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SutureBridge Rotator Cuff Repair
SutureBridge™ Double Row Rotator Cuff Repair
using the Bio-PushLock™ and Bio-Corkscrew® FT

Surgical Technique
Surgical Technique

SutureBridge Double Row Rotator Cuff Repair
using the Bio-PushLock and Bio-Corkscrew FT




1                                                     2


Assess the size and mobility of the tear using a      Prepare pilot holes for the two Bio-Corkscrew FT
KingFisher™ Suture Retriever/Tissue Grasper to        anchors in the medial row. Use a Bio-Corkscrew
determine whether a U or L-shaped component           FT Punch, at a 45° “deadman” angle, adjacent
exists. In the case of large tears extending to the   to the articular margin of the humerus. Advance
superior aspect of the glenoid, margin convergence    the punch to the laser line. Tapping is typically
suturing is performed to reduce the tear volume       not required.
and strain on the repair.

Create a bleeding bed for enhanced tendon to
bone healing. This may be accomplished with a
motorized burr to perform a light dusting of the
greater tuberosity or by using a Chondro Pick to
microfracture the footprint and maximize vascular
channels. Avoid complete decortication of the
bone, to maximize suture anchor fixation.




3                                                     4


Place both Bio-Corkscrew FT anchors. These            Remove one strand of suture from each anchor
anchors will assure full contact of the detached      (preferably opposite colors). Using a KingFisher,
tendon along the medial footprint of the greater      retrieve one of the four remaining sutures through
tuberosity.                                           the lateral (or anterolateral) cannula and pass it
                                                      through the tendon using the Scorpion™ Suture Passer.

                                                      Repeat for the three remaining sutures to create a
                                                      horizontal mattress configuration. Maintain a soft
                                                      tissue bridge of one to two centimeters between the
                                                      mattress stitches.
5                                                        6


Tie the medial row but do not cut the FiberWire®         Retrieve one FiberWire strand from each
tails. These tails will be draped over the lateral       Bio-Corkscrew FT through the lateral
aspect of the tendon and held in place with two          (or anterolateral) Crystal Cannula®. Thread both
knotless PushLock anchors.                               FiberWire strands through the Bio-PushLock
                                                         eyelet on the distal end of the driver.
Prepare pilot holes for the Bio-PushLock directly
in line with the medial anchors and approximately
5-10 mm distal to the lateral edge of the greater
tuberosity. It may be necessary to increase abduction
or to rotate the arm for optimal PushLock placement.




7                                                        8


Bring the distal tip of the Bio-PushLock to the edge     Completely advance the driver into the pilot hole
of the pilot hole while holding onto the suture tails.   beyond the first laser line, until the anchor body
This will reduce the tendon to its desired position      contacts bone. Evaluate tissue tension. If it is
on the footprint.                                        determined that the tension is not adequate, the
                                                         driver can be backed out and tension readjusted.
Note: The knot stack from the medial anchors             Alternatively, additional tension may be applied,
is tensioned flat against the tendon, minimizing         while leaving the driver in place, by pulling on
potential impingement issues from the suture.            each suture strand independently.

                                                         Use a mallet to tap the anchor body into the
                                                         pilot hole until the second laser line is flush with
                                                         the humerus.
9                                                           10


Turn the driver counterclockwise six full turns               Repeat steps 6-9 for the second Bio-PushLock.
to disengage the eyelet from the driver shaft.

Cut the sutures flush using an open ended
FiberWire Suture Cutter.




                                              Surgical Pearl
       An option for large tears is to retain all of the Bio-Corkscrew FT sutures (instead of removing one
       from each anchor). These additional sutures can be passed through the tendon and tied to obtain
              additional medial fixation. The extra suture tails are then either cut or fixed laterally
          with the PushLock anchors. Each PushLock eyelet can support as many as four suture tails.




                                         Ordering Information
         Implants/Disposables:

         Bio-Corkscrew FT, 5.5 mm x 15 mm, w/two #2 FiberWire                        AR-1927BF
         Bio-PushLock, 4.5 mm x 18.5 mm                                              AR-1922B
         Scorpion Needle                                                             AR-13990N
         Crystal Cannula, 5.75 mm I.D. x 7 cm                                        AR-6560

         Accessory Instruments:
         Bio-Corkscrew FT Punch, reusable                                            AR-1927PB
         Bio-Corkscrew FT Punch, disposable                                          AR-1927PBS
         Punch/Tap for Bio-Corkscrew FT, reusable                                    AR-1927CTB
         Punch for 4.5 mm PushLock                                                   AR-1922P
         Scorpion Suture Passer, 16 mm                                               AR-13990
         KingFisher Suture Retriever/Tissue Grasper                                  AR-13970SR
         Suture Cutter, open ended                                                   AR-11794L

                           Other implant sizes and materials are available.
               Please contact your Arthrex Sales Representative for more information.




                       This brochure is printed on durable and washable material.
SutureBridge
   A transosseous equivalent SutureBridge that enhances footprint compression
  and promotes tendon healing to bone can be achieved with minimal knot tying.
   The repair consists of a tied medial row constructed with two Bio-Corkscrew
  FT anchors, combined with knotless lateral fixation using two Bio-PushLocks.
    The result is a quick, secure and low profile repair with maximized contact
    between tendon and bone. The construct provides stability in rotation and
           protects a broad healing zone from synovial fluid infiltration.


  Developed in conjunction with Neal ElAttrache, M.D., and James Tibone, M.D.,
           at Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California.




                       Bio-Corkscrew FT          Bio-PushLock




          ...the Science Behind the Technology
                                               SutureBridge            Single Row Repair

Pressure sensitive Fuji film studies
show greater tendon compression
for the SutureBridge vs. a standard
single row repair.




                                                                500
A matched-pair cadaveric study compared the SutureBridge                    460
                                                                400
to a standard single row repair using two Bio-Corkscrew FT      300                   373
anchors and four simple stitches.                               200
                                                                100
The SutureBridge averaged a 23% higher load to failure            0
                                                                          Load To Failure (N)
and a 54% reduction in gap formation under cyclic loading.
                                                                  3

                                                                                       2.4
                                                                  2
        SutureBridge
                                                                  1
        Single Row                                                           1.1

                                                                  0
                                                                      Cyclic Displacement (mm)


Two reference points were marked on the rotator cuffs             8
                                                                  7
(medial and lateral) and the specimens were subjected             6
to a total of 120° of internal and external rotation.             5
Displacement of the points was measured.                          4
                                                                  3
                                                                  2
The average displacement was 76% less with the SutureBridge.      1
                                                                  0
                                                                        Medial           Lateral
                                                                  Rotator Cuff Displacement (mm)
                                                                                       Data on file.
Arthrex, Inc.
                           1370 Creekside Boulevard, Naples, Florida 34108-1945 • USA
                       Tel: 239-643-5553 • Fax: 239-598-5534 • Web site: www.arthrex.com

                                                   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.
                               © Copyright Arthrex Inc., 2007. All rights reserved. LT0515D
                  U.S. PATENT NOS. 5,964,783; 6,652,563; 6,716,234; 7,029,490 and PATENT PENDING


                                                        #LT0515#

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Lt0515 d suturebridge

  • 1. SutureBridge Rotator Cuff Repair SutureBridge™ Double Row Rotator Cuff Repair using the Bio-PushLock™ and Bio-Corkscrew® FT Surgical Technique
  • 2. Surgical Technique SutureBridge Double Row Rotator Cuff Repair using the Bio-PushLock and Bio-Corkscrew FT 1 2 Assess the size and mobility of the tear using a Prepare pilot holes for the two Bio-Corkscrew FT KingFisher™ Suture Retriever/Tissue Grasper to anchors in the medial row. Use a Bio-Corkscrew determine whether a U or L-shaped component FT Punch, at a 45° “deadman” angle, adjacent exists. In the case of large tears extending to the to the articular margin of the humerus. Advance superior aspect of the glenoid, margin convergence the punch to the laser line. Tapping is typically suturing is performed to reduce the tear volume not required. and strain on the repair. Create a bleeding bed for enhanced tendon to bone healing. This may be accomplished with a motorized burr to perform a light dusting of the greater tuberosity or by using a Chondro Pick to microfracture the footprint and maximize vascular channels. Avoid complete decortication of the bone, to maximize suture anchor fixation. 3 4 Place both Bio-Corkscrew FT anchors. These Remove one strand of suture from each anchor anchors will assure full contact of the detached (preferably opposite colors). Using a KingFisher, tendon along the medial footprint of the greater retrieve one of the four remaining sutures through tuberosity. the lateral (or anterolateral) cannula and pass it through the tendon using the Scorpion™ Suture Passer. Repeat for the three remaining sutures to create a horizontal mattress configuration. Maintain a soft tissue bridge of one to two centimeters between the mattress stitches.
  • 3. 5 6 Tie the medial row but do not cut the FiberWire® Retrieve one FiberWire strand from each tails. These tails will be draped over the lateral Bio-Corkscrew FT through the lateral aspect of the tendon and held in place with two (or anterolateral) Crystal Cannula®. Thread both knotless PushLock anchors. FiberWire strands through the Bio-PushLock eyelet on the distal end of the driver. Prepare pilot holes for the Bio-PushLock directly in line with the medial anchors and approximately 5-10 mm distal to the lateral edge of the greater tuberosity. It may be necessary to increase abduction or to rotate the arm for optimal PushLock placement. 7 8 Bring the distal tip of the Bio-PushLock to the edge Completely advance the driver into the pilot hole of the pilot hole while holding onto the suture tails. beyond the first laser line, until the anchor body This will reduce the tendon to its desired position contacts bone. Evaluate tissue tension. If it is on the footprint. determined that the tension is not adequate, the driver can be backed out and tension readjusted. Note: The knot stack from the medial anchors Alternatively, additional tension may be applied, is tensioned flat against the tendon, minimizing while leaving the driver in place, by pulling on potential impingement issues from the suture. each suture strand independently. Use a mallet to tap the anchor body into the pilot hole until the second laser line is flush with the humerus.
  • 4. 9 10 Turn the driver counterclockwise six full turns Repeat steps 6-9 for the second Bio-PushLock. to disengage the eyelet from the driver shaft. Cut the sutures flush using an open ended FiberWire Suture Cutter. Surgical Pearl An option for large tears is to retain all of the Bio-Corkscrew FT sutures (instead of removing one from each anchor). These additional sutures can be passed through the tendon and tied to obtain additional medial fixation. The extra suture tails are then either cut or fixed laterally with the PushLock anchors. Each PushLock eyelet can support as many as four suture tails. Ordering Information Implants/Disposables: Bio-Corkscrew FT, 5.5 mm x 15 mm, w/two #2 FiberWire AR-1927BF Bio-PushLock, 4.5 mm x 18.5 mm AR-1922B Scorpion Needle AR-13990N Crystal Cannula, 5.75 mm I.D. x 7 cm AR-6560 Accessory Instruments: Bio-Corkscrew FT Punch, reusable AR-1927PB Bio-Corkscrew FT Punch, disposable AR-1927PBS Punch/Tap for Bio-Corkscrew FT, reusable AR-1927CTB Punch for 4.5 mm PushLock AR-1922P Scorpion Suture Passer, 16 mm AR-13990 KingFisher Suture Retriever/Tissue Grasper AR-13970SR Suture Cutter, open ended AR-11794L Other implant sizes and materials are available. Please contact your Arthrex Sales Representative for more information. This brochure is printed on durable and washable material.
  • 5. SutureBridge A transosseous equivalent SutureBridge that enhances footprint compression and promotes tendon healing to bone can be achieved with minimal knot tying. The repair consists of a tied medial row constructed with two Bio-Corkscrew FT anchors, combined with knotless lateral fixation using two Bio-PushLocks. The result is a quick, secure and low profile repair with maximized contact between tendon and bone. The construct provides stability in rotation and protects a broad healing zone from synovial fluid infiltration. Developed in conjunction with Neal ElAttrache, M.D., and James Tibone, M.D., at Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California. Bio-Corkscrew FT Bio-PushLock ...the Science Behind the Technology SutureBridge Single Row Repair Pressure sensitive Fuji film studies show greater tendon compression for the SutureBridge vs. a standard single row repair. 500 A matched-pair cadaveric study compared the SutureBridge 460 400 to a standard single row repair using two Bio-Corkscrew FT 300 373 anchors and four simple stitches. 200 100 The SutureBridge averaged a 23% higher load to failure 0 Load To Failure (N) and a 54% reduction in gap formation under cyclic loading. 3 2.4 2 SutureBridge 1 Single Row 1.1 0 Cyclic Displacement (mm) Two reference points were marked on the rotator cuffs 8 7 (medial and lateral) and the specimens were subjected 6 to a total of 120° of internal and external rotation. 5 Displacement of the points was measured. 4 3 2 The average displacement was 76% less with the SutureBridge. 1 0 Medial Lateral Rotator Cuff Displacement (mm) Data on file.
  • 6. Arthrex, Inc. 1370 Creekside Boulevard, Naples, Florida 34108-1945 • USA Tel: 239-643-5553 • Fax: 239-598-5534 • Web site: www.arthrex.com 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. © Copyright Arthrex Inc., 2007. All rights reserved. LT0515D U.S. PATENT NOS. 5,964,783; 6,652,563; 6,716,234; 7,029,490 and PATENT PENDING #LT0515#