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Achilles SutureBridgeTM

Surgical Technique

                          Achilles SutureBridge
Surgical Technique
Achilles SutureBridge

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The 5.5 mm Bio-Corkscrew FT anchors are double...
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                                            Insertional calcific Ac...
Arthrex, Inc.
                           1370 Creekside Boulevard, Naples, Florida 34108-1945 • USA
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Lt0460 b achilles suturebridge


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Lt0460 b achilles suturebridge

  1. 1. Achilles SutureBridgeTM Surgical Technique Achilles SutureBridge
  2. 2. Surgical Technique Achilles SutureBridge 1 2 A direct midline incision is made posteriorly with the patient in The Haglund’s prominence is removed using the micro-sagittal the prone position. The incision is carried down to the calcaneus saw and osteotome. Care is taken to chamfer off the medial and and calcaneal tendon insertion. The Achilles tendon is split at the lateral sides of the calcaneus so as not to leave a prominence that is line incision, full thickness, from dorsal to ventral and is debrided palpable under the skin creating difficulties with footwear. removing all tendinopathic tissue. The Achilles tendon is released distally, and reflected medially and laterally, exposing the whole calcaneal tuberosity with a Haglund's prominence. Care is taken to maintain some medial and lateral attachments to assist with the accurate restoration of the Achilles’ length. Complete tendon debridement may require complete tendon detachment in some cases. 3 4 Prepare the bone for insertion of the two 5.5 mm Bio-Corkscrew® Insert the Arthrex 5.5 mm Bio-Corkscrew FT anchors into the FT anchors by punching and tapping. Two holes are created about holes. The anchors are fully seated when inserted to the laser line 1 cm proximal to the distal insertion of the Achilles tendon and on the driver shaft. Slide the window open on the driver handle to central to each half of the tendon. release the FiberWire sutures and needles. Pull the driver handles out of the anchors. The needles may be cut from the suture, but it is critical to leave sufficient suture tails for the SutureBridge construct.
  3. 3. 5 6 The 5.5 mm Bio-Corkscrew FT anchors are double-loaded with Just distal to the end of the Achilles tendon insertion and directly two #1 FiberWire sutures, one in blue and one in TigerWire® inferior to the Bio-Corkscrew FT anchor placements, the 3.5 mm (black/white). For a simple, single stitch proximally, one suture PushLockTM anchor punch is used to create two holes for the from each anchor is sufficient. The excess sutures are cut and distal row. unloaded, leaving a blue FiberWire suture in one anchor and a TigerWire suture in the other. The Achilles tendon is tensioned proximally and approximated to its native location. Depending on surgeon preference, either a Mason-Allen or mattress type stitch is used to bring the tendon down to bone. 7 8 One blue FiberWire and one TigerWire suture from each of the With appropriate tension maintained on the sutures, the medial proximal anchors are passed through the eyelet of the 3.5 mm button on the back of the handle is struck with a mallet to drive Bio-PushLock anchor (a 4.5 mm PushLock may be substituted in the anchor into the bone and lock the sutures in place. The handle softer bone). The 3.5 mm Bio-PushLock anchor is inserted up to is removed by turning counterclockwise until it releases from the the laser line, just until the back tak portion of the anchor is even eyelet tip. with the cortex. Suture tension is achieved by pulling one suture at a time.
  4. 4. Optional: Bio-TenodesisTM Screws may be used for distal fixation. Post-op Protocol Postoperatively patients are treated with a below-knee 9 walking boot with or without a heel lift, depending on surgeon preference - allowing them to weight-bear. The SutureBridge construct can provide excellent security, and avoiding the lift helps maximize flexibility and may enhance rehabilitation. The patient should be protected Steps 6-8 are followed for the other 3.5 mm Bio-PushLock anchor with crutches for approximately four weeks, at which with the one remaining blue FiberWire and one TigerWire suture point physical therapy and range of motion is begun. from each of the 5.5 mm Bio-Corkscrew FT anchors. Gradually wean your patients from the walking boot. The resulting suture pattern should look similar to a capital 'M' or sideways hourglass with the anchors at each corner. The FiberWire suture is trimmed at the level of the cortex. Implants Achilles SutureBridge Convenience Pack AR-8927BNF-CP contains the following, packaged for convenience and cost-effectiveness: 2 ea. Bio-Corkscrew FT, 5.5 mm x 15 mm, w/two #1 FiberWire and Tapered Needles AR-8927BNF 2 ea. Bio-PushLock, 3.5 mm x 14 mm AR-1926B Instruments Bio-Corkscrew FT Punch, reusable AR-1927PB Punch/Tap for Bio-Corkscrew FT AR-1927CTB PushLock Punch, 3.5 mm AR-1926P Bio-Corkscrew FT Bio-PushLock
  5. 5. n ce de nfi Co Insertional calcific Achilles tendinosis is a painful and frequently disabling condition. While most patients with insertional ith Achilles tendinosis can be managed nonoperatively, those patients who do not kW respond to conservative treatment may al require decompression and debridement of the diseased tendon. The literature has W described numerous operative approaches for reattachment of the Achilles tendon and for an associated tendon transfer of the flexor hallucis longus (FHL) for augmentation. While Arthrex provides means of fixation for both, the reattachment of the tendon is the focus of this technique guide. The SutureBridge is a novel concept in Achilles reattachment, following debridement. While standard anchor fixation of the tendon creates only a single point of compression directly over the anchor, the SutureBridge enables an hourglass pattern of FiberWire® suture to be laid over the distal end of the tendon. This four-anchor construct enables a greater area of compression for the Achilles tendon on the calcaneus, improving stability and possibly allowing for earlier return to normal activities. Arthrex Achilles SutureBridge vs. Two-Anchor Construct Peak Load Comparison* Average Normalized Peak Load 3.5 Peak Load 3.0 2.5 2.0 2.05 1.5 1.0 1 0.5 0 SutureBridge Two-Anchor *data on file
  6. 6. Arthrex, Inc. 1370 Creekside Boulevard, Naples, Florida 34108-1945 • USA Tel: 239-643-5553 • Fax: 239-598-5534 • Web site: Arthrex GmbH Liebigstrasse 13, D-85757 Karlsfeld/München • Germany Tel: +49-8131-59570 • Fax: +49-8131-5957-565 Arthrex Iberoamérica Howard Hughes Tower, 6701 Center Drive West, Suite 550, Los Angeles, California 90045 • USA Tel: 310-670-6080 • Fax: 310-670-6087 Arthrex S.A.S. 5 Avenue Pierre et Marie Curie, 59260 Lezennes • France Tel: +33-3-20-05-72-72 • Fax: +33-3-20-05-72-70 Arthrex Canada Lasswell Medical Co., Ltd., 405 Industrial Drive, Unit 21, Milton, Ontario • Canada L9T 5B1 Tel: 905-876-4604 • Fax: 905-876-1004 • Toll-Free: 1-800-224-0302 Arthrex GesmbH Triesterstrasse 10/1 • 2351 Wiener Neudorf • Austria Tel: +43-2236-89-33-50-0 • Fax: +43-2236-89-33-50-10 Arthrex BvbA Technologiepark Satenrozen, Satenrozen 1a, 2550 Kontich • Belgium Tel: +32-3-2169199 • Fax: +32-3-2162059 Arthrex Ltd. Unit 16, President Buildings, Savile Street East, Sheffield S4 7UQ • England Tel: +44-114-2767788 • Fax: +44-114-2767744 Arthrex Hellas - Medical Instruments SA 103, Ethnikis Antistasseos str., N. Psichico 154 51 Athens • Greece Tel: +30-210-8079980 • Fax: +30-210-8000379 Arthrex Sverige AB Turbinvägen 9, 131 60 Nacka • Sweden Tel: +46-8-556 744 40 • Fax: +46-8-556 744 41 Arthrex Korea Rosedale Building #1137, 724 Sooseo-dong, Gangnam-gu, Seoul 135-744 • Korea Tel: +82-2-3413-3033 • Fax: +82-2-3413-3035 Arthrex Mexico, S.A. de C.V. Insurgentes Sur 600 Mezanine, Col. Del Valle Mexico D.F. 03100 • Mexico Tel: +52-55-91722820 • Fax: +52-55-56-87-64-72 Arthrex Swiss AG Müllerenstrasse 3, 8604 Volketswil • Switzerland Tel: +41-43-399-45-20 • Fax: +41-43-399-45-29 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. U.S. PATENT NOS. 5,964,783; 6,652,563; 6,716,234; 7,029,490 and PATENT PENDING © Copyright Arthrex Inc., 2007. All rights reserved. LT0460B