SwiveLock® Anchor System

SURGICAL TECHNIQUE
SwiveLock® Anchor System
The Knotless Surgical Technique for Ligament Reconstruction
2
F2
•
T3
•
1
3
6
4
7
5
8
9
12
10
13
11
Knotless SwiveLock Anchors and FiberTape®
Provide our Strongest and Lowest Profile Constructs:
• Strong, Knotless Constructs
• PEEK Anchor Material
– PEEK (polyetheretherketone) is an inert, nonabsorbable,
thermoplastic material
• Vented Anchor Bodies
– Promotes bone marrow flow and allows for bony ingrowth
– Canine pilot study shows evidence of bony ingrowth at eight weeks
• FiberTape Suture
– High strength
– More resistant to tissue cut-through than round sutures
– Large footprint
Cannulation
with bony
ingrowth
Vent
Cross section of a Vented BioComposite
p
SwiveLock
eight
weeks
implantation
eigh
ei
ghtt w
week
we
eks after
a
on in a canine model
mod
odel
el
showing
show
sh
o ing
ng
g bony
bon
bo
n ingrowth in the
he vents
ven
vents
ts and
an
and center
cannulation.
cann
ca
nnulat
ation.
tio
ion. Data on file
PEEK SwiveLock
5.5 mm
AR-2323PSLC
Spade Tip Drill
for 5.5 mm
SwiveLock Anchor
AR-1927D
927D
Tap for 5.5 mm
SwiveLock Anchor
AR-1927CTB
O R D E R I N G I N F O R M AT I O N
Implants/Disposables:
PEEK Knotless SwiveLock Kit includes:
– PEEK SwiveLock, 5.5 mm x 19.1 mm, closed eyelet, qty. 5
– FiberTape, 2 mm, 54 inches, qty. 6
– Suture Button, 3.5 mm x 11 mm, qty. 5
Suture Passing Wire, Nitinol, 8"
Instruments:
Tap for 5.5 SwiveLock Anchor
Spade Tip Drill for 5.5 SwiveLock Anchor
Cannulated Drill, 2.5 mm
Guide Wire, .041, qty. 4
AR-1927CTB
AR-1927D
AR-1530C-25
AR-1530K
VAR-2323PSLK
-2323
3PSLK
AR-2323PSLC
2323PS
SLC
AR-7237
7237
AR-8920
8920
AR-1255-08
255-08
Banana
ana Knife
Hook Knife
nife
Push Knife
Handle for Knives
es
VAR-5001
V
VAR-5003
V
VAR-5005
V
VAR-5020
V
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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 Vet Systems 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.
© 2010, Arthrex Vet Systems. All rights reserved. VLT0005A
U.S. PATENT NO. 6,716,234 and PATENT PENDING
TightRope CCL Multicenter Clinical Outcomes Study
Cases Reported: 2,563 cases Duration: 3 mo to > 5 yrs Weight Range: 2‐93 kg Centers Reporting Data: 43 Reported Success Rate 94.9% Success rate 64.6% Full Function (restoration to, or maintenance of, full intended level and duration of activities and performance from pre‐injury or pre‐disease status without medication) 30.3% Acceptable Function (restoration to, or maintenance of, intended activities and performance from pre‐injury or pre‐disease status that is limited in level or duration and/or requires medication to achieve) Complications 0.02% Catastrophic (resulting in permanent disability or death) 9.8% Major (requires further treatment based on current standard of care) Subsequent Meniscal Tears – 5.2% Instability/Failure – 2.9% Infection – 1.7% 9.1% Minor (not requiring additional surgical or medical treatment to resolve) *Reported complication rates for TPLO, lateral suture, TTA, and cranial closing wedge osteotomy range from 17‐59% in the peer‐
reviewed veterinary literature *An independent investigation by Dr. Rich Evans using Number Needed to Harm and Number Needed to Treat analyses showed TightRope to have the highest safety to efficacy ratio of all CCL procedures commonly used based on available data. Surgeons contributing to the multicenter clinical study:

 Dr. Caroline Garzotto – Willingboro Veterinary Clinic  Dr. Sheri Morris – Willamette Valley Animal Hospital Dr. Mark Albrecht – Gallatin Veterinary Hospital 
 Dr. Mitch Gillick – Toronto Veterinary Emergency Hosp  Dr. Paul Newman – Mobile Veterinary Surgical Services Dr. Jeff Baker – Crawford Animal Hospital 
Dr. Toni Barnes – Westside Veterinary Clinic 
Dr. Charles Greco – Animal Medical Hospital  Dr. Frank Ogden – Bonita Springs Veterinary Hospital  Dr. Bert Blackburn – Buck Animal Hospital  Dr. Peter Haase – Arlington Veterinary Surg. Spec.  Dr. Antonio Pozzi – University of Florida  Dr. Lee Breshears – Animal Emergency & Spec. Center  Dr. Tom Hay  Dr. Charles Pullen – Animal Medical and Surgical Center Dr. Cal Cadmus – Oakdale Veterinary Group 
 Dr. Craig Hook – Mid‐Michigan Veterinary Referral Center  Dr. Patrick Ridge – Ridge Referrals Dr. Jimi Cook – University of Missouri 
 Dr. Jauernig  Dr. Matt Rooney – Aspen Meadows Veterinary Specialists Dr. Robert Cook ‐ Animal Medical Center of St. Charles  Dr. Joanna Johansen – Linwood Animal Clinic 
 Dr. Jeff Schuett – Pewaukee Veterinary Services 
 Dr. Abbie Tipler – Kydd Veterinary Health Centre Dr. David Crouch – Western Carolina Veterinary Surgery  Dr. Nick Kalafatic – Meridian Veterinary Hospital 
 Dr. Peter Veling – Caring Hands Pet Hospital Dr. Chad Devitt – Veterinary Referral Center of Colorado  Dr. Garren Kelly – Byron Pet Clinic 
Dr. Felix Duerr – Aspen Meadows Veterinary Specialists 
Dr. David Kydd – Kydd Veterinary Health Centre of London  Dr. Arathi Vinayak ‐ Arlington Veterinary Surgery Specialist 
Dr. Jay Erne – Affiliated Veterinary Specialists 
Dr. Tom Liebl – Clinton Parkway Animal Hospital  Dr. Ned Williams – Eastern Carolina Veterinary Referral  Dr. Will Wright – Capitol Illini Veterinary Services  Dr. Mike Ferber – North Shore Animal Hospital  Dr. Julius Liptak – Alta Vista Animal Hospital  Dr. Mark Freiberg – Rose Hill Animal Hospital
 Dr. Dale Marker – Jackson Hwy Veterinary Clinic Trade Center Way ● Naples, FL 34109
 Dr. Garrett – Animal Hospital of Fayetteville
 1958
Dr. Thomas McNicholas – Affiliated Veterinary Specialists (888) 215-3740 Phone ● (866) 898-2059 Fax
www.arthrexvetsystems.com
Advantages of TightRope CCL Potential Contraindications for TightRope CCL e
ay
cis
er
Ex
Pl
y
ity
tiv
Ac
ap
p
H
ud
e
At
t it
oo
d
M
O
ve
ra
ll
VA S Score
VAS Score
mm
mm
 Bone to Bone fixation  Tibial Plateau Angle > 32 degrees  Helps ensure isometric implant placement  Angular Limb Deformity  Allows for minimally invasive technique  Connective tissue healing abnormalities  Strength and Stiffness of Fibertape  Condyle < 12mm cranial to caudal  Low profile Implant with good handling  Poor postop compliance  Potential for addressing all abnormal forces Biomechanical Testing Data Yield (N)
Creep (mm)
1500
6
1000
4
500
2
0
0
Subjectively measured stifle stability for TightRope (TR) vs TPLO Tibial Thrust TR vs TPLO
Cranial Drawer TR vs TPLO
10
20
8
15
6
10
4
TR
TR
TPLO
TPLO
2
5
0
0
Pre
Imm Post
8 wk
6 mo
-2
Pre
Imm Post
8 wk
6 mo
-4
-5
Time Point
Time Point
Client‐based Outcomes Assessments for TightRope (TR) vs TPLO at 6 months after surgery 10
10
8
8
TR
6
TR
6
TPLO
4
TPLO
4
2
2
0
0
AM Stiffness
PM Stiffness
Lameness
Pain
Higher is better
Lower is better
Cook JL, Luther JK, Beetem J, Karnes J, Cook CR. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for
treatment of cranial cruciate ligament deficiency in dogs. Vet Surg 2010; 39:315-323
1958 Trade Center Way ● Naples, FL 34109
(888) 215-3740 Phone ● (866) 898-2059 Fax
www.arthrexvetsystems.com
Things
to remember
about
youryour
dog’s
Things
toremember
remember
about
your
Things
to
about
cruciate
dog’sproblem:
cruciateproblem
problem
dog’s
cruciate
Yourdog
doghas,
has,or
orwill
willdevelop,
develop,arthritis
arthritisassociated
associated
1.1. Your
withthe
thecruciate
cruciateligament
ligamentproblem
problem––this
thiswill
willnot
not
with
becured
curedwith
withsurgery
surgeryor
ormedications
medicationsso
sowe
wewill
will
be
needto
tomanage
managethis
thisfor
forthe
therest
restof
ofyour
yourdog’s
dog’slife.
life.
need
Whatyou
youdo
doafter
aftersurgery
surgeryisismore
moreimportant
importantthat
that
2.2. What
whatisisdone
donein
inthe
theoperating
operatingroom
room––you
youneed
needto
to
what
committo
toall
allof
ofthe
theinstructions
instructionsin
inyour
yourdischarge
discharge
commit
summaryin
inorder
orderto
tooptimize
optimizeyour
yourdog’s
dog’soutcome.
outcome.
summary
Indogs
dogswith
withone
onecruciate
cruciateproblem,
problem,there
thereisisaa
3.3. In
50-70%chance
chancethat
thatthe
theother
otherknee
kneewill
willhave
havethe
the
50-70%
sameproblem
problemwithin
withinweeks
weeksto
toyears
yearsof
ofthe
thefirst
firstone.
one.
same
Aftersurgery,
surgery,complications
complicationsor
orsubsequent
subsequentproblems
problems
4.4. After
canoccur
occur––each
eachprocedure
procedurehas
hasvarying
varyingcomplication
complication
can
ratesranging
rangingfrom
fromless
lessthan
than10%
10%to
toover
over50%
50%
rates
dependingon
onmany
manyfactors.
factors.The
Theoverall
overallcomplication
complication
depending
ratefor
forTightRope
TightRopeCCL
CCLisiscurrently
currently18.6%,
18.6%,with
with9.9%
9.9%
rate
requiringfurther
furthertreatment
treatmentwhich
whichinclude:
include:
requiring
••
••
••
Infection––4.9%
4.9%
Infection
Instability––3.6%
3.6%
Instability
Meniscaltears
tears––4.2%
4.2%
Meniscal
References
References:
References:
1.1.
2.2.
3.3.
4.4.
5.5.
6.6.
ElkinsAD,
AD,Pechman
PechmanR,R,Kearney
KearneyMT,
MT,et
etal,
al,
Elkins
“ARetrospective
RetrospectiveStudy
StudyEvaluating
Evaluatingthe
theDegree
Degreeofof
“A
DegenerativeJoint
JointDisease
Diseaseininthe
theStifle
StifleofofDogs
Dogs
Degenerative
FollowingSurgical
SurgicalRepair
RepairofofAnterior
AnteriorCruciate
CruciateLigament
Ligament
Following
Rupture,”JJAm
AmAnim
AnimHosp
HospAssoc
Assoc1991:
1991:27:
27:533-540.
533-540.
Rupture,”
InnesJF,
JF,Bacon
BaconD,
D,Lynch
LynchC,C,etetalal, ,“Long-Term
“Long-TermOutcome
Outcome
Innes
Surgeryfor
forDogs
Dogswith
withCranial
CranialCruciate
CruciateLigament
Ligament
ofofSurgery
Deficiency,”Vet
VetRec
Rec2000;
2000;147:
147:325-328.
325-328.
Deficiency,”
JohnsonJA,
JA,Austin
AustinC,C,Breur
BreurGJ,
GJ,“Incidence
“IncidenceofofCanine
Canine
Johnson
AppendicularMusculoskeletal
MusculoskeletalDisorders
Disordersinin16
16
Appendicular
VeterinaryTeaching
TeachingHospitals
Hospitalsfrom
from1980
1980to
to1989,”
1989,”
Veterinary
VetComp
CompOrthop
OrthopTraumatol
Traumatol1994;
1994;7:7:56-59.
56-59.
Vet
Johnson,JM,
JM,Johnson,
Johnson,LA,
LA,“Cranial
“CranialCruciate
CruciateLigament
Ligament
Johnson,
RuptureVet
VetClin
ClinofofNorth
NorthAm:
Am:Small
SmallAnim
AnimPrac.”
Prac.”1993,
1993,
Rupture
23,717-733.
717-733.
23,
Whitehair,JG,
JG,Vasseur,
Vasseur,PB,
PB,Willits,
Willits,NH,
NH,“Epidemiology
“Epidemiology
Whitehair,
CranialCruciate
CruciateLigament
LigamentRupture
RuptureininDogs,”
Dogs,”JAVMA.
JAVMA.
ofofCranial
1993,203,
203,1016-D
1016-D1019.
1019.
1993,
Duval,JM,
JM,Budsberg,
Budsberg,SC,
SC,Flo,
Flo,GL,
GL,Sammarco,
Sammarco,JL,
JL,
Duval,
“Breed,Sex,
Sex,and
andBody
BodyWeight
Weightas
asRisk
RiskFactors
Factorsfor
forRupture
Rupture
“Breed,
theCranial
CranialCruciate
CruciateLigament
LigamentininYoung
YoungDogs,”
Dogs,”
ofofthe
JAVMA.1999,
1999,215,
215,811-814.
811-814.
JAVMA.
Thevery
verybest
bestthings
thingsyou
youcan
cando
doto
tominimize
minimizethe
the
5.5. The
chancesand
andeffects
effectsassociated
associatedwith
with1-4
1-4are:
are:
chances
••
••
••
••
Keepyour
yourdog
dogat
atan
anideal
idealweight
weight
Keep
Followthe
thedischarge
dischargeinstructions
instructionsexactly
exactly
Follow
Keepyour
yourfollow-up
follow-upappointments
appointments
Keep
Continuewellness
wellnesscare
carewith
withyour
yourregular
regular
Continue
veterinarian
veterinarian
Arthrex Vet Systems
27300 Riverview Center Blvd.
ArthrexVet
VetSystems
Systems
Arthrex
Suite 200
27300Riverview
Riverview
Center
Blvd.
27300
Bonita
Springs,
FLCenter
34134 Blvd.
Suite200
200
Suite
Phone
(888) 215-3740
BonitaSprings,
Springs,FL
FL34134
34134
www.arthrexvetsystems.com
Bonita
(888)215-3740
215-3740Phone
Phone
(888)
www.arthrexvetsystems.com
www.arthrexvetsystems.com
VLP0004A
VLP0004A
© 2009, Arthrex Vet Systems. All rights reserved. VLP0004B
TightRope® CCL
Client Information
What is
is cranial
cranial cruciate
ligament disease?
disease?
What
cruciate ligament
disease?
What
is
cranial
What is cranial cruciate ligament disease?
The cranial
cranial cruciate
cruciate ligament
ligament (CCL)
(CCL) is
is one
one of
of the
the main
main
The
stabilizing structures
structures of
of the
the knee
knee (stifle)
(stifle) joint
joint in
in the
the
stabilizing
The cranial cruciate ligament (CCL) is one of the main
hindlimbs of
of dogs.
dogs. The
The CCL
CCL is
is aa rope-like
rope-like structure
structure inside the
hindlimbs
stabilizing
structures
of the knee
(stifle) joint in the inside the
joint
that
acts
as
a
static
(constant)
stabilizer
of the
the knee,
knee,
joint that acts
as a The
staticCCL
(constant)
stabilizer
of
hindlimbs
of dogs.
is a rope-like
structure
inside the
preventing
abnormal
“slipping”
of
the
two
bones
of
the knee
knee
preventing
abnormal
“slipping”
of stabilizer
the two bones
the
joint
that acts
as a static
(constant)
of theof
knee,
joint, the
the femur
femur and
and tibia.
tibia. Its
Its main
main job
job is
is to
to hold
hold the
the femur
femur
joint,
preventing abnormal “slipping” of the two bones of the knee
and tibia
tibia in
in proper
proper alignment
alignment during
during all
all forms
forms of
of activity.
activity.
and
joint,
the femur
and tibia. Its main
job is to
hold the
femur
and
tibia
in
proper
alignment
during
all
forms
of
activity.
Deficiency of
of the
the CCL
CCL is
is the
the most
most common
common orthopaedic
orthopaedic
Deficiency
problem in
in dogs
dogs and
and inevitably
inevitably results
results in
in degenerative
degenerative joint
joint
problem
Deficiency of the CCL is the most common
orthopaedic
1-3
disease (arthritis)
(arthritis) in
in the
the knee
knee joint
joint1-3
. ItIt is
is referred
referred to
to as
as aa
disease
.
problem in dogs and inevitably results in degenerative joint
disease because
because it is typically
typically the
the result
result of
of aa degenerative
degenerative
disease
disease
(arthritis) itinisthe
knee joint1-3
. It is referred
to as a 4-6
process in
in dogs,
dogs, rather
rather than
than from
from athletic
athletic injury
injury or
or trauma.
trauma.4-6
process
disease because it is typically the result of a degenerative
Although itit is
is often
often noticed
noticed after
after running,
running, playing,
playing, or
or
Although
process in dogs, rather than from athletic injury or trauma.4-6
jumping,
the
disease
process
has
been
present
for
weeks
to
jumping, itthe
disease
process
hasrunning,
been present
foror
weeks to
Although
is often
noticed
after
playing,
months when
when symptoms
symptoms occur.
occur.
months
jumping, the disease process has been present for weeks to
months when symptoms occur.
What are
are the
symptoms of
disease?
What
the symptoms
symptoms
of CCL
CCL disease?
disease?
What
of
CCL
What are the symptoms of CCL disease?
Some of
of the
the symptoms
symptoms your
your pet
pet may
may display
display are:
are:
Some
Some•of the
symptoms your pet may display are:
Limping
•
Limping
••
Holding
the hindlimb
hindlimb up
up
Holding the
• • Limping
Sitting with
with the
the leg
leg stuck
stuck out
out to
to the
the side
side
•
Sitting
• • Holding
the
hindlimbafter
up exercise
Stiffness,
especially
•
Stiffness,
especially
after
exercise
• • Sitting
with the
stuck
out to the side
Not wanting
wanting
toleg
play
or exercise
exercise
Not
to
play
or
••• Stiffness,
especially
after
exerciseor moved
Pain
when
the
joint
is
touched
Painwanting
when the
is touched or moved
••• Not
to joint
play
Swelling of
of the
the
jointor exercise
Swelling
joint
••• Pain
when
the
joint
is
Clicking sound
sound when
when touched
walking or moved
Clicking
walking
•• Swelling
of the joint
•
Clicking sound when walking
How
is
diseasediagnosed?
diagnosed?
How is
is CCL
CCL disease
disease
diagnosed?
How
CCL
How is CCL disease diagnosed?
Your veterinarian
veterinarian should
should review
review your
your dog’s
dog’s medical
medical history
history
Your
and
perform
a
complete
examination
using
tests
of
the
and perform
a complete
examination
usingmedical
tests of history
the
Your
veterinarian
should review
your dog’s
integrity of
of the CCL
CCL including
including the
the “cranial
“cranial drawer”
drawer” and “tibial
“tibial
integrity
and
performthe
a complete
examination
using tests ofand
the
thrust” tests.
tests. X-rays
X-rays should
should be
be performed
performed to
to assess
assess the
the
thrust”
integrity of the CCL including the “cranial drawer” and “tibial
amount of
of arthritis present
present and
and aid
aid in
in determining
determining treatment
treatment
amount
thrust”
tests.arthritis
X-rays should be
performed
to assess the
options. Sedation
Sedation or
or anesthesia
anesthesia is
is necessary
necessary for
for making
making the
the
options.
amount of arthritis present and aid in determining treatment
definitive diagnosis
diagnosis to
to avoid
avoid causing
causing pain
pain to
to your
your pet.
pet.
definitive
options. Sedation or anesthesia is necessary for making the
definitive diagnosis to avoid causing pain to your pet.
Whatare
aremy
my treatment
treatmentoptions?
options?
What
What
are
treatment
options?
What are my treatment options?
First, itit is
is important
important to
to know
know that
that there
there is
is no
no cure
cure for
for CCL
CCL
First,
disease
in
dogs.
The
goals
for
all
treatments
are
to
relieve
disease
dogs. The
allthere
treatments
are to
First,
it isin
important
togoals
knowfor
that
is no cure
forrelieve
CCL
pain, improve
improve function,
function, and
and slow
slow down
down the
the arthritis.
arthritis.
pain,
disease
in dogs. The goals
for all treatments
are to relieve
With these
these realistic
realistic goals
goals in
in mind,
mind, aa number
number of
of treatment
treatment
With
pain,
improve
function, and
slow down
the arthritis.
options
can
be
very
successful
in
accomplishing
all of
of them.
them.
options
canrealistic
be verygoals
successful
in accomplishing
all
With
these
in mind,
a number of treatment
options
can betreatment
very successful
in accomplishing
all of them.
Nonsurgical
entails
rest and
and nonsteroidal
nonsteroidal
Nonsurgical
treatment entails
rest
anti-inflammatory
medication
for
6-8
weeks.
Once
the
anti-inflammatory
medication
for
6-8and
weeks.
Once the
Nonsurgical
treatment
entails
rest
nonsteroidal
initial pain
pain and
and
inflammation
have
subsided,
a strengthstrengthinitial
inflammation
have
subsided,
a
anti-inflammatory
medication
6-8 weeks.
the
building exercise
exercise program
program
andfor
weight
loss (if
(ifOnce
necessary)
building
and
weight
loss
necessary)
initial
pain
and
inflammation
have
subsided,
a
strengthshould be
be initiated.
initiated. Nonsurgical
Nonsurgical treatment
treatment of
of CCL
CCL
should
building
exercise
program at
and
weight loss (if
necessary)
disease can
can
be successful
successful
accomplishing
our
goals,
disease
be
at
accomplishing
our
goals,
should
be initiated.
Nonsurgical
treatment of CCL
however,
the
success
rate
for
accomplishing
all
of our
our
however,
rateatfor
accomplishing
allgoals,
of
disease
canthe
besuccess
successful
accomplishing
our
treatment
goals
is not
not high
high and
and typically
typically only
only
small dogs
dogs
treatment
goals
is
small
however,
the
success
rate
for
accomplishing
all of our
weighing
less
than
30
lbs.
may
have
good
long-term
weighing goals
less than
30high
lbs. may
good
long-term
treatment
not
and have
typically
only
small dogs
results with
with this
thisisapproach.
approach.
results
weighing
less than
30 lbs. may have good long-term
results
with
this approach.
Surgical
treatment
options are
are numerous
numerous and
and no
no
Surgical
treatment
options
treatment
has
been proven
proven to
to be
be better
better than
than another.
another.
treatment
has
been
Surgical
options
are numerous
and noof the
is vital
vital treatment
to remember
remember
that complete
complete
assessment
ItIt is
to
that
assessment
of the
treatment
has
been
proven
to
be
better
than
joint with
with treatment
treatment of
of damaged
damaged tissues
tissues such
suchanother.
as the
the
as
Itjoint
is
vital
to
remember
that
complete
assessment
of
the
CCL and
and meniscus,
meniscus, as
as well
well as
as exceptional
exceptional postoperative
postoperative
CCL
joint
with
treatment
of
damaged
tissues
such
as
the
management and
and rehabilitation
rehabilitation programs
programs are
are as,
as, or
or even
even
management
CCL
andimportant
meniscus,than
as well
exceptional
postoperative
more,
the as
“CCL
surgery” itself.
itself.
The decision
decision
more,
important
than
the
“CCL
surgery”
The
management
andon
rehabilitation
programs
or even
should be
be based
based
the best
best available
available
dataare
onas,
safety
and
should
on the
data
on
safety
and
more,
important
than
the
“CCL surgery”
itself.
The
decision
success,
the
surgeon’s
experience
with
the
techniques,
success,
the
surgeon’s
experience
with
the
techniques,
should
be based on for
theeach
best patient
available
datathe
on information
safety and
and individualized
individualized
using
and
for experience
each patient
using
the
information
success,
the
surgeon’s
with
the
techniques,
from
the
exam
and
discussion
with
you
regarding
your
fromindividualized
the exam andfor
discussion
withusing
you regarding
your
and
each patient
the information
goals
and
concerns.
goalsthe
andexam
concerns.
from
and discussion with you regarding your
goals and concerns.
Most
Mostcommon
CommonCCL
CCL surgery
Surgerytechniques:
Techniques:
Most
Common
CCL
Surgery
Techniques:
Most Common CCL Surgery Techniques:
Tibial Plateau
Plateau Leveling
Leveling Osteotomy
Osteotomy (TPLO)
(TPLO) is
is one
one of
of the
the
Tibial
“bone-cutting”
techniques
and
is
designed
to
change
the
“bone-cutting”
techniques
and is designed
the
Tibial
Plateau Leveling
Osteotomy
(TPLO)tois change
one of the
anatomy
of
the
knee
so
that
it
no
longer
“slips”
without
anatomy of thetechniques
knee so that
it no
longer “slips”
without
“bone-cutting”
and
is designed
to change
the
having to
to try
try to
to replace
replace the
the function
function of
of the CCL.
CCL.
having
anatomy
of the
knee so that
it no longerthe
“slips” without
semicircular cut
cut is
is made
made at
at the
the top
top of
of the
the tibia
tibia with a
AA semicircular
having
to try to replace
the function
of the
CCL. with a
curved
saw
so
that
the
tibial
joint
surface
is
“leveled out”
out”
saw socut
thatisthe
tibial
jointtop
surface
“leveled
Acurved
semicircular
made
at the
of theistibia
with a
to prevent
prevent forward
forward slipping
slipping of
of the
the joint.
joint. AA plate
plate and
and screws
screws
to
curved saw so that the tibial joint surface is “leveled out”
are applied
applied to
to stabilize
stabilize the
the cut bone
bone during
during healing.
healing.
are
to
prevent forward
slipping cut
of the joint.
A plate and screws
are applied to stabilize the cut bone during healing.
Tibial Tuberosity
Tuberosity Advancement
Advancement (TTA)
(TTA) is
is the
the other
other
Tibial
“bone-cutting” technique
technique which
which is
is designed
designed to
to change
change
“bone-cutting”
Tibial Tuberosity Advancement (TTA) is the other
the
knee
anatomy,
so
that
muscle
forces
are
rebalanced
the knee anatomy,
so thatwhich
muscle
forces areto
rebalanced
“bone-cutting”
technique
is designed
change
to limit
limit the
the tibia
tibia from
from “slipping”
“slipping” forward.
forward. In
In this procedure,
procedure,
to
the
knee anatomy,
so that muscle
forces arethis
rebalanced
the bony
bony attachment
attachment of
of the
the quadriceps
quadriceps muscles
muscles is
is cut,
cut,
the
to limit the tibia from “slipping” forward. In this procedure,
moved forward,
forward, and
and held
held in
in place
place with
with aa spacer,
spacer, plate,
plate,
moved
the bony attachment of the quadriceps muscles is cut,
and screws
screws during
during healing.
and
moved
forward, andhealing.
held in place with a spacer, plate,
and screws during healing.
Lateral Suture
Suture Stabilization
Stabilization is
is the
the most
most common
common
Lateral
technique used
used to
to treat
treat CCL
CCL disease
disease in
in dogs.
dogs. ItIt is
is one of the
technique
Lateral Suture Stabilization is the most commonone of the
“extracapsular” techniques
techniques which
which means
means the
the function
function of
of
“extracapsular”
technique used to treat CCL disease in dogs. It is one of the
the
CCL,
which
is
inside
the
joint,
is
replaced
by
placing
a
the CCL, which techniques
is inside thewhich
joint, means
is replaced
by placing
“extracapsular”
the function
of a
suture outside
outside the
the joint.
joint. The
The suture,
suture, most
most commonly
commonly aa
suture
the CCL, which is inside the joint, is replaced by placing a
type of
of medical
medical grade
grade “fishing
“fishing line,”
line,” is
is placed
placed around
around the
type
suture
outside the
joint. The suture,
most
commonly athe
fabella
and
through
the
tibia
providing
a
soft
tissue-tofabella
and through
tibia providing
a softaround
tissue-totype
of medical
gradethe
“fishing
line,” is placed
the
bone
stabilizer
of
the
joint
during
healing.
The
suture acts
acts
bone stabilizer
of the
joint
during
healing.
The
suture
fabella
and through
the
tibia
providing
a soft
tissue-toas aa temporary
temporary stabilizer
stabilizer as
as the
the dog
dog makes
makes new
new functional
functional
as
bone stabilizer of the joint during healing. The suture acts
scar tissue
tissue around
around the
the knee
knee for
for long-term
long-term joint
joint stability.
scar
as
a temporary
stabilizer
as the dog
makes new stability.
functional
scar
tissue around
thedeveloped
knee for long-term
joint
stability.
TightRope
CCL
was
two
years
ago
to
TightRope CCL was developed two years ago to
provide aa minimally
minimally invasive
invasive and
and improved
improved method
method for
for
provide
TightRope
CCL was developed
two years ago
to
extracapsular stabilization
stabilization of
of the
the CCL.
CCL. This
This technique
technique does
does
extracapsular
provide a minimally invasive and improved method for
not require
require cutting
cutting of
of bone
bone like
like the
the TPLO
TPLO or
or TTA
TTA procedures.
procedures.
not
extracapsular stabilization of the CCL. This technique does
Instead, itit uses
uses small
small drill
drill holes in
in the femur
femur and
and tibia
tibia to
to
Instead,
not
require cutting
of boneholes
like thethe
TPLO or TTA
procedures.
pass
a
synthetic
ligament-like
biomaterial
through
a
small
pass a synthetic
ligament-like
a small
Instead,
it uses small
drill holesbiomaterial
in the femurthrough
and tibia
to
incision to
to provide
provide bone-to-bone
bone-to-bone stabilization
stabilization during
during
incision
pass
a synthetic
ligament-like biomaterial
through a small
healing. The
The biomaterial
biomaterial used
used for
for the
the TightRope
TightRope CCL
CCL is
healing.
incision
to provide
bone-to-bone
stabilization
during is
called
FiberTape®.
This
is
a
kevlar-like
material
that
is used
called FiberTape®.
This isused
a kevlar-like
material that
healing.
The biomaterial
for the TightRope
CCLisisused
extensively in
in human
human surgery
surgery for
for many
many orthopaedic
orthopaedic
extensively
called FiberTape®. This is a kevlar-like material that is used
applications. This
This material
material has
has properties that
that
applications.
extensively
in human
surgery forproperties
many orthopaedic
make
it
stronger
and
less
prone
to
failure
make it stronger
less prone
to failure that
applications.
Thisand
material
has properties
than any
any other
other suture
suture materials
materials
than
make
it stronger
and less prone to failure
currently being
being used
used for
for CCL
CCL
currently
than
any other suture
materials
reconstructions.
reconstructions.
currently
being used for CCL
reconstructions.
Surgical Technique
The patient is positioned in lateral or dorsal recumbency under general anesthetic.
A hanging limb technique with aseptic preparation and appropriate draping should
be performed.
A lateral parapatellar approach with arthrotomy is performed and complete exploration
of the stifle joint is completed. Pathologic ligament and meniscus should be treated
appropriately. The joint is thoroughly lavaged and the joint capsule closed.
Developed in conjunction with
James L. Cook, DVM, PhD, at
Comparative Orthopaedic Laboratory,
University of Missouri,
Columbia, Missouri.
1
After the joint capsule is closed,
a combination of sharp and blunt
dissection is used to separate the
vastus lateralis and biceps femoris muscles and retract the biceps
caudally (Senn retractor) to allow
for exposure and palpation of the
lateral fabella (pin pointing to it).
2
The curved needle on the Canine
Cruciate Suture is then placed with
the tip on the midpoint of the lateral
fabella and “walked” proximally until
it can be inserted between the fabella
and femur and passed completely
around the fabella from proximal
to distal.
3
It is important to make sure the
needle is around the fabella and
not caudal to it. This can be verified
after suture placement by pulling
on both strands of the suture to
ensure they are around the bone
of the fabella and not soft tissues
caudal to it. It is also important to
minimize the amount of soft tissue
encompassed in the suture throw,
paying particular attention to the
peroneal nerve distally. The curved
needle on the Canine Cruciate
Suture is designed to help promote
correct placement.
6
As the pin or drill is removed,
the straight needle on the Canine
Cruciate Suture is inserted in the
tibial hole from medial to lateral,
and the suture is advanced to
allow for easy tying.
4
The straight needle on the
Canine Cruciate Suture is passed
deep to the patellar ligament
from lateral to medial at the most
distal point possible. The suture
should be caudal to the ligament
and cranial to the fat pad.
7
Both needles are cut off of the
Canine Cruciate Suture and
the suture is tied at the desired
tension so as to prevent abnormal
cranial drawer and internal
rotation. The stifle is then put
through a range of motion to
ensure the suture has been placed
correctly and is not impinging
on periarticular structures. The
area is lavaged.
5
A 2-3 mm hole is drilled in the
proximal tibia using a pin and
Jacob’s chuck or drill bit and drill.
The location of the hole should
be immediately distal to Gerdy’s
tubercle and immediately proximal
to the point of origin of the cranial
tibial muscle. The hole should
be slightly angled caudoproximal
to craniodistal to match the final
direction of the suture.
8
The lateral fascia is closed with
the imbricating pattern of choice.
Routine subcutaneous tissue and
skin closures are performed.
Postoperatively, the patient is
typically bandaged for a minimum
of 24 hours. Exercise restriction
with controlled physical rehabilitation is recommended through
12 weeks after surgery.
Revolutionizing
Orthopaedic Surgery
FiberWire suture is constructed of a muti-stranded
long chain ultra-high molecular weight polyethylene
core with a polyester braided jacket that gives
FiberWire superior strength, soft feel and abrasion
resistance that is unequaled in orthopaedic surgery.
Suture breakage during knot tying is virtually
eliminated, especially critical during arthroscopic
procedures. FiberWire represents a major advancement
in orthopaedic surgery.
Strength
FiberWire has greater strength than comparable size
standard polyester suture. Multiple independent
scientific studies document significant increases
in strength to failure, stiffness, knot strength and
knot slippage with much less elongation1.
Tie Ability and Knot Profile
Superior strength allows tighter loop security
during knot tying, increasing knot integrity while
reducing the knot profile compared to standard
polyester suture.
Abrasion Resistance
The multi-strand long chain ultra-high molecular
weight polyethylene core dramatically increases
FiberWire abrasion resistance. Surgical procedures
that create bone edges, tunnel edges, and articulating
surface abrasion areas are appropriate indications for
FiberWire. FiberWire is over five times more abrasion
resistant than standard polyester suture.
Safety in Numbers
Trusted by leading orthopedic surgeons
worldwide since its introduction in 2002,
FiberWire has contributed to successful surgical
outcomes in over one million orthopaedic
surgical procedures. Extensive biocompatibility,
animal and clinical testing prove that FiberWire
demonstrates biocompatibility characteristics
equivalent to standard polyester suture.
FiberWire Tensioner
The FiberWire Tensioner provides controlled
tensioning option of FiberWire loops during knot
tying. When reapproximating soft tissue, the blunt
tip keeps the knot in place while the tensioning
wheel and spring mechanism gently tension the
loop to tighten the repair.
The tensioning wheel is then turned in a counterclockwise fashion as the tension meter is read. Once
the desired amount of tension/reduction is achieved,
three reverse half-hitches can be thrown down the
barrel of the tensioner to secure the
fixation.
FiberWire Scissor
The FiberWire Scissor was designed to cut any size
or style suture, especially FiberWire, in open surgical
cases where an arthroscopic suture cutter is not
necessary. With its specially designed cutting
edges, it can cut FiberWire cleanly and
effortlessly without frayed edges.
O R D E R I N G I N F O R M AT I O N
Canine Cruciate Suture
FiberWire Tensioner
FiberWire Scissor
VAR-2000
AR-1929
AR-11796
References:
1
Burkhart SS. Arthroscopic Knots: The Optimal Balance of Loop Security
and Knot Security. Arthroscopy 2004; 20.
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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 Vet Systems, 2006. All rights reserved. VLT0002A
U.S. PATENT NOS. 6,716,234 and PATENT PENDING
#VLT0002#
SURGICAL TECHNIQUE
Canine Cranial Cruciate Ligament Repair Kit