Bio Mini-Revo™

Surgical Technique MINI SIZED, MAXIMUM PERFORMANCE

Self-Reinforced 96L/4D Poly Lactic Acid

Low Profile Instrument Set

High Pull-out Strength

Proven Screw-in Design Ensures Optimal Purchase in bone

PreloadedDisposableInserter

2.1 mm Bone Punch

2.1 mm Drill Bit

2.4 mm Tap

Serrated Drill Guide

Fishmouth Drill Guide

Bio Mini-Revo™

3.1mmOuterDiameter

#2Hi-FiHighStrengthSuture

Self-Reinforced96L/4DPolyLacticAcid

Proximalanddistallaseretchmarks

Bio Mini-Revo™

Mini Size, Maximum Performance

Surgical Technique

inTrODucTiOnTheBioMini-Revosutureanchorisa3.1mmdiameterscrew-inimplantmanufacturedfromConMedLinvatec’spatentedSelfReinforced96L/4DPolyLacticAcid.Theimplantispre-loadedonadisposabledriverandispre-threadedwith#2Hi-Fihighstrengthsuture.Thecombinationofhighpulloutstrengthandidealbioabsorbablecharacteristicsinasmallpre-loadedimplantwillmakeittheimplantofchoiceforallshoulderinstabilityprocedures.Theuniquelowprofileinstrumentsetthatincludesdrillguides,drillbit,bonepunchandaself-drillingtapprovidepreciseplacementofthepilotholeandtheimplantforareproducibletechnique.

The following techniques are described by Stephen J. Snyder, MD, Van Nuys, CA

Bio Mini-Revo™ Surgical Technique

STep 1 – Tobegintheposterior-inferiorcapsularplicationasynovialraspisusedtoabradetheposteriorinferiorcapsuleandthelabraledge.AConMedLinvatec4.2mmUltraCut®bladeisalsousedtodebrideanyfrayedortornlabralorsynovialtissue.

STep 2 – Inserta8mmDry-Doc®cannulaintotheposteriorportal.Createthefirstposteriorplicationstitchbyinsertinga45°or60°degreeSpectrum®IISutureHookloadedwithaShuttleRelay™suturepasserintotheposteriormid-glenoidportal.Thefirststitchismadeatthe6:30posi-tionabout1to1.5cmawayfromthelabrum.Passtheneedleperpendicularlythroughthecapsuleandrotateittocapturea4-5mm“pinch”oftissue.Advancetheneedletothelabrum-capsulejunctiontopiercethetissuesothattheneedleexitsnearthearticularcartilage.RetrievetheShuttleRelay™outtheanteriormid-glenoidportalwithanarthroscopicgraspingforceps.

Anterior Instability Reconstruction and Posterior Capsular PlicationThisarthroscopicshoulderinstabilityprocedurecanbeperformedwiththepatienteitherinthelateraldecubitusorbeachchairposition.Forthelateralposition,thearmissuspendedin70degreesofabductionand10degreesofforwardflexionusingashouldertractiondevice.Thestandardposteriormid-glenoidportalandahighanterior-superior(rotatorinterval)portalareestablishedusinganoutside-intechnique.Amid-glenoidoperatingportaliscreatedbyfirstinsertingaspinalneedle2cminferiorand1cmmedialtotheanteriorsuperiorportalsothatitentersthejointatthesuperior-lateralattachmentofthesubscapularistendon.A8mmDry-Doc®operatingcannulaisinsertedeitherdirectlyintothejointorovertheguiderod(whentheportalisalreadyestablished).Thescopeismaintainedintheanteriorsuperiorportalforviewingboththeanteriorandposteriorrepair.

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Posterior Plication Stitches

Bio Mini-Revo™ Surgical Technique Designed in conjunction with Stephen J. Snyder, MD

STep 3 – LoadtheShuttleRelay™suturepasserwitha#2polyestersutureandpullbackthroughthelabrumandouttheposteriorDry-Doc®cannula.

STep 4 – Usingacrochethookfromtheanteriorportal,retrievetheposteriorlimbofthesamesutureouttheanteriorcannulaandtheanteriorlimbintotheposteriorcannulatoprepareforafigure-8stitch.

STep 5 – PasstheSpectrum®IISutureHookloadedwithaShuttleRelay®againthroughthecapsuleandlabruminasecond“pinch-tuck”about1cmposteriorandparalleltothefirstpass.

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Bio Mini-Revo™ Surgical Technique

STep 6 – LoadtheShuttleRelay™suturepasserwiththesutureintheanteriormid-glenoidportalandcarryitbackthroughthelabrumandintotheposteriorcannula.

STep 7 – Usingacrochethook,theotherlimbofsutureisretrievedouttheposteriorcannula.

STep 8 – StorethispairofsuturesinagreenSutureSaver™sheathoutsidetheposteriorcannula.Theywillbetiedaftertheanteriorstabilizationiscompleted.

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Bio Mini-Revo™ Surgical Technique Designed in conjunction with Stephen J. Snyder, MD

STep 9 – Performadditionalposteriorplicationstitchesasneeded,eitherassimple,horizontalmattressorFigure-8stitchesandstoreeachpairinaSutureSaver™sheathoutsidetheposteriorcannula.

STep 10 – LoosentheSutureSaver™sheathsandbackthemoutafewcentimeterstorelaxtheposteriorplicationsuturessothatcapsuleisnottightwhileperformingtheanteriorreconstruction.

STep 11 – Mobilizetheanterior–inferiorcapsuleandlabrumbydetachingthemfromtheneckoftheglenoidusingaLiberator™knife/elevator.ThebonesurfaceislightlydebridedusingaConMedLinvatecUltraCut®shaverblade

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Bio Mini-Revo™ Surgical Technique

STep 12 – TheBio-Instability™FishmouthDrillGuideisinsertedthroughtheanteriormid-glenoidDry-Doc®cannulatothedesiredlocation1-2mmonthearticularsurfacearoundthe5:30position.

STep 13 – The2.1mmBio-Instability™DrillBitispassedthroughtheguideanddrilledintotheboneuntilthedistaldepthmarkisbelowthebonesurfaceandtheproxi-maldepthstophasmadecontactwiththeDrillGuide.

STep 14 – The2.4mmself-drillingBoneTapisinsertedthroughthedrillguideandscrewedintothepilotholeuntilthehorizontaldistaletchmarkisbelowthebonesurface.

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The 2.4mm Bio-Instability™ Bone Punch may also be used for this this step.

Anterior Instability Reconstruction

Bio Mini-Revo™ Surgical Technique Designed in conjunction with Stephen J. Snyder, MD

STep 15 – TheBioMini-Revo™implantisinsertedthroughthedrillguideandintothepilotholeuntilthedistaldepthmarkonthedriverisbelowthebonesurface.Do not advance the driver past this point or implant breakage may occur.Atwo-fingertorqueinsertiontechniqueisrec-ommended.Aligntheverticaletchmarkstowardtheanteriorinferiorcapsuletoensurethattheeyeletisdirectedtowardthosetissues.Removethedriverbypullingstraightback,beingsurenottotoggleitorchangethealignment.

STep 16 – Usethecrochethookthroughtheposteriorcannula,toretrievethesuturelimbfromtheanchorthatisontheanteriorinferiorsideoftheanchor.

STep 17 – A45°or60°degreeSpectrum®IISutureHook

loadedwithaShuttleRelay™suturepasserispassedthroughthecapsuleand“under”thelabrumtoforma“pinch-tuck”stitch.TheShuttleRelayisretrievedouttheposteriorcannulastay-ingabovetheanchorwithagraspingforceps.

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Bio Mini-Revo™ Surgical Technique

STep 18 – TheShuttleRelay™suturepasserisloadedwiththesutureoutsidetheposteriorcannulaandcarriedacrosstheglenoid,thelabrumandouttheanteriormid-glenoidDry-Doc®

cannula.

STep 19 – Testthemobilityofthesuturestobesuretheyeasilyslidethroughtheeyelet.Iftheyslideeasily,anSMCorotherslid-ingknotisused.Iftheydonotslide,astaticknotsuchastheRevoknotshouldbeused.

STep 20 – AdditionalBioMini-Revo™implantsareinsertedmovinginferiortosuperioruntilthelabrumissecurelyfixedtotheglenoid.

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Designed in conjunction with Stephen J. Snyder, MD

STep 21 – RemovetheposteriorcannulafromtheposteriorportalandretightentheposteriorSutureSaver™sheathsdowntothecapsuleandclampthem.ReleasetheclampfromthemostsuperiorSutureSaver™sheathandpullthesuturesandthesheathintothecannulausinganarthrosocpicgrasper.

STep 22 – PushtheSutureSaver™sheathbackdowntothecapsuleandholditstraightsothatitcanfunctionasaguiderod.Pushthecannulabackintothejointoverthesheath,removethesheathandtiethesuturesusingaRevoknot.

STep 23 – Tietheremainingsuturesusingasimilartechniquetofinishtheoperation.

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Tying the Posterior Plication Sutures

Bio Mini-Revo™ Surgical Technique

©2006 Linvatec Corporation, a subsidiary of ConMed Corporation, 2/2006, CST 3029

Implant Description ...........................................................Cat. No. BioMini-Revo,Pre-threadedwithonestrandof............................. C6170H #2Hi-Fi,disposabledriverBio Instability Instrument Set BioInstabilityDrillGuide,FishMouth............................................. C6171 BioInstabilityDrillGuide,Serrated................................................. C6172 BluntObturator............................................................................ C6173 SharpTrocar................................................................................ C6174 BioInstabilityDrillBit,2.1mm........................................................ C6175 BioInstabilityBonePunch,2.1mm................................................. C6176 BioInstabilitySelf-DrillingBoneTap,2.4mm.................................... C6177 BioInstabilitySterilizationTray...................................................... C6178Suture Passing Instrumentation Spectrum®IIHandle...................................................................... C6350 SpectrumIISterilizationTray.......................................................... C6355 SpectrumIIRollerWheelReplacementKit....................................... C6356 SutureHook,45°Right,LimitedReuse............................................ C6360 SutureHook,45°Left,LimitedReuse.............................................. C6361 SutureHook,60°Right,LimitedReuse............................................ C6362 SutureHook,60°Left,LimitedReuse.............................................. C6363 SutureHook,90°Right,LimitedReuse............................................ C6364 SutureHook,90°Left,LimitedReuse.............................................. C6365 SutureHook,CorkScrew,Right,LimitedReuse................................. C6366 SutureHook,CorkScrew,Left,LimitedReuse.................................... C6367 SutureHook,Straight,LimitedReuse............................................... C6368 SutureHook,Crescent,Small,LimitedReuse.................................... C6369 SutureHook,Crescent,Medium,LimitedReuse................................ C6370 SutureHook,Crescent,Large,LimitedReuse................................... C6371 SutureHook,45°Right,Sterile,Disposable(Red)............................ C6380 SutureHook,45°Left,Sterile,Disposable(Blue).............................. C6381 SutureHook,60°Right,Sterile,Disposable(Orange)....................... C6382 SutureHook,60°Left,Sterile,Disposable(Yellow)........................... C6383 SutureHook,Straight,Sterile,Disposable(Pink)............................... C6384 SutureHook,Crescent,Small,Sterile,Disposable(White)................. C6385 SutureHook,Crescent,Medium,Sterile,Disposable(Teal)................ C6386 SutureHook,Crescent,Large,Sterile,Disposable(Purple)................ C6387Accessories LoopHandleKnotPusher.............................................................. C6112 CrochetHook.............................................................................. C6105 SutureScissor,3.4mmDiameter,Straight......................................GU1005 Guillotine™SutureCutter,3.5mmDiameter,Straight.....................GU1007 GraspingForceps,3.4mmDiameter,StraightwithRatchet............11.1001 SutureRetrievalForceps,3.4mmDiameter....................................16.1018 Liberator™Knife.......................................................................25.50014 SutureSaver™Kit(5kits/box)........................................................ C6180 *RaspLiberatorKnife......................................................................... 25.50017 Rasp,30degree,topandbottomserrations......................................C8537.1 Mini-Probe,3.5mmdia.,straight......................................................... 21.1001 ShuttleRelay™SuturePasser(10/box)....................................................C6004 Dry-Doc®Cannula,8.0mmx75mm,yellow(5/box)................................C7367 Reusable,CannulatedObturator,8.0mmx75mm................................... 9833 Dry-DocCannula,8.0mmx85mm,red(5/box.......................................C7368 Reusable,CannulatedObturator,8.0mmx85mm................................... 9834*Buildtoorder,notCEMarked

This product contains Dyneema® Purity. Dyneema® Purity is a Registered Trademark of Royal DSM N.V.