CMC Mini TightRope
![CMC SLAM]()
Drilling with the C-Ring Guide– To avoid skiving while holding the C-Ring guide in place, first insert the K-wire in the approximate trajectory wanted in the base of the thumb. The guide can then be assembled on and around the K-wire. Advance the K-wire with the help of the C-Ring Guide to achieve the correct trajectory.
Drilling Freehand– It is often easier to drill from the second metacarpal to the base of the first metacarpal. By drilling in this direction, the knot stack will be on the base of the thumb. The best way to avoid soft tissue irritation is to bury the knots under the APL.
Placing the Mini TightRope– To make sure that the thumb is maintained in an anatomic position, place the Mini TightRope before performing the trapeziectomy. Throw two to three provisional knots on the Mini TightRope, perform your trapeziectomy, and verify the tension of the construct. Proceed with tying down the last few knots or loosen and adjust the tension.
A good rule of thumb for tensioning is to place Kelly forceps under the second button and tie over it. This will prevent overtightening the construct.
SLAM
Drill Separately– The two holes in the lunate and the scaphoid can be drilled independently as well as with the SLAM guide. Place one K-wire perpendicularly into the dorsal side of the lunate and another into the scaphoid. Using these two K-wires as joysticks, open up the scapholunate joint and visualize the articular surface of the lunate. Using the stepped drill, drill into the center of the lunate until you feel the second cortex and stop.
Insert the graft anchor loaded with the Palmaris longus graft and optional LabralTape into the lunate hole. The LabralTape provides extra strength and prevents any elongation of the graft. Tap the graft anchor into the undersized hole until seated firmly.
Visualize the articular surface of the scaphoid. Aiming for the center axis of the scaphoid, drill completely through both cortices until the larger stepped part of the drill exits radially.
Using a tendon passer or a Nitinol wire, pass the Palmaris suture tails exiting the lunate through the scaphoid from the ulnar pole to the radial pole. Secure with a 4 mm Tenodesis Screw and continue the procedure as outlined in the surgical technique.
Drilling with the C-Ring Guide– To avoid skiving while holding the C-Ring guide in place, first insert the K-wire in the approximate trajectory wanted in the base of the thumb. The guide can then be assembled on and around the K-wire. Advance the K-wire with the help of the C-Ring Guide to achieve the correct trajectory.Drilling Freehand– It is often easier to drill from the second metacarpal to the base of the first metacarpal. By drilling in this direction, the knot stack will be on the base of the thumb. The best way to avoid soft tissue irritation is to bury the knots under the APL.
Placing the Mini TightRope– To make sure that the thumb is maintained in an anatomic position, place the Mini TightRope before performing the trapeziectomy. Throw two to three provisional knots on the Mini TightRope, perform your trapeziectomy, and verify the tension of the construct. Proceed with tying down the last few knots or loosen and adjust the tension.
A good rule of thumb for tensioning is to place Kelly forceps under the second button and tie over it. This will prevent overtightening the construct.
SLAM
Drill Separately– The two holes in the lunate and the scaphoid can be drilled independently as well as with the SLAM guide. Place one K-wire perpendicularly into the dorsal side of the lunate and another into the scaphoid. Using these two K-wires as joysticks, open up the scapholunate joint and visualize the articular surface of the lunate. Using the stepped drill, drill into the center of the lunate until you feel the second cortex and stop.
Insert the graft anchor loaded with the Palmaris longus graft and optional LabralTape into the lunate hole. The LabralTape provides extra strength and prevents any elongation of the graft. Tap the graft anchor into the undersized hole until seated firmly.
Visualize the articular surface of the scaphoid. Aiming for the center axis of the scaphoid, drill completely through both cortices until the larger stepped part of the drill exits radially.
Using a tendon passer or a Nitinol wire, pass the Palmaris suture tails exiting the lunate through the scaphoid from the ulnar pole to the radial pole. Secure with a 4 mm Tenodesis Screw and continue the procedure as outlined in the surgical technique.