Suture anchors for VeterinarY use For Joint Stabilization and Ligamentous and Tendon Injury Repairs in Cats and Dogs Mini QUICKANCHOR Plus Anchor GII QUICKANCHOR Plus Anchor Super QUICKANCHOR Plus Dual Suture Anchor HEALIX TRANSTEND Ti Anchor 4.5 HEALIX Ti Dual Threaded Suture Anchor technique Guide
TABLE OF CONTENTS introduction QUICKANCHOR and HEALIX Anchors 2 Orthocord Suture 3 Indications 4 technique Quickanchor Suture Anchors 5 Preloaded with ORTHOCORD Suture Quickanchor Suture Anchors 8 with Threader Tabs Healix Anchors with ORTHOCORD Suture 11 product information Instruments and Implants 12 Suture Anchors for Veterinary Use Technique Guide DePuy Synthes Vet
quickanchor and healix anchors features and BenefitS of quickanchors anchors Multiple Options range of suture anchor sizes from mini quickanchor (1.8 mm) to Super quickanchor anchors (2.9 mm) Sliding Suture Suture passes smoothly through the anchor eyelet to accommodate different knotting techniques mini quickanchor plus anchor (1.8 mm) Gii quickanchor plus anchor (2.4 mm) Super quickanchor plus dual Suture anchor (2.9 mm) Threader Tabs provides flexibility for different suture size and material features and BenefitS of healix anchors Thread Pattern dual-thread pattern independently engages both cortical and cancellous bone healix transtend ti anchor (2.9 mm) Cannulation cannulation channels blood to the surface Hex Driver deep hex recess for optimal torque transmission 4.5 healix ti dual threaded Suture anchor 1 DePuy Synthes Vet Suture Anchors for Veterinary Use Technique Guide
orthocord Suture features and BenefitS of orthocord SutureS orthocord Suture is a partially absorbable suture made of a unique combination of polyethylene and polydioxanone (pds). it has been engineered to balance strength, abrasion, cut resistance, and flexibility. ORTHOCORD Suture Features x high tensile and knot strength x Balance of knot slide ability, knot security, stiffness, and elastic tension x Less likelihood of abrasion to surrounding tissues or surgeon s hands 1 x Small knot profile x Less susceptible to bacterial adherence 2 StiffneSS comparison 3 Knot tensile StrenGth 4 4 orthocord #2 Suture fiberwire #2 40 orthocord #2 Suture fiberwire #2 3 30 grams force 2 1 1.8 3.1 pounds 20 10 19.6 18.5 0 conclusion: orthocord #2 Suture is 45% less stiff than the fiberwire #2 Suture. 0 conclusion: the knot break strength of orthocord #2 Suture is higher than the knot break strength of fiberwire #2 Suture. 1. wust dm, meyer dc, favre p, Gerber c. mechanical and handling properties of braided polyblend polyethylene sutures in comparison to braided polyester and monofilament polydioxanone sutures. Arthroscopy. 2006;22(11):1146-1153. 2. masini B, Stinner d, waterman S, et al. Bacterial adherence to high-tensile strength sutures. Arthroscopy. 2011;27(6):834-838. 3. results of Stiffness analysis test tm007-03 performed by ethicon, inc. cpc. data on file. 4. data on file at DePuy Synthes Mitek Sports Medicine. Suture Anchors for Veterinary Use Technique Guide DePuy Synthes Vet 3
INDICATIONS The DePuy Synthes Mitek Sports Medicine Suture Anchors with ORTHOCORD Sutures are indicated for:* x Medial shoulder instability x Coxofemoral dislocation (iliofemoral suture and capsulorrhaphy) x Collateral ligament injuries of the carpus and tarsus * the surgeon must be thoroughly knowledgeable on the medical and surgical aspects of these indications. The surgeon is advised to adequately protect the surgical repair and to properly advise owners on the importance of postoperative instructions. Refer to the relevant package insert for appropriate indications. 4 DePuy Synthes Vet Suture Anchors for Veterinary Use Technique Guide
QUICKANCHOR Suture Anchors Preloaded with ORTHOCORD Suture TECHNIQUE Note: Photos in this section depict the Super QUICKANCHOR Anchor, but technique is similar for the Mini and GII QUICKANCHOR Suture Anchors. Drill Drill Bit Bit Shoulder Shoulder Mini QUICKANCHOR Anchor (1.8 mm) 212038 Mini QUICKANCHOR Plus with #0 ORTHOCORD 211069 2.0 mm Drill Bit (comes packaged with 212038) 213072 Mini Drill Guide GII QUICKANCHOR Anchor (2.4 mm) 222983 GII QUICKANCHOR Plus with #2 ORTHOCORD Figure 1a 211093 GII Drill Bit 2.4 mm 213207 GII/Super/RC Slotted Drill Guide Super QUICKANCHOR Anchor (2.9 mm) 222984 Super QUICKANCHOR Plus with #2 ORTHOCORD Dual Suture 211113 Super/RC Drill Bit 2.9 mm 213207 GII/Super/RC Slotted Drill Guide Note: All QuickAnchor Suture Anchor designs use barbs for retention in bone. Once set, these anchors cannot be removed or reoriented. If needed, another anchor can be placed adjacent to the first. Refer to next section for adjacent anchor placement guidance. 1. drill to shoulder using appropriate drill bit (Figures 1a and 1b). Figure 1b Drill Bit Shoulder Suture Anchors for Veterinary Use Technique Guide DePuy Synthes Vet 5
QUICKANCHOR Suture Anchors with ORTHOCORD Suture 2. insert anchor (Figure 2) by pushing into bone until fully seated (until inserter shoulder contacts bone). A mallet may be needed to fully insert anchor. Inserter Shoulder Warning: Anchor MUST be inserted to shoulder depth to prevent suture damage. Note: Do not attempt to twist or bend handle during insertion. Figure 2: Anchor during insertion, not yet seated. 3. pull back on inserter handle until anchor has disengaged from inserter (Figure 3). There will be a slight resistance as handle is disengaged due to suture spool inside inserter handle. 4. Slide the suture cover back and remove suture. Warning: Needles are attached to suture for Mini QUICKANCHOR Suture Anchor, GII, and Super QUICKANCHOR Suture Anchor Systems. Take precautions when removing suture. 5. Pull on both ends of suture to set anchor. If it becomes necessary to slide suture through anchor eyelet after insertion, avoid contact between suture and bone by holding suture in-line with anchor, as shown in Figure 4. Do not attempt to slide the suture through the eyelet, as shown in Figure 4a, as suture damage may occur. Figure 3 Figure 3a: Open Suture Cover Figure 4: Correct orientation of suture when sliding it through anchor eyelet. Figure 4a: Incorrect orientation of suture when sliding it through anchor eyelet. 6 DePuy Synthes Vet Suture Anchors for Veterinary Use Technique Guide
quickanchor Suture anchors with orthocord Suture Placing adjacent QUICKANCHOR Suture Anchors Note: When placing adjacent anchors it is important to note the orientation of the barbs on the QUICKANCHOR Suture Anchor designs, as this will dictate minimum distance between anchors (see table below). mini quickanchor plus anchor Gii quickanchor plus anchor Super quickanchor plus dual Suture anchor AnCHOr specifications Mini QUICKAnCHOr GII QUICKAnCHOr super QUICKAnCHOr Body diameter 1.8 mm 2.4 mm 2.9 mm dist across Barbs 4.4 mm 5.9 mm 6.5 mm recommended DIstAnCE BEtWEEn AnCHOrs Mini QUICKAnCHOr GII QUICKAnCHOr super QUICKAnCHOr Barbs parallel 4.8 mm 5.4 mm 5.9 mm Barbs perpendicular 7.5 mm 9 mm 10 mm the tables above based on preserving at least 3 mm of bone stock between adjacent quickanchor Suture anchors and preventing interference between anchors. Suture Anchors for Veterinary Use Technique Guide DePuy Synthes Vet 7
QUICKANCHOR SUTURE ANCHORS with Threader Tabs TECHNIQUE The Mini QUICKANCHOR, GII, and Super QUICKANCHOR Anchors are also available without preloaded inserter handles or suture. Refer to instructions below to load free anchors onto their respective inserters. threader Tab General Instructions for Loading Suture onto Free QuickAnchor Suture Anchor: 1. insert approximately 50 mm of suture through metal threader loop (Figure 1). 2. Withdraw threader loop from anchor to transfer suture to anchor eyelet (Figure 2). 3. center anchor on suture strand by pulling suture, as shown in Fig 3. Do not attempt to slide suture, as shown in Fig 3a, as suture damage may occur. Suture Threader Loop Figure 1: 50 mm of suture loaded through threader loop. NOTE: The maximum suture size for Mini QUICKANCHOR Suture Anchor is #0; for GII and Super QUICKANCHOR Suture Anchor the maximum suture size is #2. Super QUICKANCHOR Suture Anchor can accommodate 2 strands of #2 suture. Figure 2: Suture transferred to anchor eyelet. Figure 3: Correct orientation of suture when sliding it through anchor eyelet. Figure 3a: Incorrect orientation of suture when sliding it through anchor eyelet. 8 DePuy Synthes Vet Suture Anchors for Veterinary Use Technique Guide
QUICKANCHOR Suture Anchors with Threader Tabs Instructions for attaching loaded anchor onto Inserter: Threader Tab Instruments for Mini QUICKANCHOR Suture Anchor: 210366 Mini Anchor, Threader Tab (5/box) 210466 Mini Anchor, Threader Tab (1/box) 211083 Mini Drill Bit, 2.1 mm 223124 orthocord #0, 36 inches, Taper, 22.2 mm, 1/2 Circle (12/box) 212123 Mini Syringe Inserter Slider Figure 4: Mini Syringe Inserter. Body Slots Plunger (shown extended) 1. Before attaching anchor to Mini Syringe Inserter, retract plunger by pulling back slider until it snaps into place (Figure 4). Attach loaded Mini QUICKANCHOR Suture Anchor to plunger end of Syringe Inserter. Note: Mini QUICKANCHOR Suture Anchor barbs will slide into one pair of body slots; the suture will slide into the other pair of slots (Figure 5). 2. pull both ends of suture tight to hold anchor in place, then wrap ends of suture under rubber ring on slider. Suture should be routed through slots in slider flange (Figure 6). Figure 5: Mini QUICKANCHOR Anchor loaded on Mini Syringe Inserter. 3. insert anchor by placing tip into pre-drilled 2.1 mm hole and pushing on slider until anchor is fully inserted. Note: Do not attempt to twist or bend handle during insertion. 4. Pull on both ends of suture to set anchor in the bone. Figure 6: Suture ends secured under rubber ring. Suture Anchors for Veterinary Use Technique Guide DePuy Synthes Vet 9
QUICKANCHOR Suture Anchors with Threader Tabs Threader Tab Option for GII QUICKANCHOR Suture Anchor Inserter End 210393 GII Anchor with Threader Tab (5/box) 210493 GII Anchor with Threader Tab (1/box) 211093 GII Drill Bit, 2.4 mm Inserter Shoulder 212094 GII Inserter 223111 ORTHOCORD Blue (without needles) (12/box) Threader Tab Option for Super QUICKANCHOR Suture Anchor 210309 Super Anchor with Threader Tab, (5/box) 210409 Super Anchor with Threader Tab, (1/box) 211113 Super/RC Drill Bit, 2.9 mm 212114 Super/RotCuff Inserter 223111 ORTHOCORD Blue (without needles) (12/box) Figure 7 Figure 7a: Anchor properly attached to Super Inserter (similar for GII.) 1. attach anchor (with suture) to distal end of GII or Super QUICKANCHOR Suture Anchor Inserter. 2. to secure anchor on Inserter, pull both ends of suture proximally, then slide suture ends through slots in inserter handle (Figure 7). If anchor does not fit snugly into end of Inserter, check Inserter end for possible damage (Figure 7a). 3. fully insert anchor into predrilled hole (until Inserter shoulder contacts bone). A mallet may be needed to fully insert anchor. 2.4 mm hole for GII Anchor 2.9 mm hole for Super QUICKANCHOR Anchor 4. Pull on both ends of suture to set anchor in the bone. Warning: Anchor MUST be inserted to shoulder depth to prevent suture damage. If excessive resistance is felt during anchor insertion, check inserter end for damage (Figure 7a). Note: Do not attempt to twist or bend handle during insertion. 11 DePuy Synthes Vet Suture Anchors for Veterinary Use Technique Guide
Healix Anchors with ORTHOCORD Suture TECHNIQUE HEALIX Transtend Ti Anchor (2.9 mm) 222260 HEALIX Transtend Ti Anchor with #2 ORTHOCORD 222281 HEALIX Transtend 2.2 mm Drill Bit 4.5 HEALIX Ti Anchor (4.5 mm) 211026 PANALOK Drill Bit 3.5 mm 222253 4.5 HEALIX Ti Anchor with #2 ORTHOCORD dual Suture 222226 HEALIX Cortical Awl/Tap 4.5 mm Figure 1 Figure 2 1. Pre-drill using appropriate drill bit. x 2.2 mm drill bit for HEALIX Transtend Ti Anchor x 3.5 mm drill for 4.5 HEALIX Ti Anchor Optional Technique: Use 4.5 mm Cortical Awl / Tap. 2. insert the anchor by turning clockwise (Figure 1) until the anchor is fully inserted and the distal laser line on inserter is just below bone surface (Figure 2). Figure 3 Warning: Distal laser line should not be visible when anchor is properly inserted. Note: Vertical line on inserter indicates the orientation of the sutures (Figure 3). The sutures are oriented in the same direction as the laser line and open slot on the driver. 3. Pull up to disengage inserter from anchor. 4. Open slider on handle and remove suture spool. Note: When placing adjacent Healix Anchors, it is recommended to leave at least 5 mm of bone between them. Suture Anchors for Veterinary Use Technique Guide DePuy Synthes Vet 11
Instruments AND IMPLANTS Ordering Information (call 800-255-2500 to order): Mini QUICKANCHOR Plus Anchor (1.8 mm) Super Mini QUICKANCHOR Plus Anchor (2.9 mm) CODE Description CODE Description 212038 Mini QUICKANCHOR Plus with #0 ORTHOCORD (OS-2), 2.0 mm Drill Bit Comes sterile packaged 211083 Mini Drill Bit, 2.1 mm 223124 ORTHOCORD #0, 36 inches, Taper, 22.2 mm, 1/2 Circle (12/box) Threader Tab Option for Mini QUICKANCHOR Anchor 210466 Mini Anchor, Threader Tab (1/box) 210366 Mini Anchor, Threader Tab (5/box) 212123 Mini Syringe Inserter 223124 ORTHOCORD #0, 36 inches, Taper, 22.2 mm, 1/2 Circle (12/box) Additional Instruments 213072 Mini Drill Guide GII QUICKANCHOR Plus Anchor (2.4 mm) CODE Description 222983 GII QUICKANCHOR Plus with #2 ORTHOCORD CP-2 needles Threader Tab Option for GII Mini QUICKANCHOR Anchor 210493 GII Anchor with Threader Tab, (1/box) 210393 GII Anchor with Threader Tab, (5/box) 212094 GII Inserter 223111 ORTHOCORD Blue (without needles), (12/box) Additional Instruments 211093 GII Drill Bit 2.4 mm 213207 GII/Super/RC Slotted Drill Guide 222984 Super QUICKANCHOR Plus with #2 ORTHOCORD Dual Suture (CP-2 needles) Threader Tab Option for Super Anchor: 210409 Super Anchor with Threader Tab, (1/box) 210309 Super Anchor with Threader Tab, (5/box) 212114 Super/RotCuff Inserter 223111 ORTHOCORD Blue (without needles), (12/box) Additional Instruments 211113 Super/RC Drill Bit 2.9 mm HEALIX Transtend Ti Anchor (2.9 mm) CODE Additional Instruments 399.41 Mallet Description 222260 HEALIX Transtend Ti Anchor with #2 ORTHOCORD Dual Suture Additional Instruments 222281 HEALIX Transtend 2.2 mm Drill Bit 4.5 HEALIX Ti Anchor (4.5 mm) CODE Description 222253 4.5 HEALIX TI Anchor with #2 ORTHOCORD 211026 PANALOK Drill Bit 3.5 mm Additional Instruments 222226 HEALIX Cortical Awl/Tap 4.5 mm To order in the U.S. call, Johnson & Johnson Health Care Systems Inc. Customer Support Services at 800-255-2500. 11 DePuy Synthes Vet Suture Anchors for Veterinary Use Technique Guide
To order in the U.S. call, Johnson & Johnson Health Care Systems Inc. Customer Support Services at 800-255-2500. Not all products are currently available in all markets. DePuy Synthes Vet 1302 Wrights Lane East West Chester PA 19380 Tel: (610) 719-5000 www.depuysynthes.com Distributed in the USA by: DePuy Mitek, Inc. 325 Paramount Drive Raynham, MA 02767 USA Tel: +1 (800) 382-4682 DePuy Synthes Vet, a division of DOI 2014. All rights reserved. DSUS/VET/0814/0016 12/14