sOurCE - Conmed

2007 OCTOBER EDITION
SOURCE
The Newsletter of ConMed Linvatec Australia Pty Ltd
HIGH DEFINITION
ENDOSCOPIC
IMAGING
ARTHROSCOPY
ELECTROSURGERY
ENDOSURGERY
Double Row Rotator
Cuff Reconstruction
Using the UltraFix RC® and
the Super Revo® Anchors
John Randle, M.D. Newmarket, Ontario, Canada
Double row repairs of the rotator cuff
offer several key advantages. Besides being
a stronger construct, double row repairs allow
for better contact between the tendon and its
native footprint. This larger contact area creates
a stronger interface once the tendon has healed
to the bone. The technique I will describe will
work for most cuff tears that have a transverse
component to them.
GASTROENTEROLOGY
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Smart OR®
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Personal
Protection
NITI-S® STENTS
CUSTOMER ORDERS & ENQUIRIES
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Orthopaedic
POWERED
INSTRUMENTS
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While viewing from the posterior portal and after
debriding the greater tuberosity, I place (through
individual small “stab” incisions) two Super
Revo anchors at the edge of the articular
surface with the eyelet of the anchor ultimately
facing antero-posterior. I try to position them
well-spaced and at the anterior and posterior
margins of the tendon tear. A like-colored pair
of sutures is then passed from the anterior
anchor in a horizontal mattress pattern at
least 1 – 1.5cm medially from the free edge of
the tendon. The same is then done with the
posterior like-colored pair. For smoother suture
management, I keep the pairs in their respective
“anchor portals” unless I am shuttling the suture
through the tendon.
Each pair of sutures is tied with a slidinglocking knot, and if I don’t think that I need the
second suture from each anchor, I remove it.
Sometimes I use the second suture to close
a small “L-component” of the tear. For this
reason, keep the second suture until you
are sure that you don’t need it. I then bring
the anterior-most suture from the anterior
horizontal mattress stitch and the anterior-most
suture from the posterior stitch out my working
portal and pass them through the eyelet of
an empty UltraFix anchor using the attached
suture-threader.
These sutures are then passed through the
eyelet in the same direction. My assistant will
then rotate the shoulder such that the working
cannula is just anterior to the anterior-most
horizontal mattress stitch while I seat the
UltraFix awl to its “shoulder”, remove it, and
then insert and deploy the anchor. I transfer this
pair out the anterior anchor portal and repeat
the process with a second UltraFix anchor
just posterior to the posterior-most horizontal
mattress stitch. This correct site of insertion is
best chosen by having my assistant internally
rotate the shoulder. Each pair is tied with 4 – 5
half-hitches and the tails cut. When viewed from
the lateral working portal, the completed repair
forms a straight-lined infinity sign (∞) with the
cuff edges firmly “pushed” against the raw bony
surface of the well-prepared greater tuberosity.
I think that this is a straightforward method of
reliably performing a double row rotator cuff
repair incorporating two easy-to-use anchors,
each with superb pull-out strength.
CONMED LINVATEC AUSTRALIA PTY LTD
1
Dry-Doc
Cannula System
®
Katana High Strength
Suture Cutter for
Shoulder Arthroscopy
™
You no longer have to choose…
finally, a smooth and ribbed
Cannula in ONE!
Imag
e sho
wn –
not a
ctual
size
Images shown – not actual size
ConMed Linvatec Australia is pleased to announce the
release of our newest Master Shoulder Anthroscopic Instrument,
the Katana High Strength Suture Cutter.
As the name implies, the Dry-Doc system is designed to keep the
doctor dry, however these products also solve the ongoing issue of
whether to use a smooth or ribbed Cannula.
Unique Design
The Dry-Doc Cannulas are the FIRST smooth/ribbed Cannulas
on the market. With a unique patented design that incorporates
a semi-flexible inner tube covered with an accordion-like outer sleeve,
the Cannula is smooth during insertion. After insertion, the outer sleeve
of the Dry-Doc acts as ribs, gently filling the portal channel thus
preventing inadvertent backout.
Due to the semi-flexible material of the Cannula, the outer diameter is
smaller and without ribs during insertion. There are no sharp edges and
the distal tip is rounded.
Optimal Fluid Control
These semi-translucent, coloured Cannulas also permit visual monitoring
of the tools and knots, while providing optimal fluid control with an
innovative click-lock ratchet stopcock.
The Dry-Doc Cannulas are available in 8 mm diameter with two lengths of
75 mm and 85 mm.
KATANATM SUTURE
CUTTER PROMOTION
SPECIAL PROMOTION AVAILABLE
UNTIL 31st DECEMBER 2007
Side Loading Design
The Katana offers a simple side loading design that allows the surgeon
to lay the cutter on top of the sutures, rotate the instrument 90 degrees,
slide the cutter down the suture to the knot and cut. No more trimming
sutures, threading sutures, pressing several levers, frayed cuts or
cutting just one suture at a time.
When comparing the Katana to the competitor suture cutters, the
Katana eliminates several steps, including but not limited to, the
trimming of sutures after knot tying to even the suture lengths, as well
as the threading of the sutures through the small opening in the tip.
We believe that this new Cutter will provide you with a new
and improved option for cutting the high strength sutures used
in Arthroscopic procedures.
For a limited time only, ConMed
Linvatec is offering a promotion for
the Katana Suture Cutter. You can
find more details below.
ConMed Linvatec would like to offer you the opportunity to evaluate
the Katana Suture Cutter.
For every Katana Suture Cutter that is purchased, you will receive a box of Dry-Doc®
Cannulas free of charge. Orders must be placed before the 31st December 2007.
To take advantage of this promotion, please fill out the Reader Reply Card
and send or fax it back to us.
CONMED LINVATEC Sports Medicine
Image shown – not actual size
For a limited time only, ConMed Linvatec
is offering a promotion for this product.
You can find more details below.
In keeping with ConMed Linvatec’s tradition as the leader in
arthroscopic manual instruments, we are proud to add the Katana
High Strength Suture Cutter to our extensive line of manual instruments.
While our competitors may offer high strength suture cutters,
we believe the Katana will offer the surgeon an improved method
of cutting high strength suture.
2
ConMed Linvatec SE™ Graft Tensioner
and XtraLok BioScrew
®
®
Submitted by Laurie hiemstra, M.D. Banff, Canada
I have been using the Linvatec SE Tensioner
and the XtraLok BioScrew exclusively for over
a year, in approximately 250 ACL reconstruction
procedures. Below I outline the reasons that
I prefer this form of tensioning and tibial fixation
as well as give some tips and pearls that I’ve
learned over the past year.
Then check the tension again and adjust
prior to screw insertion.
XtraLok Tibial Fixation
Interference Screw
Major Benefits:
1. XtraLok Screw allows for circumferential
compression of all four tendons against
bone – Maximizing bone/tendon interface for
maximum healing potential.
SE Graft Tensioner
Major Benefits:
Image shown – not actual size
1. Reproducible – You know exactly how
much tension you are placing on the graft
each time you use the Tensioning Device.
2. Consistent – Each case is consistent and
not dependent on your assistant or whoever
is applying tension on the graft. This reduces the
variance in the amount of tension on each ACL
reconstruction that you do.
3. Easily Adjustable – I can adjust the tension
on each tendon dependent on the size of
the tendon. For smaller tendons, less tension.
For larger tendons, more tension. If the tendons
are unequal in relative size, for example a large
Semi-Tendinosus and a small Gracilis, I can
adjust the tension individually to account
for this. This equalizes the stress in each
tendon independently.
8. Allows for hands free tensioning –
There is no need for your assistant to hold
tension on the graft in-situ during cycling and
scoping; you can let the Tensioner do the work
while you scope the knee for final pictures.
4. Tibial Fixation can be performed by
a single surgeon – You do not need an
assistant to apply tension on the graft while you
place the screw. This can be difficult if you don’t
have a reliable assistant.
Clinical Tips and Pearls:
6. Allows you to choose your femoral
fixation. The Tensioner works with any type
of femoral fixation.
7. Allows for in-situ tensioning to minimize
creep after screw insertion – Tension is
applied in-situ rather than on the Graft Master
where the benefit is lost once the tendon is
removed from the Graft Master to be placed in
the knee. Creep occurs in-situ and the graft is
fixed immediately therefore minimizing creep after
interference screw insertion.
increases pullout strength even for softer bone.
3. Bevelled screw means no prominent
fixation – There is no need for removal of
hardware in the future.
9. Posterior Tibial Loading –
The Tensioner reduces the tibia against
the countertensioned PCL.
1. A small incision can still be made by using
a Hemostat to stretch skin around the Tensioner,
inserting it inline with your incision and then
twisting it to the desired orientation.
Image shown – not actual size
5. Can be used for both hamstring and
patellar tendon graft – Although designed
to provide tension for a double stranded graft,
one wheel can be used if a patellar graft is used
or if there was difficulty harvesting one of the
hamstring tendons.
2. No need for back up fixation –
The XtraLok screw provides firm enough
fixation (1400N+) so that no back up Post
or staples are required. Cortical fixation
2. Make sure you mark sutures to be able
to determine which tendon is which. I use
a single knot on the Gracilis and no knots on
the SemiTendinosus. Pick a system that works
for you and stick with it.
3. Separate sutures prior to placing Tensioner
– this is a very effective time saver.
4. Tie square knots and use a Hemostat
if knot slips.
5. Tension, cycle the knee through flexion and
extension 10-20 times and re-tension. Repeat
this until the tension no longer drops, usually
two or three times. Then scope the knee, check
graft position, take pictures, and clean up any
Hematoma or bone chips. This gives the graft
3-5 minutes to creep in-situ prior to fixation.
Clinical Tips and Pearls:
1. The XtraLok screw size is same as tunnel size.
There is no need to put in a screw bigger than
drilled tunnel size because of the taper on the
screw. Only twice have I not been happy with
the bite of the screw. As a result, I took it out and
put in 1 mm larger screw with good results.
2. Thirteen turns to proper insertion of screw.
It can be hard to see through the Tensioner to
see if your screw is flush with the tibial cortex.
CONMED LINVATEC Sports Medicine
3
Spectrum II Tissue Repair System
®
Now with Disposable Suture Hooks
Available configurations include:
Straight
Crescent, Small
Crescent, Medium
Images shown – not actual size
Crescent, Large
The latest additionS to our Spectrum II
Tissue Repair System are the new Spectrum II
Disposable Suture Hooks.
For many years, the original Spectrum system
from ConMed Linvatec has been considered
the “Gold Standard” for passing suture through
tissue during arthroscopic procedures.
This patented suture passing system is the most
versatile system available, and it has now been
redesigned to make it even easier to use.
PRECISE SUTURE PLACEMENT
The Spectrum II Disposable Suture Hooks
feature 8 different hook configurations that allow
precise suture placement in any arthroscopic
shoulder procedure. The Disposable Suture
FEATURES
45° Right
60° Left
For those instability procedures where the inferior
quadrant is hard to reach, or where there is a
massive rotator cuff tear, these new Spectrum II
hooks will make it more accessible.
The Spectrum II handle features a larger
roller wheel that ensures smoother passage
of monofilament suture (sizes 2-0 to #1)
and ConMed Linvatec’s versatile Shuttle
RelayTM Suture Passer. The ergonomic design
of the handle and easy-to-use locking
mechanism make it the simplest to use, and
the most dependable.
BENEFITS
8 Disposable Suture hook variations
Ergonomic handle design
Larger rolling wheel
Quick-connect loading mechanism
45° Left
Hook range includes the newly designed 60°
suture hook, providing access to areas of the
shoulder joint that were once thought to be
unreachable.
Provide access to all areas of the shoulder
Ease of manueverability and handling
Increased traction with suture material
Fast and easy suture hook attachment
60° Right
The Spectrum II Disposable Suture Hooks
are available with a coloured hub for each
configuration to assist with better recognition
during a surgical procedure, and are individually
packed sterile in a box of 5.
If you are looking for a sharp tip every case,
or your institution uses disposable over reusable
instruments, then this is the perfect solution.
Please note: for those using the original
Spectrum Tissue Repair System, replacement
hooks will continue to be available from
ConMed Linvatec.
I AM INTERESTED IN THE FOLLOWING PRODUCTS:
Name ..........................................................................................................
Position ........................................................................................................
Hospital .......................................................................................................
State ....................................................................... Postcode ....................
Tel (
) ................................... Email .........................................................
CONMED Linvatec Sports Medicine
UltraFix RC®
Super Revo®
Dry-Doc® Cannula System
Katana™ Suture Cutter
SE™ Graft Tensioner
XtraLok® BioScrew®
Spectrum® II Tissue Repair System
CONMED Linvatec Promotion
Yes, I would like to place an order for a Katana Suture Cutter
and receive a box of Dry-Doc Cannulas free of charge
CONMED Linvatec Education & Workshops
ConMed Linvatec is a quality assured company and we welcome your feedback.
READER REPLY CARD
Fax Back Option: 1800 238 298
Shoulder Rotator Cuff Repair – DVD0007
Shoulder Instability Repair – DVD0008
SMC Knot Tying Techniques – CD04
ACL Made Simple – CD02
Hamstring Arthroscopic ACL Reconstruction – CD05
Knee Surgical Techniques – DVD0002
Please contact me regarding the
ConMed Linvatec Arthroscopic Workshops
4
Our Commitment to Education
Hands-on surgical training opportunities
Knowledge and practical skills gained
through Arthroscopic Workshops are invaluable
to learning and mastering the technical aspects
of arthroscopic surgical procedures. In particular,
the finer points of arthroscopic surgery can be
demonstrated in a set-up similar to true human
Multimedia
All CD/DVDs cover surgical techniques
Additional to the ConMed Linvatec Arthroscopic
Workshops, there are a number of educational
surgical technique CD/DVDs to choose from in
both Knee and Shoulder Arthroscopy:
in a step-by-step format, guiding you through the
procedures. To receive your copy of the surgical
technique CD/DVDs, just choose your topic of
interest and send in the Reader Reply Card.
anatomy. Using all the tools and instruments that
Shoulder Rotator Cuff Repairs - DVD0007;
If you and your colleagues are interested
are found in a theatre setting, you will pick up
Shoulder Instability Repairs - DVD0008;
in organising an educational workshop,
the tricks, tips and hints to become a Master of
SMC Knot Tying Techniques - CD04;
please contact your local ConMed Linvatec
Arthroscopic Surgery.
ACL Made Simple - CD02;
representative to discuss and plan your next
Hamstring Arthroscopic ACL
workshop. Alternatively, send in the Reader
Arthroscopic Workshops
ConMed Linvatec can provide you with the
Reply Card and we will contact you.
Reconstruction - CD05;
Knee Surgical Techniques - DVD0002.
very tools needed to further your education.
From Arthroscopic Workshops to support
materials, we have all aspects covered to
provide you with comprehensive educational
support. You will be able to gain practical
experience with imaging equipment, shaver
systems, implants and instruments associated
with Arthroscopic Surgery.
Workshops can be conducted for small groups
of up to 12 people with varying technical and
experience levels.
ConMed
Linvatec
workshops
specific
sponsibility
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to the requirements of the participants, Post if any changes are required.
correct addressing and formatting standards will result in the customer being ineligible for the discounted Reply Paid small letter rate.
including, but not limited to the following topics:
Knee Arthroscopy;
Shoulder Arthroscopy;
Fracture Fixation (Trauma);
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Equipment Considerations
for Arthroscopic Surgery
It seems like the amount of equipment and
instruments required for Arthroscopic Surgery
grows year by year. Set-ups become more
and more complicated, equipment is frequently
updated and instruments are by their thousands.
The reassuring factor with all of these changes is
that the principles of Arthroscopic Surgery remain
the same. For Arthroscopic Surgery, whichever
joint the procedure is being performed on, the
surgeon still requires an image, fluid to distend
the joint, a shaver or electrosurgical tool to modify
tissue and instruments to manipulate tissue.
Following is a short list recommendations for
the set-up of equipment and instruments for
Arthroscopic Surgery. It is not an extensive list
that covers all equipment from all companies,
but sums up the most important aspects.
Endoscopic Imaging
Check the correct function/operation of the
monitor, video input/output, light source,
preset selection on the camera console and
peripherals (digital capture system, printer);
Make sure the light lead is in good working
order. Check that the fibre bundles are
distributing light by holding one end up to a
room light and viewing the other end. Do not
use the light source to check the light lead.
The minimum recommendation is 80% of the
bundles are intact.
Shaver
Select the correct size and aggressiveness
of the shaver blade;
Ensure the suction is connected to the
shaver handpiece and flowing to the suction
bottles. Wall suction should be ON;
Select the correct settings of speed
on the shaver console.
Fluid Distention
Ensure all ends of the tubing are accounted
for and connected on the correct connection;
Ensure there are enough fluid bags with
several additional bags close by;
Ensure the fluid tubing cartridge on
the pump is connected correctly and
fluid lines are purged.
Instruments
Select the correct instrument tray for
the procedure being performed;
Make sure all instruments are in correct
working order and not damaged, bent or stiff;
Check that instruments fit with their
intended other and are matching.
IMPLANTS
Always check that the instrumentation
is correct;
Check that there are enough Implants
available and they are within the expiry date;
If unsure of the technique, contact a
company representative for technical
assistance.
For more information regarding the technical
aspects of setting up for Arthroscopic
Surgery using ConMed Linvatec equipment
or instruments, or if you would like a ConMed
Linvatec representative to take you and your
staff through an educational workshop for
Arthroscopic Surgery, please contact your
local Representative.
Images shown – not actual size
Make sure the contacts of the camera head
lead and lens system are clean and well
maintained. Correctly connect the camera
head into the controller;
Always use a clean and well
maintained scope;
Endoscopic Imaging
Fluid and Resection
Implants
CONMED LINVATEC Sports Medicine
6