ACL Attachable Button System Surgical Technique

Attachable Button System (ABS) The ABS has revolutionized tibial fixation of ACL and PCL grafts used in knee ligament surgery. ABS loops can be used on all graft types and attached to a variety of button configurations for fixation over sockets created with a drill or full tunnels with concave buttons. The flat-tape ABS loop improves handling characteristics and is designed to reduce graft abrasion. The two-piece ABS implant easily passes through narrow bone tunnels and allows increased cortical fixation with the assembly of a large button over the cortical bone. Use the ABS for tibial fixation...

ABS Implant (Standard) The standard ABS implant was designed specifically for grafts that can be folded over the looped end of the implant. The improved packaging design conveniently holds the ABS implant and blue passing suture. The passing suture can be attached in between the spliced portions of the ABS implant as a luggage tag stitch to aid in shuttling the ABS implant through the tunnel. ACL Attachable Button System I 03

ABS Button Overview The advantages of the ABS implant include: ■ Strong, reliable cortical fixation superior to interference screws1 ■ Maximum graft-to-bone contact improves incorporation and healing2 Concave ABS Buttons Ideal for both sockets and full tunnel applications (14 mm and 20 mm buttons). The centering feature of these buttons maintains position over the tunnel and provides a better seal at the cortex than standard flat buttons. The concave surface countersinks sutures and knots. The 14 mm and 20 mm buttons have slots for the implant loop along with two holes for additional sutures....

Graft Options ABS implant fixation can be used with any graft type. The ABS loop allows the fixation of grafts that can be passed around a closed loop (hamstrings). ACL Attachable Button System I 05

Technique: Fixation Over Tibial Sockets Using the InternalBrace Technique A tibial socket can be prepared with the FlipCutter drill and the side-release RetroConstruction guide. FlipCutter drills create socket diameters from 6 mm to 12 mm while only leaving a small 3.5 mm perforation through the cortex. 2 Pass the ABS loop through the tibial socket by attaching a passing suture to the spliced area. Note: Pass any backup sutures attached to the graft. 06 I ACL Attachable Button System 3 Once the ABS loop is passed, remove the passing suture and pull on the inside of the loop and backup sutures...

4 Load the 11 mm concave ABS button onto the proximal portion of the loop by passing each side through its respective slot on the button. Pull on the tensioning strands to advance the button toward the bone. Load the FiberTape and backup sutures into the slots before the button enters the skin. 6 Use the 5.2 mm tap in the drilled hole and tap the socket. 5 Using the spade-tip drill from the ACL Backup Kit, drill into the tibia to the depth of the drill collar. This represents 20 mm. 7 In full extension, pass the FiberTape and backup sutures through the SwiveLock anchor. Insert the anchor into...

8 Cut the FiberTape suture flush. Cycle the knee several times and retension the RT and ABS implants. 08 I ACL Attachable Button System 9 Final fixation: Tie the tensioning sutures of the tibial ABS implant over the ABS button for additional resistance.

Technique: Fixation Over Full Tunnels After passing the graft transtibially, attach the ABS button to the proximal ABS loop by inserting each side into its respective slot and pulling the button down to the spliced area where it will be locked onto the loop (1a). If using backup sutures, place them through the additional holes in the button. Pull the ABS implant tensioning strands to advance the button to bone. Ensure the collar of the button enters the tunnel and the button is lying on the cortex (1b). 2 Final graft tension may now be set by pulling on the tensioning strands of the implant....