Q: At the last Faculty Forum meeting, you presented on your concept of ACL Preservation. Can you discuss what you mean by this?

A: ACL Preservation refers to my approach to the treatment of ACL injuries. It is a novel and progressive approach that focuses on trying to save as much of the native ligament remnant as possible. The current standard of care is reconstruction that generally resects the ligament remnant and reconstructs the ligament with one of multiple graft choices. With my approach, I use reconstruction as a last resort. For many of my patients I am able to save most, or all, of their native ligament with several techniques that I have developed in collaboration with Arthrex. (1, 2)

Q: In your last blog entry you updated us on your ACL Primary Repair technique. Can you discuss the augmentation technique that you use?

A: My approach of preserving the native ACL tissue started with my work on ACL Primary Repair (1) for proximal avulsion tears. As my skills and results improved, I became frustrated that I couldn’t repair more tears. Far more tears are proximal 20% tears, than are avulsion tears, and after attending ArthroLondon in 2012 and hearing Dr. van der Merwe’s lecture on Biologic ACL Reconstruction, I had an epiphany. It dawned on me that I could combine his technique of augmenting the ligament with my technique of repairing the remnant to avoid the rather high rate of Cyclops lesions (a ball of scar tissue created by the sagging ligament remnant that blocks knee extension and can cause pain) that can complicate standard augmentation techniques. The resultant technique is called ACL Primary Repair with Central Augmentation and the technique video can be viewed on Arthrex.com (2).

Q: Are there any differences between augmentation and reconstruction besides preserving the remnant?

A: Yes, augmentation is a more conservative approach than reconstruction in many ways. Preserving the remnant maintains the native ligament tissue, nerve endings and blood supply with obvious benefit. Thus, it is not necessary to use such a large graft like is used in the typical reconstruction. Typical reconstructions create 10 mm tunnels in the femur and tibia to place the graft into. Using a 7 or 8 mm graft in a reconstruction generally makes the surgeon somewhat nervous about the graft not being strong enough, however, this is routine in an augmentation. Maintaining the remnant obviates the need to use such a large graft and conserves bone.

Q: For what percentage of your patients are you able to use your ACL Preservation approach?

A: Currently, my ACL Preservation approach encompasses ACL Primary Repair and ACL Repair with Central Augmentation as mentioned. Using this approach, I am able to save most, or all, of the native ligament for approximately 50% of my patients. This, to me, is a tremendous advantage over the standard reconstructive approach in that native tissues are preserved with all of the concomitant benefits. At the same time, very few surgical bridges are burned, such that revision surgery, when needed, is almost like performing a primary reconstruction.

Q: Have you noticed a difference in the postoperative course and rehab with augmentation versus reconstructions?

A: Interestingly, I have. At first, I didn’t think that there would be much of a difference between the two techniques since tunnels were being drilled in both cases. However, anecdotally, I have definitely noticed that the augmentations seem to have less pain and swelling and a more stable/normal knee subjectively and objectively in follow-up. I explain to my patients that instead of having a “one size fits all” approach to ACL surgery that is currently the standard of care in my mind, I offer a customized approach to ACL injury. I utilize small (repair), medium (augmentation) and large (reconstruction) surgeries, depending on the nature of the ligament injury and the quality of the remnant tissue. For each patient, the final decision as to which procedure is best suited for them is made on the table when the tear type and tissue quality are determined intraoperatively.

Q: As ACL Preservation seems like a rather intuitive approach to ACL injury, why do you think such an approach wasn’t adopted historically?

A: The answer to that question is best summed up by the old saying “hindsight is 20/20.” Original attempts at repair were performed open, on all injury types and heterogeneous patient populations that yielded mixed results, at best. This led some authors to move towards augmentations that actually had somewhat more predictable results, even when done open. However, at right about the same time, arthroscopy was coming to the forefront, and in the early days of arthroscopy the technology, the instruments and the surgical skills were not sophisticated enough to preserve the remnant. I like to say that the first surgeon to look good performing an arthroscopic ACL reconstruction was the first surgeon to resect the entire ligament so that they could see what they were doing. Once that bridge was burned there was very little discussion about remnant preservation in the literature for the ensuing 25 years or so. Current imaging technology, anatomic and biologic understanding, and both surgical technology, and skill, have enabled us to reinvigorate the discussion of what was, in my mind, the right idea at the wrong time.

References:
1. ACL Preservation: Early Experience Presentation Video
2. ACL Preservation with Central Augmentation Using the FlipCutter® and TightRope® RT Presentation

Arthrex was honored to take part in Collier County Schools' 5th Annual iSTEM (Science, Technology, Engineering and Math) Conference once again this year on Saturday, October 3. Associate Employee Relations Specialist Hayley Wonka presented students with an overview about Arthrex and our STEM-related career fields.   

"The group was very engaged about the business as a whole and possible employment in the future," shared Hayley. "I was able to provide support to those students interested in internships and co-op opportunities, along with answering questions regarding our apprentice program."

More than 700 teachers, parents, students, community members and school district staff participated in 25 exciting break-out sessions where they got hands-on with science, technology, engineering and math. Participants engineered robots, built solar cars, learned about sustainable gardening, integrated the arts into STEM, and so much more. Students from high school career academies also demonstrated their STEM-related work. 

This is the fourth year Arthrex has supported the iSTEM Conference. Click here to view the iSTEM Conference's video footage to learn more.  

Source: Florida Weekly; October 14, 2015

Arthrex is pleased to announce Great Place to Work® and Fortune have recognized the company as one of the 50 Best Workplaces For Diversity in the country. 

Arthrex was highlighted in particular for its diverse workforce and the many opportunities all employees have as a global company to enrich their language skills. 

This is the fourth designation Arthrex has been recognized for this year by Great Place to Work® and Fortune. The other three designations include:

• Great Workplaces in Manufacturing & Production 
• 100 Best Workplaces for Millennials 
• Fortune's 100 Best Companies to Work for®

To read more on Arthrex's ranking in Fortune, click here. 

As a proud local cause sponsor of the American Heart Association's Collier County Heart Walk once again this year, Team Arthrex's hard work paid off, surpassing its $15,000 goal by fundraising over $16,000 this year on top of our sponsorship contribution! The team showed the community how “Making People Better is Why" at the 5K Heart Walk on Saturday, November 7, 2015 in downtown Naples, with participation from nearly 50 Arthrex employees, family members and even dogs!

Arthrex has supported the Southwest Florida Chapter of the American Heart Association for more than a decade by sponsoring and participating in the Collier County and Lee County Heart Walks, National Wear Red Day, the Southwest Florida Heart Ball, the Go Red For Women Luncheon and funding a teaching garden at Village Oaks Elementary in Immokalee, FL.   

This Veterans Day, Arthrex is proud to honor veterans and the many employees in our company that have served in the military. Arthrex sponsors the Collier County Chapter of Honor Flight (CCHF), an organization that provides war veterans a free trip to Washington D.C. to visit the National World War II Memorial and other memorials in the nation’s capital.

The local chapter raises funds and connects with veterans, guardians and companies to participate. Many Arthrex employees have welcomed veterans back from their flights and even supported the chapter as guardians on the flights. On Saturday, November 7, 2015, CCHF conducted its seventh mission escorting 70 WWII Veterans and two Korean War veterans to Washington, DC for the day to visit the memorials constructed in their honor.  Serving as guardians on this flight representing Arthrex were Donna Brown, Dr. Paul Hobaica, Marli de Carvalho, Bill Canfield and George Rego.

Arthrex made the day a family affair with Dr. Hobaica serving as guardian for his father, Henry, a Korean War Veteran. “We all gained a wonderful experience,” said Dr. Hobaica. “For me to have been able to escort my dad was pure bonus.”

Bill Canfield agreed, “The entire experience was very overwhelming, but personally rewarding in so many ways. My vet was incredible and his stories were amazing. I am very grateful to Arthrex and the ‘super guardians’ for this opportunity.”

“My veteran, Ray, enjoyed the day,” shared Donna Brown. “We both couldn’t believe the incredible welcome the veterans received both in DC and at Southwest Florida International Airport (RSW) – it was very emotional and very heartwarming!  The crowd at RSW must have been over 1,000 people – simply amazing!  I’m glad I was able to be a part of this special day!

Marli Carvahlo summed up the importance of supporting CCHF when she said, “So many of them live alone in assisted living and think the world doesn’t care about them or what they have done in the service. This trip is a solid message to them that all generations have not and will never forget! Arriving in DC and then back here with all the fanfare and hugs and kisses from the kids...it was special to them! I was honored to be part of their day!

Prior to the flight, at a meet and greet event that brings together the guardian and the veteran for the first time, Arthrex Photographer Chris Toalson was honored by the CCHF Board with the designation of Honorary Chairman of Mission 7. Prior to each flight the board recognizes one volunteer whose efforts in supporting the program go above and beyond all expectations. Chris has been a part of Honor Flight since Mission 2. At each meet and greet event prior to the flight, Chris takes a portrait of the veteran, the veteran and his/her guardian, and the veteran and any family members that may be present – about 200 portraits in total in just two hours. Photographs on flight day start for Chris at approximately 6 a.m. and do not often end until after midnight. His photographs have documented the journeys of hundreds of veterans and preserved precious memories for the veterans and their families. 

In addition to his photography skills, Chris helps CCHF staff and the treasured travelers wherever needed during flight day. And as if this was not enough, when announcing Chris as the Honorary Chairman, CCHF Director Sean Lux cited Chris’ invaluable help in revamping the CCHF website and creating a central repository for easy access to flight pictures. When asked what Chris’ contributions mean to the team, Sean said, “We (CCHF) give veterans the day of their life, and Chris gives them memories that last a lifetime.”

Arthrex hosted its annual Years of Service awards ceremony on Thursday, October 27, 2015, and recognized an impressive total of 191 Inc. and AMI employees with 5, 10, 15 and 20 years of service! The 20-year-veterans included Dan Hall, VP of Shareholder Relations and Taxation; Kathy Johnson, Distributor Finance Analyst (soon to retire); Renee Power, Exhibit and Event Supervisor; and Andy Stewart, VP of Sales, US & Canada. 

They each share about their time at Arthrex over the last two decades: 

"I have many fond memories of Arthrex over the last twenty years. One, in particular, is a vivid memory of watching customer service (Patti Gilmore and her three employees) select product picking (Charlie Cremin), and shipping (Rich Hughes and his crew) departments ALL working together in one small area of the office (three offices ago). For me, this is always a good reminder of Arthrex growth and employee commitment over the many years."
– Andy Stewart

“I am fortunate and proud to be a part of so many employee events which 'Help Make People Better' as well as exhibits which 'Help Surgeons Treat Their Patients Better.' After 20 years, I am still in AWE of how we work across departments to make this happen!"
– Renee Power

"I fondly recall the very first office that Kathy Johnson and I shared when we both started working at Arthrex. Only Reinhold, Kathy Sparrow, Kathy Johnson and I had offices. Our desks faced opposite directions and our chairs would bump into each other if we both backed up at the same time.  It was referred to by some employees as the 'Taj Mahal.' This memory helps me keep things in perspective. We have come a long way, and I am fortunate in my position to have actually seen the numbers grow year after year!" 
– Dan Hall

"I don’t remember where or who said this, but I have had both of these quotes on my desk for the last 15 years: 'I am too blessed to be stressed' and 'A day without smiling is a wasted day.' I live by both of these, and I leave Arthrex with mixed feelings...since I have spent more time at Arthrex than anywhere else for the past 20 years, and I am thankful for every day, however, I am also very excited about experiencing my life after Arthrex. This is not goodbye, I leave with joy that I have been allowed the opportunity to see the growth of such a wonderful company, and the privilege to know and work with so many over the years. Don’t worry I’m only a phone call away, and will be watching to see the growth that is to come in the future years. Wishing you all the best." – Kathy Johnson

Congratulations to all who have met major milestones this year! We look forward to celebrating the success of many more employees in the years to come. Thank you all for your dedication to Arthrex and for the contributions you make each and every day to healthcare product innovation that’s Making People Better.  

Arthroplasty Engineer Zach Ingwer had the unique opportunity to be North Naples Middle School's "Principal for a Day" as part of Collier County's annual event in which community members are invited into schools to live a day in the life of a principal. He spent the day visiting classrooms, overseeing cafeteria duties (no food fights on his watch!) and shadowing the school's actual principal, Margaret Jackson.

"Zach made such an impact on our students," shared Principal Jackson. "A few teachers told me that after he visited, the kids were still talking about what he did and they were amazed! He did such a great job talking about his background, how he still uses algebra, geometry, calculus and the scientific method in his job, and why he became an engineer. And I’m telling you, they listened!"

While Zach was making an impact on the students, the students were making an impact on him. "I think the best part about being the principal for the day was how interested the students seemed to be. I had the opportunity to speak to the science classes and you could see some of the kids light up when I told them about what I do. I was fortunate to be able to share with the students and teachers why I love what I do, and it’s fantastic to see kids so engrossed in learning about the design process."

Read more about Zach's experience in the Naples Herald's article, "Arthrex Engineer Takes Over North Naples Middle School for the Day." 

Discover Arthrex…we are a global medical device company and leader in new product development and medical education in orthopaedics. With a corporate mission of helping surgeons treat their patients better, Arthrex has pioneered the field of arthroscopy and developed more than 8,500 innovative products and surgical procedures to advance minimally invasive orthopaedics worldwide.

Arthrex continues to experience unprecedented growth and demand for our products throughout the world; however, we remain a privately-held company with a family business culture that is committed to delivering uncompromising quality to the healthcare professionals who use our products, and ultimately, the millions of patients whose lives we impact.

We invite you to #DiscoverArthrex and the positive contributions we are making to medicine and the communities we serve. Find out what makes us a FORTUNE "100 Best Companies to Work For®" by following us on Facebook, LinkedIn, Instagram and YouTube. #DiscoverArthrex to learn more about what it's like to live in Southwest Florida through the eyes of our employees and their families.

Arthrex EMEA is pleased to announce that Arthrex Spain & Portugal SLU opened a new office on November 10, 2015, growing from a Marketing office to a now fully-operational subsidiary based in Spain’s capital city, Madrid. The new state-of-the-art office, which also includes a logistics warehouse, was essential to be able to reach every corner of Spain and Portugal, evolving with its leading position.

Knee Product Manager Drew Osika and President and Founder Reinhold Schmieding recently visited Arthrex Manufacturing East (AMIE) in Ave Maria, FL, to personally thank the employees who assemble SpeedCinch, a product that brings all-inside knee meniscal repair to a new level of simplicity and speed for surgeons.

“This product is not easy to assemble and we were pushing hard to get it released prior to the Academy of Arthrex Technology Consultants (AATC) Meeting in October,” said Drew. “It was crucial to the integrity of the product in the eyes of our sales force that we were able to launch it at AATC. Because AMIE employees burned the midnight oil to meet this deadline, Arthrex was able to launch SpeedCinch at AATC, receiving many cheers and applause. I wanted the AMIE employees to understand how appreciative we are of their hard work and how important they are to the success of any product, especially SpeedCinch.” 

There were approximately 150 employees gathered, all having some type of involvement with SpeedCinch, for the presentation and SpeedCinch All-Inside Meniscal Repair animation viewing party in celebration of the launch. As Drew showed a clip from his AATC presentation, employees could hear the excitement that came from the AATC crowd when the innovative product was introduced and feel proud they played an instrumental part in its successful launch.
 
Reinhold thanked all the employees for their hard work and explained the function of the knee’s meniscus and how important it is to have a device like SpeedCinch for meniscal repair. All involved felt a special connection to how they, too, are an integral part of “Helping Surgeons Treat Their Patients Better.”

Arthrex was recently honored as The Salvation Army Naples Regional Coordinate's "Partner of the Year" for consistently contributing to a stronger, healthier community and supporting The Salvation Army and its mission in Collier County.

The Salvation Army Naples Regional Coordinate honored Arthrex with "Partner of the Year" at the organizations' annual Doing the Most Good Civic Luncheon on November 6, 2015.

Bob Hackett, Global Director of Packaging and current Salvation Army Advisory Board Chairman, accepted the award on behalf of Arthrex at the organizations' annual Doing the Most Good Civic Luncheon held November 6, 2015. As an advisory board member for the past four years, Bob shared: 

"The Salvation Army is dedicated to one overall mission, enriching the lives of others. This cause has a direct connection with the goals of Arthrex that includes the commitment to Making People Better. Attending to this shared goal, The Salvation Army of Collier County has been empowered to be successful in its outreach in our local community by the strong and continual commitment of charitable donations and sponsorships. Arthrex has been at the forefront of consistent and generous support of this organization, and was awarded the Partner of the Year Award this year on the 150^th anniversary of the founding of the organization. This rewarding association is of great significance to many in our community, and the support from Arthrex is very highly valued and appreciated by The Salvation Army, helping them to complete their mission. 

Click here to watch The Salvation Army Partner of the Year Award presentation video. 

On Thanksgiving morning, several Arthrex employees, like Project Manager of Marketing Communications Lisa Taylor and Advertising Coordinator Taylor Hebble, participated in this year's Gobble Gobble Four Miler benefiting St. Matthew's House and The Safe and Healthy Children’s Coalition of Collier County. Arthrex was a proud sponsor of this event once again this year and has sponsored many events like it in the past as part of its commitment to employee wellness, charitable giving and community involvement. Organizers of the Gobble Gobble Four Miler showed their appreciation by sharing this message on Arthrex's Facebook page:  

"Thank you Arthrex. We are so humbled to have your support year after year. It is companies like yours who set the standard for community and what leadership means for business in your town. Your green initiatives, your work incentives and policies at the workplace are impressive by any standard. Major kudos to you!"

Q: Performing a Radial Collateral Ligament (RCL) reconstruction with InternalBrace augmentation with the 3.5 DX SwiveLock SL is a new variation on what you have done in the past. Can you give us a brief overview of what you were doing and how you are changing your technique?

A: I was using the Arthrex 3 x 8 mm tenodesis screws with a palmaris graft for my reconstructions of both the radial and ulnar collateral ligaments of the thumb MCP joint. I still think that technique is solid and works well but have found a few differences that highlight some of the advantages of the new DX SwiveLock SL. 

• On the radial side, I can incorporate 1.5 mm LabralTape as an InternalBrace augmentation for my biologic graft repair.
• I like the idea of not having any suture left behind on the ulnar side as I would normally have with using a 3 x 8 mm tenodesis screw technique. The blind tunnel technique of the 3.5 SwiveLock eliminates any concern I had about irritation from the small strand of suture left behind in the pull-through tenodesis technique.
• If LabralTape is used as an InternalBrace, you do not have to whipstitch or suture your graft. In addition to saving time, LabralTape gives the immediate strength to the construct while the soft tissue repair heals and incorporates.
• Lastly, there is no need to measure the graft length as is necessary with the standard tenodesis screw reconstruction technique. Tension is achieved by grabbing the tendon with the forked eyelet and bringing it down into the unicortical hole. Any remaining tendon can be cut flush to the bone.

Q: InternalBrace has been gaining popularity for a variety of techniques. Are you changing your post-op protocol to reflect the extra stability?

A: There were times in the past when I was concerned about repair strength or patient compliance and I would temporarily place a K-wire across the MCP joint to help protect the repair for a short period of time. These new techniques and anchors from Arthrex have allowed me to eliminate the need for a K-wire by internally bracing the repairs using 1.5 mm labral tape from Arthrex.

Q: Are there any other procedures that you see the 3.5 DX SwiveLock SL being used for?

A: The new 3.5 DX SwiveLock has allowed me to explore improving current techniques that we are using in the upper extremity. Recently, I had a perilunate dislocation with obvious scapholunate ligament rupture. Although I acutely repaired the ligament through drill holes using FiberWire, I worried that my repair might not heal or may not be strong enough. The amount of force per unit area that the ligament and joint see is extremely high and likely accounts for the high rate of failure for many of the techniques that we are trying to utilize to reconstruct and repair this ligament.

I repaired the ligament back to the footprint on the lunate through drill holes. I then protected my repair by internally bracing using 1.5 mm LabralTape from Arthrex. I utilized the new 3.5 DX SwiveLock by placing one in the superior proximal pole of the scaphoid, one in the lunate, and then finally one in the very distal, dorsal aspect of the scaphoid. By linking the two bones in this manner with an internal brace I hope to protect the repair long after I remove the K wires that were placed. 

Q: Do you have anything further to add regarding the new 3.5 DX SwiveLock anchor from Arthrex?

A: It is nice to have the product on the shelf as a bailout option to help me if I run into trouble in a procedure. For instance, although I have not had to have the need to use it in this circumstance, there are definitely some people that are using the new anchor for CMC arthroplasty procedures. I certainly could see the anchor being useful if I had a catastrophic failure during my FCR tendon transfer. One could easily use a free graft and back it up with an internal brace in order to perform a suspensionplasty in that circumstance by utilizing the new Arthrex 3.5 DX SwiveLock anchor.

Pete Russano, Director of Supply Chain, and Hasan Kajtezovic, Supply Chain Buyer/Planner II, recently had a unique opportunity to present to a class of undergraduate business students at Florida Gulf Coast University's Lutgert College of Business.
 
Pete and Hasan were invited by Hasan’s former professor, Dr. Hulya Yazici, to speak on the topic of Arthrex Global Supply Chain Operations from the practitioner’s point of view. They presented how course topics of New Product Development, Global Sourcing, Procurement and Inventory Management are practiced by Arthrex today on a global basis.  
 
Dr Yazici noted that “It was an excellent presentation, very comprehensive and full of useful information for our students…I hope Arthrex and FGCU can continue to collaborate in the future and use this event to build on our existing relationship.”
 
For Pete and Hasan, this was a great occasion to meet local business students and faculty, promote Arthrex at FGCU and encourage students to consider Supply Chain Management as an exciting career path.

In celebration of the past year of Arthrex innovations, our third annual anniversary editions of our "What's New" email newsletters will highlight the top 12 features over the past year, including our most popular surgical technique videos, presentations, demonstrations and blogs by leading orthopaedic surgeons from around the world. The year’s top 12 features have been selected based on the number of visits these assets obtained throughout the year by your peers.

We expanded our newsletter family of What’s New emails once again this year to specifically focus on content in the areas of arthroscopy & sports medicine, arthroplasty, hand and wrist surgery, foot and ankle surgery, orthopaedic imaging technology, endoscopic imaging technology, orthobiologics and research and education.

If you’re not already subscribed to What’s New or would like to update your subscription preferences per specialty, click here.

You can also stay up to date on our innovations by:

• Visiting the front page of Arthrex.com for new features daily

• Following us on Twitter @ArthrexWhatsNew

• Subscribing to our What’s New in Orthopaedics Top Tending Videos YouTube Channel

Stay tuned for even more exciting technology updates from Arthrex in 2016, continuing our mission of Helping Surgeons Treat Their Patients Better™ through innovations in orthopaedics!

The Birmingham Biceps™ technique for subpectoral tenodesis was developed in conjunction with Drs. Lyle Cain, Jeff Dugas and Benton Emblom from the Andrews Sports Medicine & Orthopaedic Center. The technique was designed to minimize the potential for postoperative humeral fractures by placing a small 5.5 mm PEEK SwiveLock^® Tenodesis implant near the top of the pectoralis at a newly defined anatomical landmark, the Pallium Pectoralis. This is a fascial sleeve that connects from the top of the pec to the medial border of the humerus approximately 2 cm distal to the transverse humeral ligament at the metaphyseal-diaphyseal junction.

The Birmingham Biceps Implant System includes everything needed for the procedure making it very convenient for surgeon and staff.

The DX SwiveLock® suture anchor, 3.5 x 12.5 mm is the second addition to the DX SwiveLock family. It is an all PEEK anchor with a closed eyelet that has been optimized to better incorporate FiberTape® suture. The DX SwiveLock product is indicated for use in Deltoid Ligament Repair (bridging type procedures or knotless constructs), Brostrom Repair (bridging type procedures or knotless constructs) and InternalBrace™ Augmentation Procedures (necessitates the use of a 3rd anchor such as in Deltoid InternalBrace or CFL Limb for Lateral Ankle InternalBrace). 

Q: What made you want to use the Mini TightRope for something other than thumb basal joint arthritis?

A: I treat many high-level athletes in my practice, including competitive athletes. One day, I got a call that an athlete sustained a Bennett fracture-dislocation of his right (dominant) thumb. The Bennett fragment was very small. He begged me to do something to allow him to get back to playing earlier than the usual six weeks. Normally, I would have pinned the fracture and the CMC joint and then placed the thumb into a cast for four weeks before allowing him to move the thumb. One would expect the usual downsides of this option: risk of pin site infection, disuse atrophy, stiffness, etc. I’ve become very familiar with the Mini TightRope, which I’ve used for my revision thumb CMC joint arthroplasties; I’m still a fan of the LRTI technique with tenodesis screw for my primary arthroplasties. The Mini TightRope does such a good job of suspending the thumb metacarpal after excision of the trapezium, so why not use this for cases of thumb CMC joint instability? So I offered this option to the player and he jumped at this option before I could even explain it to him!

Q: Can you tell us about the surgery?

It’s the same approach and technique as the suspensionplasty for thumb CMC joint arthritis, except the trapezium is retained. I first passed a #2 FiberWire suture around the base of the thumb metacarpal, essentially lassoing the fragment to reduce it into place. The knot was tied dorsally and buried in the thenar muscles. However, there was still some instability at the CMC joint, so I proceeded with placing the Mini TightRope across the bases of the thumb and index metacarpals, and this gave excellent stability to the thumb CMC joint. I then imbricated the dorsal capsuloligamentous complex and closed the incision.

What happened postoperatively?

Due to the stability of the joint following the Mini TightRope, I allowed him to start moving his thumb within a few days.

Can you discuss any other cases where you have used the Mini TightRope for a similar indication?

I performed this technique in the dominant thumb of a professional athlete as well. He had a larger Bennett fragment that was amenable to screw fixation, but due to some persistent instability at the thumb CMC joint following the fracture repair, I added the Mini TightRope as well.

The Plantar Lapidus Plate was designed to provide fixation for a Lapidus procedure. The plate is placed plantar on the first tarsometatarsal (TMT) joint and is fixed with two 3.5 mm locking screws at both the distal and proximal end, optimizing construct strength. The precontoured left and right plates allow secure plantar placement and spares the tibialis anterior tendon. The plantar plate provides compression over the entire arthrodesis area and eliminates an additional dorsal Compression Screw. The accompanying Aiming Guide allows for placement of the Compression Screw in a specified direction without interfering with the proximal locking screws. The plantar fixation of the Lapidus Arthrodesis minimizes soft tissue irritation and avoids gapping of the arthrodesis during early weight-bearing.