Knee Ligament Solutions

Smith+Nephew invites you to reimagine reconstruction with our ligament portfolio based on patient pathology and high-quality techniques.

Watch the reimagine reconstruction animation:

Hamstring grafts are still the most popular graft choice for reconstructing the ACL globally.¹

The UltraSTAR ACL-R (Single Tendon ACL Reconstruction) technique is a great solution for surgeons who want to use a hamstring graft but also want lower case morbidity from reduced hamstring harvest² without having to change their drilling approach.

UltraSTAR features a double ULTRABUTTON^◊ Adjustable Fixation Device construct which has shown low displacement during cyclic loading.^*3-6

Watch the UltraSTAR animation

Surgical technique videos with Dr. Mark Bowen

• UltraSTAR Hamstring Graft Harvest
• UltraSTAR Short Hamstring Graft Preparation
• UltraSTAR Hamstring Graft Preparation

Want the full picture? Read the brochure

*For an adjustable fixation device; as demonstrated in bench top testing

References

1. ISAKOS - Newsletter v1 (2021)​
2. Sengoku T, Nakase J, Asai K, et al. The effect of gracilis tendon harvesting in addition to semitendinosus tendon harvesting on knee extensor and flexor strength after anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg. Published online April 2, 2021.​
3. Arthrocare 2016. Test Report: Comparative Testing of ULTRABUTTON Adjustable Fixation Device to Competitive Devices P/N 69889-01 C. NOTE: The results of in vitro simulation testing have not been proven to predict clinical performance.​
4. Ahmad SS, Hirschmann MT, Voumard B, et al. Adjustable loop ACL suspension devices demonstrate less reliability in terms of reproducibility and irreversible displacement. Knee Surg Sports Traumatol Arthrosc. 2018;26(5):1392-1398. ​
5. Arthrocare Corporation 2018. Test Report: Comparative Testing of ULTRABUTTON Adjustable Fixation Device to Competitive Devices. P/N 69889-01 F.​
6. Arthrocare 2018. Test Report: Comparative Testing of ULTRABUTTON Adjustable Fixation Device to Competitive Devices P/N 69889-01 D.

The most commonly used graft for ACL Reconstruction is a semitendinosus with a gracilis.¹

The UltraSURE ACL Reconstruction technique enables the use of this type of graft along with trusted fixation technologies with the ULTRABUTTON^◊ Adjustable Fixation Device and the advanced biocomposite screw, BIOSURE^◊ REGENESORB^◊. Versatile drilling options provide the ability to use single fluted reamers designed to minimize iatrogenic damage to the femoral condyle when drilling or other preferred drilling options​.

Watch the UltraSURE animation

Surgical technique videos with Dr. Vehniah Tjong​

• UltraSURE Hamstring Graft Harvest
• UltraSURE Hamstring Graft Preparation

Want the full picture? Read the brochure

Reference

1. Tibor L, Chan P, Funahashi T, et al. Surgical technique trends in primary ACL reconstruction from 2007 to 2014. J Bone Joint Surg Am. 2016;98:1079-89.​

Quad tendon bone grafts can provide​

• Direct bone-to-bone integration of the graft, similar to BTB grafts
• Predictable, larger graft diameter^1,2,3

The REGENESORB quad tendon-bone (QT-B) technique uses the innovative, open-architecture BIOSURE^◊​
REGENESORB Interference Screw for bone ingrowth across the screw^*4 with a quadriceps tendon bone​ graft which provides a lower risk of anterior knee pain^1,5,6 and predictable, larger graft diameter^1,2,3 as compared to bone-tendon-bone and BTB or hamstring grafts, respectively.

Watch the rationale for quad tendon graft with Dr. Lee Murphy

Surgical videos with Dr. Geoffrey Van Thiel​

• REGENESORB QT-B Quadriceps Tendon with Bone Block Graft Harvest Technique
• REGENESORB QT-B Quadriceps Tendon with Bone Block Graft Preparation Technique

Want the full picture? Read the brochure

* As demonstrated in vivo​

References

1. Buerba RA, Boden SA, Lesniak B. Graft Selection in Contemporary Anterior Cruciate Ligament Reconstruction. JAAOS: Global Research and Reviews. 2021;5(10).​
2. Todor A, Nistor DV, Caterev S. Clinical outcomes after ACL reconstruction with free quadriceps tendon autograft versus hamstring tendons autograft. A retrospective study with a minimal follow-up two years. Acta Orthop Traumatol Turc. 2019;53(3):180-183. doi:10.1016/j.aott.2019.03.004​
3. Runer A, Csapo R, Hepperger C, Herbort M, Hoser C, Fink C. Anterior Cruciate Ligament Reconstructions With Quadriceps Tendon Autograft Result in Lower Graft Rupture Rates but Similar Patient-Reported Outcomes as Compared With Hamstring Tendon Autograft: A Comparison of 875 Patients. AJSM. 2020;48(9).​
4. Smith+Nephew 2015. BIOSURE^◊ REGENESORB^◊ ovine ACL implantation study NCS250.​
5. Lund, Bent et al. “Is Quadriceps Tendon a Better Graft Choice Than Patellar Tendon? A Prospective Randomized Study.” Arthroscopy 2014; 30(5): 593-598.​
6. Malinowski K, Paszkowski J, Mostowy M, Goralczyk A, Laprade RF, Hermanowicz K. Quadriceps Tendon-Bone Full-Thickness Autograft: Reproducible and Easy Harvesting Technique Using Simple Surgical Tools. Arthroscopy Techniques. 2021;10(4).​

ACL reconstruction with a BTB graft offers:​

• High initial graft strength and stiffness^1,2,3​
• Faster fixation site healing as compared to soft tissue to bone^4​
• Favorable clinical results^5,6​
• High level of patient satisfaction after long term follow-up^5,6

The REGENESORB bone-tendon-bone (BTB) technique takes BTB ACL reconstruction procedure to the next level by utilizing an advanced biocomposite, open-architecture BIOSURE^◊ REGENESORB Interference Screw for fixation. The CLANCY ANATOMIC CRUCIATE GUIDE Flexible Drill System provides the instrumentation to achieve the right trajectory and femoral entry point in anatomic repairs.^7-11

Watch the REGENESORB BTB animation

Watch surgical technique videos with Dr. Jorge Chahla​

• REGENESORB BTB Hamstring Graft Harvest
• REGENESORB BTB Hamstring Graft Preparation

Want the full picture? Read the brochure

References

1. Cerulli G, Placella G, Sebastiani E, et al. ACL reconstruction: choosing the graft. Joints. 2013;1(1):18-24.​
2. West RV, Harner CD. Graft selection in Anterior Cruciate Ligament Reconstruction. J Am Acad Orthop Surg. 2005;13(3):197-207.​
3. Slone H, Romine S, Premkumar A, Xerogeanes J. Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction: A Comprehensive Review of Current Literature and Systematic Review of Clinical Results. J Arthrosc Relat Surg. 2015;31(3):541-554.​
4. Buerba RA, Boden SA, Lesniak B. Graft Selection in Contemporary Anterior Cruciate Ligament Reconstruction. JAAOS: Global Research and Reviews. 2021;5(10).​
5. Salmon LJ, Russell VJ, Refshauge K, et al. Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med. 2006;34(5):721-32.​
6. Lebel B, Hulet C, Galaud B, Burdin G, Locker B, Vielpeau C. Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft: a minimum 10-year follow-up. Am J Sports Med. 2008;36(7):1275-82. ​
7. Kim JG, Chang MH, Lim HC, et al. An in Vivo 3D Computed Tomographic Analysis of Femoral Tunnel Geometry and Aperture Morphology Between Rigid and Flexible Systems in Double-Bundle Anterior Cruciate Ligament Reconstruction Using the Transportal Technique. Arthroscopy. 2015;31(7):1318-1329. ​
8. Smith+Nephew 2012.Validation, CLANCY Anatomic Flexible Drill Guide System. Internal Report. 15001409 Rev A. ​
9. Bedi A, Altchek DW. The "footprint" anterior cruciate ligament technique: an anatomic approach to anterior cruciate ligament​ reconstruction. Arthroscopy. 2009;25(10):1128-1138. ​
10. Rasmussen JF, Lavery KP, Dhawan A. Anatomic Anterior Cruciate Ligament Reconstruction With a Flexible Reamer System and 70° Arthroscope. Arthroscopy Techniques. 2013;2(4):e319-e322. ​
11.  Runer A, Csapo R, Hepperger C, Herbort M, Hoser C, Fink C. Anterior Cruciate Ligament Reconstructions With Quadriceps Tendon Autograft Result in Lower Graft Rupture Rates but Similar Patient-Reported Outcomes as Compared With Hamstring Tendon Autograft: A Comparison of 875 Patients. AJSM. 2020;48(9).