Inion® ACL Reconstrution
Surgical Technique
Inion FlipButton™
1
Inion FlipButton™
Introduction:
Inion FlipButton™ provides loop lengths from 12 to 60 mm, which can be used for bone and soft tissue fixation in
many indications, e.g. ACL/PCL reconstruction, AC joint dislocation, distal biceps tendon reconstruction.
• Continuous ultra-high molecular weight polyethylene
(UHMWPE) loop, with superior strength and stiffness, less loop
displacement, ensuring a reliable fixation
• Pre-loaded with two UHMWPE USP #5 sutures (1 x white, 1 x
white/blue), simplifying the use of the device
• 11 different loop lengths from 12 to 60 mm provide more
fixation choices
• Ti alloy based button creats safe and stable fixation in femoral
cortex
Mechanical test:
2
Figure 1a: Displacement of the Inion FlipButton™,
Figure 1b: Maximum pull-out load of the Inion
TightRope® and ENDOBUTTON® CL ULTRA after ten
FlipButton™
cycles of loading from 0 to 60 N
Inion FlipButton™, 20 mm
Inion FlipButton™, 50 mm
TightRope[1]
Inion FlipButton™, 15 mm
[1]
ENDOBUTTON CL ULTRA, 10 mm
Inion FlipButton™, 55 mm
Inion FlipButton™, 35 mm
Data on file at Inion.
The Inion FlipButton™ has 20 times smaller displacement after 10 times loading from 0 to 60 N compared to
TightRope® and lower displacement compared to ENDOBUTTON® CL ULTRA (Fig 1a).
Excellent fixation strength. Average maximum pull-out load of the Inion FlipButton™ Fixation device is 1881 N.
Reference: 1. Perriello M, Berube R, Moore C. Displacement of a Fixed Versus Adjustable Suspensory Fixation Device for Anterior Cruciate
Ligament Reconstruction. Bone & Joint Science 3(7), 2012.
Surgical technique
1. Preparing the graft
1.1 Harvest desired tendons and
suture both ends, typically around 30
mm.
Make sure the graft is in good tension
by adjusting the clamp. Graft should be
covered by a moist sponge.
1.2 Fold up the graft and measure the
diameter by using the Graft sizer (INS9341).
2. Drilling a tibial tunnel
2.1 Assemble the Drill guide pin sleeve
(INS-9332), Tibial pin marking hook
(INS-9333) and Drill guide arm (INS9331). Adjust the Tibial pin marking
o
hook to the position of 55 , then place
the tip of Tibial pin marking hook in the
center of ACL footprint.
2.2 Push the Drill guide pin sleeve to
the bone surface and fix the position.
Use the Drill guide pin w/o eyelet (INS9336) to drill through the tibia.
To creat a longer tibial tunnel, increase
the angle of the Drill guide arm.
2.3 Disassemble the tibial drill guide.
Leave only the Drill guide pin in place.
Drill the tibial tunnel using the
corresponding Cannulated drill bit (INS9301–9305) that matches the graft
diameter.
3
Surgical technique
3. Drilling a femoral tunnel
3.1 Select the right size of the femoral
guide.
Inion provides various Femoral drill
guides with different offsets (5/6/7
mm) (INS-9321–9323).
Always ensure that enough posterior
cortex (at least 2 mm) re­mains.
Femoral drill guide size = Radius of the
4 mm
2 mm
6 mm
tunnel + 2 mm posterior cortex.
E.g. Femoral tunnel is 8 mm,
Femoral drill guide = 4 + 2 = 6 mm
3.2 Place the hook of the Femoral drill
guide at the over-the-top position, in
direct contact with the bony cortex.
Different techniques can be used, e.g.
transtibial or medial portal techniques.
Ideal position is the footprint of ACL,
or use 10–11 o'clock in the right knee
4
or 1–2 o'clock in the left knee as the
reference.
3.3 Use the Drill guide pin w/ eyelet
(INS-9337) to drill through the femur
and penetrate the skin.
A 4.5 mm Cannulated headed reamer
(INS-9326) is used to make the femur
passing channel.
3.4 Measure the total length of passing
channel using the Femoral depth
gauge (INS-9327).
Surgical technique
3.5 Select the Cannulated headed
reamer (INS-9306–9310) that
corresponds to the graft size needed to
create the femoral tunnel.
The length of Inion FlipButton™ loop
is in relation to the total length of
the passing channel and the desired
femoral tunnel.
loop length = passing channel –
desired femoral tunnel + 10 mm
10 mm for button flipping
Note: For grafts thicker than 8 mm in
diameter, select the next larger loop
size.
Passing channel
Loop length
E.g. passing channel is 45 mm,
the desired femoral tunnel is 35 mm,
loop length = 45 – 35 + 10 = 20 mm.
Desired femoral tunnel
Inion FlipButton™ provides different
length loops from 12 mm to 60 mm.
5
Femoral tunnel
35 mm
3.6 Pass the graft through the Inion
FlipButton™ loop. Mark a line on the
graft 35 mm (the desired femoral
tunnel) from the looped end of the
graft..
4. Introducing the graft
4.1 Load a #2 or #5 polyester suture as
the passing suture through the eyelet
of the Drill guide pin (INS-9337). Pull
the Drill guide pin through the femoral
channel. Pass one end of the suture
out of the knee joint via femoral tunnel
and leave another end of the suture in
the knee joint.
A grasper is used to retrieve and then
pull out the other end of the suture
through tibial tunnel.
Surgical technique
4.2 Use either one of the two #5
sutures preloaded to Inion FlipButton™
as the leading suture or the flipping
suture.
Use the passing suture to pass the
leading suture and the flipping suture
out of proximal skin. Then remove the
passing suture.
1
4.3 Pull the leading suture first to
advance the ACL graft into femoral
tunnel until the marking line reaches
the internal femoral aperture.
2
Then pull the flipping suture to flip the
button plate.
6
3
Hold the Inion FlipButton™
perpendicular to the femoral cortex
and then pull back the graft to lock the
button plate to the femoral cortex.
5. Creating tibial fixation
5.1 Insert the Inion Hexalon™ screw
with the cannulated screwdriver over
the guide wire to tibial side.
Screw diameter is usually same or a
size larger than the graft diameter, and
length 30 mm.
Insert the screw up to the tibial plateau,
but ensure that the screw tip remains
completely inside the bone.
5.2 Cut the remaining part of the graft
outside the tibial tunnel.
Ordering information
Inion FlipButton™
Art. No.
Description
FLB-0012
Inion FlipButton™ 12 mm
FLB-0015
Inion FlipButton™ 15 mm
FLB-0020
Inion FlipButton™ 20 mm
FLB-0025
Inion FlipButton™ 25 mm
FLB-0030
Inion FlipButton™ 30 mm
FLB-0035
Inion FlipButton™ 35 mm
FLB-0040
Inion FlipButton™ 40 mm
FLB-0045
Inion FlipButton™ 45 mm
FLB-0050
Inion FlipButton™ 50 mm
FLB-0055
Inion FlipButton™ 55 mm
FLB-0060
Inion FlipButton™ 60 mm
Inion Hexalon™
Art. No.
Description
ACL-4113
Single packed Screw 6 x 20 mm
ACL-4114
Single packed Screw 6 x 25 mm
ACL-4115
Single packed Screw 6 x 30 mm
ACL-4101
Single packed Screw 7 x 20 mm
ACL-4102
Single packed Screw 7 x 25 mm
ACL-4103
Single packed Screw 7 x 30 mm
ACL-4104
Single packed Screw 8 x 20 mm
ACL-4105
Single packed Screw 8 x 25 mm
ACL-4106
Single packed Screw 8 x 30 mm
ACL-4107
Single packed Screw 9 x 20 mm
ACL-4108
Single packed Screw 9 x 25 mm
ACL-4109
Single packed Screw 9 x 30 mm
ACL-4112
Single packed Screw 10 x 30 mm
7
Ordering Information
Inion® ACL Instrument Set
Art. No.
Description
INS-9301
Cannulated drill bit, 6 mm
INS-9302
Cannulated drill bit, 7 mm
INS-9303
Cannulated drill bit, 8 mm
INS-9304
Cannulated drill bit, 9 mm
INS-9305
Cannulated drill bit, 10 mm
INS-9326
Cannulated headed reamer, 4.5 mm
INS-9306
Cannulated headed reamer, 6 mm
INS-9307
Cannulated headed reamer, 7 mm
INS-9308
Cannulated headed reamer, 8 mm
INS-9309
Cannulated headed reamer, 9 mm
INS-9310
Cannulated headed reamer, 10 mm
INS-9321
Femoral drill guide, 5 mm offset
INS-9322
Femoral drill guide, 6 mm offset
INS-9323
Femoral drill guide, 7 mm offset
INS-9331
Drill guide arm
INS-9332
Drill guide pin sleeve
INS-9333
Tibial pin marking hook, 55°
INS-9335
Tendon stripper, 7 mm
INS-9327
Femoral depth gauge
INS-9351
Graft preparation station base
INS-9352
Soft tissue clamp, adjustable (2pcs)
INS-9341
Graft sizer
INS-9339
Jacobs chuck handle
INS-9340
Key for Jacobs chuck handle
INS-9200
Inion Hexalon™ Screwdriver
INS-9207
Inion Hexalon™ RapidNotcher
INS-9342
ACL instrument tray
INS-9300
ACL instrument set and tray (complete set)
Additional Inion® Instruments
Art. No.
Description
INS-9203
Guide wire 38 cm (5 pcs)
INS-9336
Drill guide pin w/o eyelet, 2.5 mm x 25 cm (5 pcs)
INS-9337
Drill guide pin w/ eyelet, 2.5 mm x 38 cm (5 pcs)
INION OY
INION INC
Lääkärinkatu 2
2800 Glades Circle
FI-33520 Tampere, FINLAND
Suite 138, Weston
tel: +358-10-830 6600
FL 33327
fax: +358-10-830 6601
USA
email: [email protected]
Toll-free tel: 866-INION-US
internet: www.inion.com
tel: 954-659-9224·fax: 954-659-7997
30000380
Version 1: 11 /2015