analysis of the acellular matrix, growth factors, and cytokines present in ArthroFlex® [68-20-048]. Virginia Beach, VA; 2012. 4. Arthrex, Inc. Data on file (Biomechanical properties of tendon augmentation material; LA0822-EN, TR-4926). Naples, FL; 2011. 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 and/or outcomes. ArthroFLEX, MatrACELL, and Preservon are registered trademarks of LifeNet Health. arthrex.com © 2023-10 Arthrex Inc. All rights reserved. LT1-000279-en-US_B Arthrex manufacturer, authorized representative, and importer information (Arthrex elFUs) US patent information

Biologic Tuberoplasty

FiberTape Cerclage Single-Use Tensioner ® Surgical Technique FiberTape® Cerclage Single-Use Tensioner The FiberTape cerclage single-use tensioner provides a simple and efficient way to deliver reproducible and controlled compression of the cerclage construct during fracture management and sternal closure procedures. Main Body Suture Cleat Distal Tip: Top Slot Handle Shaft Suture Wing Distal Tip: Bottom Hole Single use Tensioner is packaged sterile Intuitive design and quick technique Simply wrap the sutures around the suture wings, cleat the sutures, and turn the handle to deliver optimal tension Built-in tension gauge lines Laser marks on the shaft provide a reference to help deliver controlled and reproducible tension for each cerclage around the fracture 02 I FiberTape® Cerclage Single-Use Tensioner Surgical Technique 1 Insert one suture limb through the bottom hole and the other suture limb into the top slot at the distal end of the tensioner. Then slide the tensioner all the way down onto the knot, ensuring its flat end is covering the knot. Note: Before loading the suture limbs, ensure the tensioner’s shaft is in the starting position by turning the handle counterclockwise until it stops. 2 Wrap each suture limb at least once around the body of the suture wings and then secure the tape portion of the suture in the cleats. Make sure the suture limbs are inside the cleats to prevent the suture from slipping during tensioning. 3 Turn the handle clockwise to tension the suture until the desired amount of compression is achieved. Gauge lines are provided as a reference and aid in applying consistent tension when multiple FiberTape cerclages are used. Take caution to avoid overtensioning and going beyond the fourth gauge line, where the tensioner’s spring is nearing its maximum compression. FiberTape® Cerclage Single-Use Tensioner I 03 4 Once the desired amount of tension is reached, turn the handle completely counterclockwise to loosen the suture limbs. 5 Remove the suture limbs from the cleats and unwrap them from the body of the suture wings. Tie a half-hitch to secure the knot. If necessary, retension to remove any residual slack in the sutures then tie two alternating half-hitches to lock down the cerclage. Note: Before retensioning, turn the handle completely counterclockwise to ensure the tensioner shaft is fully extended and in the starting position. 6 04 I FiberTape® Cerclage Single-Use Tensioner FiberTape® Cerclage Implant System FiberTape cerclage—a high-strength polyester tape reinforced with UHMWPE—is a nonmetallic alternative to metal wires and cables traditionally used for circumferential fracture fixation. Delivers uncompromising strength1-3 Features broad footprint compression and a low-profile construct that allows for plates to lay flat over the tapes and flush with bone 100% radiolucent, eliminating unwanted imaging artifacts No sharp metal ends or broken wires to potentially cause injury or soft-tissue irritation Easy-to-use suture loader and tensioning device help deliver reproducible and secure fixation FiberTape cerclage supports open reduction and internal fixation of periprosthetic femur fractures FiberTape sternal closure for median sternotomy FiberTape cerclage placed prophylactically helps prevent intraoperative proximal femur fractures during hip arthroplasty FiberTape cerclage may be used as a tension band to assist in the fixation of transverse olecranon fractures References 1. Arthrex, Inc. Data on file (APT 3197). Naples, FL; 2017. 2. Arthrex, Inc. Data on File (APT 04426). Naples, FL; 2019. 3. Arthrex, Inc. Data on file (APT 4577). Naples FL; 2020. FiberTape® Cerclage Single-Use Tensioner I 05 Ordering Information Product Description Item Number FiberTape® Cerclage Disposable Tensioner AR-7820 FiberTape Cerclage and FiberTape Sternal Closure Implants FiberTape Cerclage AR-7268 TigerTape™ Cerclage AR-7268T FiberTape Sternal Closure w/ Cutting Needle AR-7288 TigerTape Sternal Closure w/ Cutting Needle AR-7288T FiberTape Sternal Closure w/ Blunt Needle AR-7289 TigerTape Sternal Closure w/ Blunt Needle AR-7289T Disposable Passing Hooks for FiberTape Cerclage Medium Straight Passer AR-7821 Large Straight Passer AR-7822 Trochanteric Passer AR-7823 Right Offset Passer AR-7824R Left Offset Passer AR-7824L Small Passer AR-7825 Products advertised in this brochure/surgical technique guide may not be available in all countries. For information on availability, please contact Arthrex Customer Service or your local Arthrex representative. FiberTape Cerclage AR-7268 FiberTape Cerclage Disposable Tensioner AR-7820 06 I FiberTape® Cerclage Single-Use Tensioner Notes FiberTape® Cerclage Single-Use Tensioner I 07 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 and/or outcomes. View U.S. patent information at www.arthrex.com/corporate/virtual-patent-marking arthrex.com © 2022 Arthrex, Inc. All rights reserved. LT1-000233-en-US_A

FiberTape® Cerclage Single-Use Tensioner

With the TensionTight™ button, perform a knotless onlay biceps tenodesis using an arthroscopic suprapectoral or open subpectoral approach. The button’s locking jaw lets the suture slide easily in one direction to reduce the tendon to the bone while locking in the opposite direction to secure the tendon against the humerus.

Subpectoral Biceps Tenodesis Using the TensionTight™ Button

Suprapectoral Biceps Tenodesis ™ With the TensionTight Locking Button Surgical Technique Knotless TensionTight™ Button Implant System With the TensionTight button, perform a knotless onlay biceps tenodesis using an arthroscopic suprapectoral or open subpectoral approach. The locking jaw in the large pec button lets suture slide easily in one direction to reduce the tendon while locking in the opposite direction to secure the tendon against the humerus. Secure the #5 FiberLink™ suture—specifically designed to work with the TensionTight button—to the biceps tendon using a Loop ‘N’ Tack™ stitch. Locking jaw of the TensionTight button Key Features and Benefits Locking jaw in the button allows for a knotless biceps tenodesis Loop ‘N’ Tack stitch enables all-arthroscopic suprapectoral onlay tenodesis Button and suture combination provide an ultimate load of 225 N with <1 mm of displacement1 AR-2350 TensionTight Implant System Each implant system contains a TensionTight locking button, two #5 FiberLink sutures, a 3.7 mm drill pin, a shoehorn cannula, and a free needle. A suture loader is attached to the button for suture shuttling. Loop ‘N’ Tack Stitch Configuration 1 Create a cinch around the biceps tendon with FiberLink suture. 2 Retrieve the FiberLink suture tail through the biceps tendon just distal to the cinch stitch, using a penetrating, grasping suture retriever like the Loop ‘N’ Tack SwiftStitch™ suture passer. 02 I Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button 3 Remove slack to complete the Loop ‘N’ Tack suture configuration. Surgical Technique The suprapectoral approach is shown below. An advantage of tenodesing in this area is leaving the biceps attached during the procedure. Doing so may better maintain the length-tension relationship. Note: The TensionTight technique can also be performed for an open subpectoral biceps tenodesis. 1 Leaving the biceps tendon attached, create a Loop ‘N’ Tack™ stitch with the #5 FiberLink™ suture (the Loop ‘N’ Tack SwiftStitch™ suture passer is shown). 2a 2b Advance the suture tail through the loader and pull it through the button until the loop begins to exit the distal portion. Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button I 03 3 Drill a unicortical hole using the 3.7 mm spade-tip drill. 5 Remove the inserter and pull the single suture limb to reduce the tendon onto the bone. If necessary, pull on each side of the loop to aid in reduction. 04 I Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button 4 Insert the TensionTight™ button into the tunnel with the black line on the inserter facing up. Leave the inserter in the tunnel and unthread the button by turning counterclockwise on the knurled knob. Pull on the sutures to flip the button in the canal. 6 To complete the repair, cut the suture and the excess tendon proximal to the tenodesis. Ordering Information Implants Product Description Item Number TensionTight™ Button Implant System TensionTight button 2 #5 FiberLink™ sutures 3.7 mm spade-tip drill Shoehorn cannula Free needle AR-2350 Instrumentation Loop ‘N’ Tack™ SwiftStitch™ Suture Passer AR-4068LNT Products advertised in this brochure/surgical technique guide may not be available in all countries. For information on availability, please contact Arthrex Customer Service or your local Arthrex representative. Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button I 05 References 1. Arthrex, Inc. Data on file (APT-04688). Naples, FL; 2020. 06 I Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button Notes Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button I 07 arthrex.com © 2023-08 Arthrex Inc. All rights reserved. LT1-000232-en-US_B Arthrex manufacturer, authorized representative, and importer information (Arthrex elFUs) US patent information 2797 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. 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 and/or outcomes.

Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button

This animation demonstrates how to perform the tensionable knotless biologic tuberoplasty procedure for an irreparable rotator cuff tear. The ArthroFlex dermal allograft is used to provide a protective biologic cushion between the acromion and the tuberosity.
ArthroFLEX® is a trademark of LifeNet Health.

Tensionable Knotless Biologic Tuberoplasty With ArthroFLEX® Dermal Allograft

This animation demonstrates the features and benefits of the Knotless FiberTak® SpeedBridge™ implant system.

AAOS 2025 Annual Meeting: Shoulder Feature Products