bullseye surgical technique

8/13/2019 Bullseye Surgical Technique

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NEW

Precise |Flexible |Intuitive

Anatomic Cruciate ReconstructionSolutions, from ConMed Linvatec.

Surgical Technique


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Before the arthroscopic ACL repair can begin, all meniscal pathology should beidentified and repaired as necessary. Adequate visualization should be ensured

by removing any fatty tissue that could interfere with the viewing of the ACL

anatomy. The medial portal is generally used for visualization in this technique

with instrument access to the femoral condyle being achieved through an

accessory medial portal approach.

Surgical Preparation

Extracortical Fixation Pre-stretched Dyneema* Loop

Prevents Graft Creep

HiFi(High Strength) Suture Included

Depth Measuring Drill Bit Technique

Bulbous Eye for Central Seatingin Tunnel

15 to 60mm Loop Lengths

Anatomic Singleor Double Bundle

Proprietary Self-ReinforcedPLA with TCP Particles

Proven Osteoconductivity

Proven Tri-Lobe Driver Interface

Wide Range of Sizes Available(5.0mm to 11.0mm) diameters

Anatomic Drilling and fixation system options:

Surgical Technique described byJohn Xerogeanes, MD, Chief of Sports Medicine

Emory Orthopaedics and Spine CenterAtlanta, GA

This product contains DyneemaPurity. DyneemaPurity is aregistered trademarkof RoyalDSM N.V.


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Eccentric Mono-fluted Drill Bit Mono-fluted to Protect CartilageWhen Sliding Past Medial FemoralCondyle (Medial Portal Approach)

Single Flute Allows for SmallerSkin Incision

5.5 to 13.0mm sizes


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Portal Creationand Incising

AccessoryAnteromedial (AAM)

Arthroscopic surgical approach

for anatomic ACL reconstruc-

tion requires three portals:

an anterolateral, an antero-

medial, and an accessory

anteromedial. The standard

anteromedial portal will be used

for arthroscopic visualization

and should be placed close to

the patellar tendon and adjacent

to the inferior pole of the patella.

The accessory anteromedial portal

will be used for drilling and should

be lower and more medial than theanteromedial portal.

With the surgical markings in place, incise theanteromedial and anterolateral portals.

Insert a ConMed Linvatec shaver to excise anyremaining ACL tissue.

Anteromedial (AM) Anterolateral (A

Step One:1


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Creation of the accessory anteromedial portal ismade under direct visualization with the arthro-

scope placed in the anterolateral portal lookingmedially.

With the knee flexed at 90 degrees, palpate themedial joint line.

Under direct visualization, insert a needle justanterior to the medial femoral condyle, directedtowards the intercondylar notch. The needle shouldbe above the medial meniscus to avoid damage.

Advance the needle to confirm access to thefemoral footprint of the ACL.

Using an 11 blade, incise the skin making sure toorient the blade away from the femoral condyle toprevent damaging the articular surface.

Step Two:

Switch the arthroscope to the anteromedial portal. Markthe center of the femoral ACL footprint usinga microfracture awl in the AAM Portal.

Once marked, use the Bullseye Native FootprintRuler to assess the footprint of the native ACL stump.

Step Three:

Step Four:

2

3

4


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Positioning and Drillingof the Femoral Tunnel

With the ACL footprint identified

and the center marked, insert the

Bullseye Femoral Footprint Guide

into the Accessory Anteromedial

portal with the knee flexed at

90 degrees.


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2

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Place the guide at the center of the ACL Footprint.

Advance the Pin a few millimeters to notch the

bone. Then check to ensure that the pin correlatesto the mark made earlier.

Step One:

Hyperflex and elevate the knee and then advancethe guidepin to the lateral cortex. Note the apertureto cortex length, then advance out of the skin.

Use a twisting motion to remove the FemoralFootprint Guide.

Step Two:

Step Three:


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4

5

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Insert the mono-fluted Sentinel Drill Bit over theguide pin through the accessory anteromedial

portal with the cutting edge facing away from thefemoral condyle and advance the Drill Bit to thefemoral ACL footprint.

Step Four:

Using a piston-like back and forth motion, drill thefemoral socket to the desired depth cautiously toprevent blow out of the lateral femoral cortex.

Keeping the hand off of the trigger, slide theSentinel Drill Bit past the medial femoral condyleand out of the portal, making sure to keep theblade oriented away from the condylar surface.

Step Five:

Step Six:


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7

8

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Use the XO Button Drill Bit to drill the femoralchannel. Advance the drill bit through the

lateral cortex.

Using the XO Button Drill Bit as you would usea standard depth gauge, manually pull backon the bit to hook the head of the drill bit on theexternal femoral cortex to confirm the apertureto cortex length.

Remove the XO Button Drill Bit leaving the graftpassing guide pin in place.

Place the two free ends of the #2 passing suturethrough the eyelet of the guide pin.

Then, pull the guide pin through the femur later-ally, making sure to keep a finger in the sutureloop to prevent it from being pulled into theknee joint.

Step Seven:

Step Eight:

Once the suture ends are retrieved laterally, pullthe looped end of the suture all the way to theentrance of the femoral tunnel.

Step Nine:


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Tibial TunnelPositioningand Drilling

Switch the arthroscope to

the anterolateral portal.

Next, insert the Lightwave

Ablator into the anteromedial

portal to mark the center of

the tibial ACL footprint.

The center of the footprint is referenced

off the Posterior aspect of the Anterior

horn of the Lateral Meniscus.


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4

5

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Set the angle of the Pinn-ACL Guide to 55 degrees.

Insert the tip into the anteromedial portal, placing

the tip of the guide into the center of the tibial ACLfootprint.

Next, advance the external guide sleeve flush tothe anterior tibial cortex.

Step One:

Using the ConMed Linvatec M-Power 2 handpiece andpin-driver attachment, advance the guide pin until itmeets the point of the guidearm.

Then, depress the Pinn-ACL drill guide lever to removethe sleeve.

Remove the Pinn-ACL guide from the guide pin and joint.

Place a curette over the point of the guide pin to pro-tect against inadvertent advancement when drilling.

Use the appropriate size Badger or Sentinel Drill Bitto drill the tibial tunnel.

Step Two:

Step Three:


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1

Next, place a probe into the accessory anteromedialportal to bring the loop of the suture into the joint.

Retrieve the loop through the tibial tunnel usingSuture Retrieval Forceps.

Step One:

Tensioner BreakawayPins Placement andGraft Passage

Using the appropriate size

SE Graft Tensioner Drill

Guide, place the guide in

the tibial tunnel and position

two Breakaway pins and

then remove the guide.


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Step One:

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3

With the suture loop exposed externally, load thesuture strands of the XO Button loaded graft into the

passing suture loop and pull them through the femo-ral tunnel, making sure to keep the graft constructoutside of the tibia.

Pull the XO Button loaded graft into the joint and throughthe femur while hyperflexing and elevating the knee toease the graft passage.

Finally, ensure that the XO Button has flipped and isseated.

Step Three:

Step Two:


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Graft Tensioningand Fixation

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2

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Load the SE Graft Tensioner Suture Separator.Spread the whip-stitch strands radially as youload the SE Graft Tensioner.

Step One:

Tying the appropriate bundle strands to the left andright tensioner wheels allows the bundles to beindividually and accurately tensioned.

Apply the desired graft tension and then cycle theknee to alleviate laxity. Hold the knee at fifteen

degrees and set the desired final tension.

Next, load the appropriately sized MatryxInterference Screw onto the Tri-Lobe driver.

Ensure that the knee is in fifteen degrees offlexion. Advance the Linvatec BioScrew HyperFlexGuidewire into the tibial tunnel and in the center ofthe four graft bundles. Load the Matryx InterferenceScrew and driver on to the guidewire and advanceit through the tensioner and into the tibial tunneluntil it is flush with the external tibial cortex.

Step Two:

Step Three:


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Lastly, remove the SE Graft Tensioner

and Breakaway pins and follow the

normal procedures to close the incisions.

Note the anatomic position of the

final graft placement. Performing ananatomic ACL reconstruction using the

AAM portal provides improved rotational

stability compared to a non-anatomic

reconstruction. Ranging the knee through

flexion and extension no graft impingement

is observed. Additionally, with this technique

a notchplasty is generally not needed exceptif an unnatural anatomy such as an A

shaped intercondylar notch is present.

These are a few of the numerous advantages

of using the ConMed Linvatec Bullseye

Anatomic Cruciate Reconstruction System,

and the anatomic single bundle technique.

Final Step


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This product contains DyneemaPurity. DyneePurity is a registered trademarkof Royal DSM

Ordering InformationBullseyeFemoral Footprint GuideDescription Cat. No.

5mm .........................................................SB5000

6mm .........................................................SB6000

7mm .........................................................SB7000

8mm .........................................................SB8000

9mm .........................................................SB9000

10mm ..................................................... SB10000

11mm ......................................................SB11000

BullseyeFemoral Footprint Ruler

Description Cat. No.

BullseyeFemoral Footprint Ruler ..................... RL1000

SentinelDrill Bits (sterile, 4 per box)

Unique mono-fluted design allows blade to be pointed

away from vital structures (condyles, PCL). Especially

useful with a medial portal approach.


5.5mm x 9 in. ..............................................S8555

6.0mm x 9 in. ..............................................S8560

6.5mm x 9 in. ..............................................S8565

7.0mm x 9 in. ..............................................S8570

7.5mm x 9 in. ..............................................S8575

8.0mm x 9 in. ..............................................S8580

8.5mm x 9 in. ..............................................S8585

9.0mm x 9 in. ..............................................S8590

9.5mm x 9 in. ..............................................S8595

10mm x 9 in. ...............................................S8510

10.5mm x 9 in. ..........................................S85105

11mm x 9 in. ...............................................S8511

11.5mm x 9 in. ..........................................S85115

12mm x 9 in ................................................S8512

12.5mm x 9 in. ..........................................S85125

13mm x 9 in. ...............................................S8513

Pinn-ACLCruciate Guide System

(includes ACL Guide Arm and Pin-Sleeve) 5, 6 ....8731

ACL Pin-Sleeve (replacement sleeve for 8731) ......8719

Accessories


14 in. High Strength Guide Pin,

2.4mm dia. ...................................................9744

Graft Passing Guide Pin,

2.4mm dia. ................................................C8675

XO Button(with HiFi)

Contains pre-stretched Dyneemaloop, and Hi-Fihigh

strength suture. Easy to flip and re-position if required.


15mm Continuous Loop ................................. T5015



30mm Continuous Loop ................................. T503035mm Continuous Loop ................................. T5035






XO ButtonInstrumentation


XO Button Drill Bit ........................................C8590

XO Button Holder ....................................... PS8834

XO Button Graft Passing Guide Pin .................. C8676

EL Depth Probe ..........................................21.1001

SE Graft Tensioner

A unique system that enables load equalization over two

soft-tissue grafts. Enables in-situ graft pre-conditioning,

and central screw insertion.


SE Graft Tensioner ........................................ C9050

SE Graft Tensioner Drill Guide, 6mm................C9051

SE Graft Tensioner Drill Guide, 8mm................C9052

SE Graft Tensioner Suture Separator ................. C9053

SE Graft Tensioner Breakaway Pins with

Graft Tension Calculator ................................ C9054

SE Graft Tensioner System Sterilization Tray ....... C9055

Screw Pick-up .................................................8606

Literature


Anatomic Single Bundle ACL Reconstruction

Technique Video and Animation .................. DVD0029

Anatomic Single Bundle Printed Technqiue .....CST1031

XO ButtonSurgical Technique Video........... DVD0025

SE Graft Tensioner Surgical Technique Video ....... CD20

SE Graft Tensioner Illustrated Guide .................. VT125

MatryxOsteconductive BioabsorbableInterference Screw(SR-96L/4D PLA with -TCP)The most advanced biocomposite on the market!Combining proprietary Self-Reinforced technology

with proven osteoconductivity.


5.0mm x 15mm .....................................235015T55.0mm x 20mm .....................................235020T5

5.0mm x 25mm .....................................235025T55.0mm x 30mm .....................................235030T55.5mm x 15mm .....................................235515T55.5mm x 20mm .....................................235520T55.5mm x 25mm .....................................235525T55.5mm x 30mm .....................................235530T56.0mm x 15mm .....................................236015T56.0mm x 20mm .....................................236020T56.0mm x 25mm .....................................236025T56.0mm x 30mm .....................................236030T56.5mm x 15mm .....................................236515T56.5mm x 20mm .....................................236520T56.5mm x 25mm .....................................236525T56.5mm x 30mm .....................................236530T57.3mm x 20mm .....................................237020T57.3mm x 25mm .....................................237025T5

7.3mm x 30mm .....................................237030T58mm x 20mm ........................................238020T58mm x 25mm ........................................238025T58mm x 30mm ........................................238030T59mm x 20mm ........................................239020T59mm x 25mm ........................................239025T59mm x 30mm ........................................239033T59mm x 38mm ........................................239038T510mm x 25mm ......................................231025T510mm x 33mm ......................................231033T510mm x 38mm ......................................231038T511mm x 25mm ......................................231125T511mm x 33mm ......................................231133T511mm x 38mm ......................................231138T5

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