SynACART™ Joint Resurfacing

SURGICAL TECHNIQUE
SynACART™ Joint Resurfacing
The Surgical Technique for Treating Osteochondral Defects
Surgical Technique
Developed in conjunction with Dr. Noel Fitzpatrick Duniv CVR CSAO MVB MRCVS, Fitzpatrick Referrals Ltd, UK
in hyperflexion, optimizing exposure of the articular surface of
the lateral femoral condyle. Strategically-placed small Gelpi
Retractors can help improve visibility.
The dog is placed in dorsal recumbency with the stifle undergoing surgery isolated in a standard four point drape fashion.
Strict adherence to aseptic technique for patient preparation
and surgery is critical to success. An assistant is required to
position the limb during surgery.
For lesions affecting the lateral femoral condyle, the proposed
skin incision is outlined by first identifying the patella and lateral
trochlear ridge. A curved parapatellar incision is made from
the tibial tuberosity to the level of the patella and continued
proximally for an equal distance. The approach is continued
with an incision through the fascia lata, along the cranial border
of the biceps femoris muscle and extending distally through
the lateral retinacular fascia, making sure to allow adequate
remaining fascia to allow closure of the approach. The joint
capsule is incised, the patella may need to be luxated medially
from the trochlear groove, and the assistant positions the stifle
For lesions affecting the medial femoral condyle, an incision is
made from the tibial tuberosity to the patella and then continued
proximally for an equivalent distance. A stab incision is made
into the joint at the level of the patella and the incision is
extended distally through the medial fascia, the vastus medialis
and the joint capsule, parallel to the straight patellar tendon.
Use caution as to not cause iatrogenic damage to the articular
cartilage of the medial condyle. The incision extends to the
distal portion of the sartorius muscle. The patella is luxated
laterally and the joint is hyperflexed by the assistant to allow
adequate visibility of the articular surface of the medial femoral
condyle. The use of the strategically-placed small Gelpi Retractors
can help improve visibility.
Guide
Cannulated Drill
MRI scan of osteochondritis dissecans
lesion of the medial condyle of the canine
stifle – the pervasive subchondral bone
marrow lesion is often underestimated
on standard radiography
CT scan of osteochondritis dissecans
lesion of the medial condyle of the
canine stifle – documentation of the
geographic extent of the lesion assists
preoperative planning
CT scan postoperatively after placement
of the SynACART implant for joint
resurfacing – note the metallic base for
osseous ingrowth and the reconstruction
of the articular surface topography
1
The articular surface is inspected and the
damaged surface is debrided with a scalpel
or curette. It is important that the lesion
is clearly defined by a circumferential
marginal collar of viable hyaline cartilage.
If the lesion is caudally disposed, this
may require extreme hyperflexion.
2
The diameter of the lesion is measured
using the concave end of the SynACART
Guide to determine the most appropriate
implant size. Once selected, the guide
should be placed perpendicular to the
defect and the 2.4 mm guide pin advanced
through the cannulation of the guide and
drilled at least 2 cm into the bone.
5
The joint is
flushed prior
to routine
closure.
3
The guide is removed and the appropriate
sized SynACART Cannulated Drill is placed
over the guide pin. The drill is advanced
until the recipient bed is prepared to a stoplimited depth of 8 mm. The recipient bed
is vigorously flushed to remove all debris
which may prevent correct implant seating.
4
The implant is introduced into the recipient
bed either by hand or by utilizing the
SynACART Implant Holder. Using the
concave end of the SynACART Guide,
tamp the implant so that it is firmly seated
to ensure accurate restoration of the articular
topography.
Recommended Postoperative Management:
• Analgesia is provided in the form of nonsteroidal anti-inflammatory medication for 10-14 days post-surgery
• Restrict to kennel rest for the first 14 days post-surgery when unobserved
• Toileting and muscle-building walks are allowed 3-4x daily, lasting a maximum of 5-10 minutes
• Further confinement of the patient is recommended between weeks 3-6. Exercise breaks can be increased by 5 minutes
per week, resulting in lead-controlled walks of 30 minutes, 3-4x daily by 6 weeks post-surgery
• Recheck examination at 6 weeks. Radiographic imaging or CT scan of joint is recommended.
• If the patient is progressing as expected, lead-controlled exercise can be gradually increased week by week until 12 weeks
post-surgery where the patient can resume off-lead activity
• The success of this intervention relies upon a controlled return to a normal exercise pattern. The patient must remain under lead
control, while not confined, and must be prevented from running, jumping or slipping on the operated limb until the appropriate
recovery period has elapsed.
O R D E R I N G I N F O R M AT I O N
Implants:
SynACART, Resurfacing Core, 8 mm x 8 mm VAR-2500-08
SynACART, Resurfacing Core, 10 mm x 8 mm VAR-2500-10
SynACART, Resurfacing Core, 20 mm x 8 mm VAR-2500-20
SynACART, Resurfacing Core, 25 mm x 8 mm VAR-2500-25
SynACART Cannulated Drill, 8 mm
SynACART Cannulated Drill, 10 mm
SynACART Cannulated Drill, 20 mm
SynACART Cannulated Drill, 25 mm
VAR-2502-08DC
VAR-2502-10DC
VAR-2502-20DC
VAR-2502-25DC
Disposable:
Drill Tip Guide Pin, 2.4 mm AR-1250L
Instrumentation:
SynACART Instrument Case
SynACART Drill, Cannulated, 8 mm
SynACART Drill, Cannulated, 10 mm
SynACART Drill, Cannulated, 20 mm
SynACART Drill, Cannulated, 25 mm
SynACART Guide, 8 mm
SynACART Guide, 10 mm
SynACART Guide, 20 mm
SynACART Guide, 25 mm
SynACART Implant Holder, 8 mm
SynACART Implant Holder, 10 mm
Part Number
VAR-2503-08
VAR-2503-10
VAR-2500C
VAR-2503-20
VAR-2502-08DC
VAR-2503-25
VAR-2502-10DC
VAR-2502-20DC
VAR-2504-08
VAR-2502-25DC
VAR-2504-10
VAR-2503-08
VAR-2500C
VAR-2503-10
AR-1250L
VAR-2503-20
VAR-2503-25
VAR-2504-08
VAR-2504-10
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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.
©2012, Arthrex Vet Systems. All rights reserved. VLT1-0007-EN_A
U.S. PATENT NO. 6,716,234 and PATENT PENDING