mitek sports medicine versaloop™ soft anchor

Mitek Sports Medicine

VERSALOOP™ SOFT ANCHORLateral Ankle Instability RepairSurgical Procedure Guide

FEATURINGDr. Timothy D. Howard

2 Surgical Procedure Guide • VERSALOOP™ Soft Anchor

Dr. Timothy D. HowardChronic ankle instability is an extremely common problem that foot and ankle surgeons will encounter. In situations where conservative measures such as anti-inflammatory medications, rehabilitation, the use of orthotics, and bracing have failed, then surgical stabilization is necessary.

The majority of lateral ankle stability is achieved through the soft tissue structures of the lateral collateral ligaments, peroneal tendons, and the syndesmosis ligaments. The lateral collateral ligaments are made up of the anterior talofibular ligament (ATFL), the calcaneal fibular ligament (CFL), and the Posterior talofibular ligament (PTFL). The ATFL is the primary stabilizer of these ligaments and is the most easily injured of the three ligaments. It is important to obtain stability of these ligaments to prevent further injury and loss of play time for the athletes and for long-term preservation of the cartilage within the ankle joint.

Numerous techniques for surgical lateral ankle stabilization have been described. These are essentially broken down into anatomic and nonanatomic repairs. The most common anatomic repair is known as the Brostrom-Gould procedure; originally described by Brostrom in 1966 and modified by Gould in 1987. This technique involves shortening and reattaching the ATF ligament to the boney surface of the fibula and enhancing the repair with advancement of the extensor retinaculum. The literature has shown this technique to be a successful and strong procedure without sacrificing other important structures.

The procedure described in this guide is a modification of the Brostrom-Gould technique with the use of a 1.8mm VERSALOOP™ Soft Anchor. This technique allows for strong stabilizing repair of the ATF ligament with the ability to evaluate the CFL and the peroneal tendons should these need repair as well. The strength of this repair allows for early weight-bearing starts at 2-3 weeks and rehabilitation post operatively, which provides patients with greater satisfaction.

Overview

Table of Contents

3VERSALOOP™ Soft Anchor • Surgical Procedure Guide

■ Notes

Overview Products Used 4

Patient Positioning 4

Incision and Bone Preparation Incision 5

Locate and Cut Appropriate Ligaments 5

Trace ATFL to Distal Fibula 6

Prepare Bone for Drilling 6

VERSALOOP™ Soft Anchor Instrumentation Use & Suture Anchor Deployment Drill the Bone 7

Insertion of VERSALOOP™ Soft Anchor 7

Setting the VERSALOOP™ Soft Anchor 8

Reattach Ligament to Fibula 8

Complete Repair and Close Incision 9

Recovery 10

Product Information 11


VERSALOOP™ Soft Anchor Straight Guide for 1.8mm anchor

Patient Positioning:Secure the patient in supine position. Place a bump under the ipsilateral hip to provide slight internal rotation and better access to the lateral ankle. At this time, foot and ankle can be draped and prepped. If using a tourniquet, it can be inflated.

VERSALOOP™ Soft Anchor 2 Tape, 1.8mm

VERSALOOP™ Soft Anchor 1.8mm Straight Drill

Products Used


Procedure Steps

1. Incision:After locating the distal fibula, make a slight curvilinear incision over the distal fibula extending down over the sinus tarsi.

■ Note:

This incisional approach allows for visualization and evaluation of the peroneal tendons, if necessary.

2. Locate and Cut Appropriate Ligaments:

Place retractors to keep the incision open for adequate visualization. Penetrate the ankle capsule with a blade. Continue cutting distally over the top of the ATFL exposing its layers.

■ Note:

Palpate ankle capsule to help identify the anterior-inferior tibio-fibular ligament (AITFL) and the anterior talo-fibular ligament (ATFL) prior to cutting.

Incision and Bone Preparation


4. Prepare Bone for Drilling:Using a rongeur or curette, roughen the surface of the fibula superior to the ligaments attachment to prepare for drilling.

Surgical Procedure Guide - Incision and Bone Preparation

3. Trace ATFL to Distal Fibula:Following incision, trace the superior aspect of the ATFL back to its attachment to the anterior aspect of the fibula.


Surgical Procedure Guide

5. Drill the Bone:Place the 1.8mm straight drill guide onto the prepared bone. Advance the 1.8mm drill bit through the guide until it bottoms out.

6. Insertion of VERSALOOP™ Soft Anchor:

Insert the 1.8mm VERSALOOP™ Soft Anchor double-loaded tape into the bone, through the drill guide. Apply impaction until the inserter is flush with the drill guide. Unwrap sutures from the inserter.

VERSALOOP™ Soft Anchor Instrumentation and Deployment of Suture Anchor


8. Reattach Ligament to Fibula:Load VERSALOOP™ Soft Anchor tail into a free needle, ensuring there is enough length to keep sutures in the eyelet during passing. While the foot is held in a dorsiflexed-everted position, pass the suture through the attenuated or ruptured ends of the ATFL to reattach or reef up the ligament to the fibula.

Surgical Procedure Guide - VERSALOOP™ Soft Anchor Instrumentation and Deployment of Suture Anchor

7. Setting the VERSALOOP™ Soft Anchor:

Remove the inserter followed by the drill guide. To deploy and set the anchor, grasp the sutures and gently pull to set the anchor beneath the cortex.



9. Complete Repair and Close Incision:With the foot still held in dorsiflexed-everted position, tie the sutures tightly to secure the ligament to the bone.



For additional support:Using a 2-0 vicryl suture, advance the retinaculum over the repair for additional support and reinforcement. Remaining anatomical layers are reapproximated with absorbable suture and the skin closed with 4-0 nylon or prolene suture.

The incision is dressed with adaptic and a posterior splint is applied with the foot again held in a dorsiflexed-everted position.

Recovery:Early weight bearing begins at 2-3 weeks post-operatively in a boot. Transition to an ankle brace and gym shoe begins by four weeks post-operatively with assistance of physical therapy.


Anchors Free Needle Loop

VERSALOOP™ Soft Anchors

210165 VERSALOOP™ Anchor 1 Suture, 1.5mm

210166 VERSALOOP™ Anchor 1 Tape, 1.5mm






Free Needle Loop

223173 Free Needle Loop MO-6 Needle 12Pack (US Only)

223174 Free Needle Loop MO-6 Needle Single-Pack

Instrumentation

Straight Instrumentation

210175 VERSALOOP™ Straight Guide for 1.5mm Anchor, Fishmouth



210178 VERSALOOP™ Straight Guide for 1.5mm Anchor, Sawtooth



210181 VERSALOOP™ 1.5mm Reusable Straight Drill



210207 VERSALOOP™ 2.5mm Reusable Awl

Curved Instrumentation

210195 VERSALOOP™ 12.5° Guide for 1.5mm Anchor, Sawtooth

210196 VERSALOOP™ 12.5° Guide for 1.8mm Anchor, Sawtooth

210197 VERSALOOP™ 25° Guide for 1.5mm Anchor, Sawtooth

210198 VERSALOOP™ 25° Guide for 1.8mm Anchor, Sawtooth

210199 VERSALOOP™ 1.5mm Disposable Drill

210203 VERSALOOP™ 1.8mm Disposable Drill

Obturators

210205 VERSALOOP™ Obturator for 1.5mm Anchor



Product Information

© DePuy Synthes 2021. All rights reserved.184985-210803 DSUS/EMEA

DePuy Mitek, Inc.325 Paramount DriveRaynham, MA 02767T. +1 (800) 382-4682

Medos International SARLChemin-Blanc 382400 Le Locle, Switzerland

T.A.G. Medical ProductsCorporation LtdKibbutz Gaaton2513000 IsraelTel: +972 (0) 4 9858400Fax: +972 (0) 4 9858404

www.depuysynthes.com

Dr. Timothy Howard is presenting on behalf of Johnson & Johnson. The presentation reflects the opinions of the individual presenter, and the steps described may not encompass the complete steps of the procedure. Additionally, other surgeons may prefer different techniques, approaches, etc., as individual surgeon experience in his/her clinical practice, as well as patient needs, may dictate variation in procedure steps. Accordingly, results from any case studies reported in this presentation may not be predictive of results in other cases.

Before using any medical device, review all labeling, including without limitation; the Instructions For Use (IFU), and relevant package inserts with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device.

Please also refer to the package insert(s) or other labeling associated with the devices identified in this Surgical Procedure Guide for additional information.

CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.

Some devices listed in this Surgical Procedure Guide may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada.

Not all products may currently be available in all markets.

The third party trademarks used herein are the trademarks of their respective owners.

Please refer to the instructions for use for a complete list of indications, contraindications, warnings and precautions.

mitek sports medicine versaloop™ soft anchor

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