BTB TransFix ACL Reconstruction

Bone Tendon Bone Bio-TransFix® II

ACL Reconstruction

Surgical Technique

Actual size of Bone Tendon

Bio-TransFix Implant

Actual size of 7 mm x 28 mm
Full Thread Bio-Interference Screw

This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals
in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use
their professional judgment in making any final determinations in product usage and technique.
In doing so, the medical professional should rely on their own training and experience and should conduct
a thorough review of pertinent medical literature and the product’s Directions For Use.

Actual size of metal

TransFix Implant

U.S. PATENT NOS. 5,895,425; 5,918,604; 6,132,433; 6,371,124; 6,537,319; 6,544,281; 6,623,524;
6,629,977; 6,733,529; 6,875,216; 6,974,477; 7,066,956; 7,077,863; 7,306,626 and PATENTS PENDING

© 2009, Arthrex Inc. All rights reserved. LT0125C

 BTB TransFix ACL Reconstruction
Bone Tendon Bone Bio-TransFix® II
ACL Reconstruction

Surgical Technique

Actual size of Bone Tendon

Bio-TransFix Implant

Actual size of 7 mm x 28 mm
Full Thread Bio-Interference Screw

This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals
in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use
their professional judgment in making any final determinations in product usage and technique.
In doing so, the medical professional should rely on their own training and experience and should conduct
a thorough review of pertinent medical literature and the product’s Directions For Use.

Actual size of metal

TransFix Implant

U.S. PATENT NOS. 5,895,425; 5,918,604; 6,132,433; 6,371,124; 6,537,319; 6,544,281; 6,623,524;
6,629,977; 6,733,529; 6,875,216; 6,974,477; 7,066,956; 7,077,863; 7,306,626 and PATENTS PENDING

© 2009, Arthrex Inc. All rights reserved. LT0125C


Bone Tendon Bone Bio-TransFix II ACL Reconstruction
mm Graft Preparation
10
Shape the proximal and distal
ends of the graft to the appro-
priate diameter. The proximal
end should have at least a
30 mm length, matching the
femoral socket length. Confirm
the size of the graft using the
Graft Sizing Block.
(Note: it is not recommended to
use any bone dowel smaller than
9 mm in diameter.)
Position the proximal bone
dowel of the graft so that the
cortical bone component is
facing up. For a BTB or
Achilles tendon graft, use a
3 mm drill to create a hole
10 mm from the proximal
end of the proximal bone
dowel. Be sure to center the
drill onto the cortical bone
component of the graft.
2 3
The femoral tunnel is created by referencing the over-the-top
position with a Transtibial Femoral ACL Drill Guide (TTG) to
create a 1 to 2 mm or less tunnel backwall.
A 2.4 mm Drill Tip Guide Pin is positioned with the TTG and
a Cannulated Headed Reamer equal to the graft diameter is drilled
to a depth of 30 mm. The drill and guide pin are removed.
Surgical Technique
1 Exposure of the guide sleeve’s marking (a) external to the guide
The tibial tunnel guide pin is anatomically positioned by
referencing a point 7 mm anterior of the PCL base with the PCL
referencing tibial guide marking hook. The tibial tunnel length
of at least 40 mm can be determined prior to guide pin place-
ment with the calibrated guide sleeve. The tibial tunnel is drilled
to a diameter 1 to 2 mm less than the graft diameter and dilators
impacted to create the final tunnel diameter equal to the graft
diameter.
The TransFix II Tunnel Hook that matches the tunnel diameter
is assembled with the TransFix II Drill Guide. The tunnel hook
is inserted through the tibial tunnel and positioned into the
femoral socket. The Guide Pin Sleeve is positioned on the skin
of the lateral thigh, a small incision is made and the sleeve
advanced to bone.
a
4 5
b a
housing indicates the need for a 50 mm Bio-TransFix Implant.
The 3 mm Drill Pin is drilled through the guide sleeve and the
tunnel hook, exiting the femur medially.
The 5 mm broach (b), with depth stop collar, is drilled over
the 3 mm guide pin to broach the cortex for the Bio-TransFix
Implant. The depth of the soft tissue is measured with the
graduations on the drill shaft and used as a secondary control
of subsequent implant insertion depth.
a TransFix Implant, 3 mm x 50 mm AR-1351L
6 b
Pass the end of a #2 FiberWire suture into the loop of the TransFix
wire.(a) Shuttle the suture out of the tibial tunnel by pulling on the
TransFix wire distally.
Remove the suture from the loop and thread the wire through the
hole in the graft (cortical side first). Reconnect the suture to the wire by
tying the end of the FiberWire around the suture loop. (b) Advance the
suture up and out of the medial knee so the connection is now outside
the knee.
The Nitinol Graft Passing Wire is hooked into the 3 mm guide
pin slot. The Guide Pin is pulled medially drawing the Nitinol
wire through the 3 mm pilot hole and the TransFix II Tunnel
Hook.
The Tunnel Hook is extracted, pulling the Graft Passing
Wire out of the tibial tunnel (a).
7 10
Cut the suture off of the TransWix wire. Simultaneously pull the
wire ends of the looped wire away from the knee to advance the
graft up through the tibial tunnel.
8 9
As the proximal bone dowel is pulled into the joint
(before pulled into the femoral socket) slight tension should
be applied to the graft distally to insure proper graft
orientation. Continue to pull the graft up into the femoral
socket. After graft passage, unrestricted back and forth
motion of the graft passing wire confirms accurate insertion
of the graft.
Secure tibial fixation is obtained with a 28 mm Full Thread Bio-
Interference Screw. A tunnel notcher should be used to create
a superior notch in the rim to ease screw insertion.
The screw may be inserted with the Torque Measurement
Device to quantify insertion torque and subsequent fixation
strength.
The 40 or 50 mm implant is hand-inserted over the Nitinol
wire. The appropriate driver is inserted over the wire until the
implant is engaged. The wire should be secured with a needle
holder at the handle exit. With combined impaction and medi-
al pulling of the wire, the implant is inserted until the driver
flange, aligned anteriorly, contacts the cortical bone surface.
Depth markings on the driver should match the prior
broach depth mark to secondarily confirm proper implant
insertion depth.
Ordering Information:
TransFix II ACL Reconstruction Set (AR-1817TS)
BTB TransFix Implants & Disposables (single use & sterile):
Bone Tendon Bio-TransFix, 3 mm x 40 mm AR-135IBT
Bone Tendon Bio-TransFix, 3 mm x 50 mm AR-1351LBT
Transtibial ACL Disposables Kit, w/o Saw Blade AR-1898S
TransFix Implants & Disposables:
Bio-TransFix Implant, 5 mm x 40 mm AR-1351B
Bio-TransFix Implant, 5 mm x 50 mm AR-1351LB
TransFix Implant, 3 mm x 40 mm AR-1351
TransFix Screw, 3 mm x 40 mm AR-1363
TransFix Screw, 3 mm x 50 mm AR-1363L
TransFix II Pin & Graft Passing Wire Set AR-1978S
Delta Screw Tibial Fixation Instrumentation:
Ratcheting Screwdriver Handle AR-1999
Cannulated Short Screwdriver Shaft
for Bio-Interference Screws AR-1997SH
Torque Measurement Device AR-1990
Tibial Fixation Implants:
Full Thread Bio-Interference Screw, 7 mm x 28 mm
Full Thread Bio-Interference Screw, 8 mm x 28 mm
AR-1370TB
AR-1380TB
Full Thread Bio-Interference Screw, 9 mm x 28 mm AR-1390TB
Full Thread Bio-Interference Screw, 10 mm x 28 mm AR-1400TB
Full Thread Bio-Interference Screw, 11 mm x 28 mm AR-1403TB
Full Thread Bio-Interference Screw, 12 mm x 28 mm AR-1404TB
Femoral and Tibial Tunnel Placement Instrumentation:
ACL Cruciate Reconstruction ToolBox Set AR-1900S
Transtibial ACL Reconstruction Set AR-1817AS
Recommended Suture:
#2 FiberLoop w/Straight Needle AR-7234
#2 TigerLoop w/Straight Needle AR-7234T

Bone Tendon Bone Bio-TransFix II ACL Reconstruction
mm Graft Preparation
10
Shape the proximal and distal
ends of the graft to the appro-
priate diameter. The proximal
end should have at least a
30 mm length, matching the
femoral socket length. Confirm
the size of the graft using the
Graft Sizing Block.
(Note: it is not recommended to
use any bone dowel smaller than
9 mm in diameter.)
Position the proximal bone
dowel of the graft so that the
cortical bone component is
facing up. For a BTB or
Achilles tendon graft, use a
3 mm drill to create a hole
10 mm from the proximal
end of the proximal bone
dowel. Be sure to center the
drill onto the cortical bone
component of the graft.
2 3
The femoral tunnel is created by referencing the over-the-top
position with a Transtibial Femoral ACL Drill Guide (TTG) to
create a 1 to 2 mm or less tunnel backwall.
A 2.4 mm Drill Tip Guide Pin is positioned with the TTG and
a Cannulated Headed Reamer equal to the graft diameter is drilled
to a depth of 30 mm. The drill and guide pin are removed.
Surgical Technique
1 Exposure of the guide sleeve’s marking (a) external to the guide
The tibial tunnel guide pin is anatomically positioned by
referencing a point 7 mm anterior of the PCL base with the PCL
referencing tibial guide marking hook. The tibial tunnel length
of at least 40 mm can be determined prior to guide pin place-
ment with the calibrated guide sleeve. The tibial tunnel is drilled
to a diameter 1 to 2 mm less than the graft diameter and dilators
impacted to create the final tunnel diameter equal to the graft
diameter.
The TransFix II Tunnel Hook that matches the tunnel diameter
is assembled with the TransFix II Drill Guide. The tunnel hook
is inserted through the tibial tunnel and positioned into the
femoral socket. The Guide Pin Sleeve is positioned on the skin
of the lateral thigh, a small incision is made and the sleeve
advanced to bone.
a
4 5
b a
housing indicates the need for a 50 mm Bio-TransFix Implant.
The 3 mm Drill Pin is drilled through the guide sleeve and the
tunnel hook, exiting the femur medially.
The 5 mm broach (b), with depth stop collar, is drilled over
the 3 mm guide pin to broach the cortex for the Bio-TransFix
Implant. The depth of the soft tissue is measured with the
graduations on the drill shaft and used as a secondary control
of subsequent implant insertion depth.
a TransFix Implant, 3 mm x 50 mm AR-1351L
6 b
Pass the end of a #2 FiberWire suture into the loop of the TransFix
wire.(a) Shuttle the suture out of the tibial tunnel by pulling on the
TransFix wire distally.
Remove the suture from the loop and thread the wire through the
hole in the graft (cortical side first). Reconnect the suture to the wire by
tying the end of the FiberWire around the suture loop. (b) Advance the
suture up and out of the medial knee so the connection is now outside
the knee.
The Nitinol Graft Passing Wire is hooked into the 3 mm guide
pin slot. The Guide Pin is pulled medially drawing the Nitinol
wire through the 3 mm pilot hole and the TransFix II Tunnel
Hook.
The Tunnel Hook is extracted, pulling the Graft Passing
Wire out of the tibial tunnel (a).
7 10
Cut the suture off of the TransWix wire. Simultaneously pull the
wire ends of the looped wire away from the knee to advance the
graft up through the tibial tunnel.
8 9
As the proximal bone dowel is pulled into the joint
(before pulled into the femoral socket) slight tension should
be applied to the graft distally to insure proper graft
orientation. Continue to pull the graft up into the femoral
socket. After graft passage, unrestricted back and forth
motion of the graft passing wire confirms accurate insertion
of the graft.
Secure tibial fixation is obtained with a 28 mm Full Thread Bio-
Interference Screw. A tunnel notcher should be used to create
a superior notch in the rim to ease screw insertion.
The screw may be inserted with the Torque Measurement
Device to quantify insertion torque and subsequent fixation
strength.
The 40 or 50 mm implant is hand-inserted over the Nitinol
wire. The appropriate driver is inserted over the wire until the
implant is engaged. The wire should be secured with a needle
holder at the handle exit. With combined impaction and medi-
al pulling of the wire, the implant is inserted until the driver
flange, aligned anteriorly, contacts the cortical bone surface.
Depth markings on the driver should match the prior
broach depth mark to secondarily confirm proper implant
insertion depth.
Ordering Information:
TransFix II ACL Reconstruction Set (AR-1817TS)
BTB TransFix Implants & Disposables (single use & sterile):
Bone Tendon Bio-TransFix, 3 mm x 40 mm AR-135IBT
Bone Tendon Bio-TransFix, 3 mm x 50 mm AR-1351LBT
Transtibial ACL Disposables Kit, w/o Saw Blade AR-1898S
TransFix Implants & Disposables:
Bio-TransFix Implant, 5 mm x 40 mm AR-1351B
Bio-TransFix Implant, 5 mm x 50 mm AR-1351LB
TransFix Implant, 3 mm x 40 mm AR-1351
TransFix Screw, 3 mm x 40 mm AR-1363
TransFix Screw, 3 mm x 50 mm AR-1363L
TransFix II Pin & Graft Passing Wire Set AR-1978S
Delta Screw Tibial Fixation Instrumentation:
Ratcheting Screwdriver Handle AR-1999
Cannulated Short Screwdriver Shaft
for Bio-Interference Screws AR-1997SH
Torque Measurement Device AR-1990
Tibial Fixation Implants:
Full Thread Bio-Interference Screw, 7 mm x 28 mm
Full Thread Bio-Interference Screw, 8 mm x 28 mm
AR-1370TB
AR-1380TB
Full Thread Bio-Interference Screw, 9 mm x 28 mm AR-1390TB
Full Thread Bio-Interference Screw, 10 mm x 28 mm AR-1400TB
Full Thread Bio-Interference Screw, 11 mm x 28 mm AR-1403TB
Full Thread Bio-Interference Screw, 12 mm x 28 mm AR-1404TB
Femoral and Tibial Tunnel Placement Instrumentation:
ACL Cruciate Reconstruction ToolBox Set AR-1900S
Transtibial ACL Reconstruction Set AR-1817AS
Recommended Suture:
#2 FiberLoop w/Straight Needle AR-7234
#2 TigerLoop w/Straight Needle AR-7234T

Bone Tendon Bone Bio-TransFix II ACL Reconstruction
mm Graft Preparation
10
Shape the proximal and distal
ends of the graft to the appro-
priate diameter. The proximal
end should have at least a
30 mm length, matching the
femoral socket length. Confirm
the size of the graft using the
Graft Sizing Block.
(Note: it is not recommended to
use any bone dowel smaller than
9 mm in diameter.)
Position the proximal bone
dowel of the graft so that the
cortical bone component is
facing up. For a BTB or
Achilles tendon graft, use a
3 mm drill to create a hole
10 mm from the proximal
end of the proximal bone
dowel. Be sure to center the
drill onto the cortical bone
component of the graft.
2 3
The femoral tunnel is created by referencing the over-the-top
position with a Transtibial Femoral ACL Drill Guide (TTG) to
create a 1 to 2 mm or less tunnel backwall.
A 2.4 mm Drill Tip Guide Pin is positioned with the TTG and
a Cannulated Headed Reamer equal to the graft diameter is drilled
to a depth of 30 mm. The drill and guide pin are removed.
Surgical Technique
1 Exposure of the guide sleeve’s marking (a) external to the guide
The tibial tunnel guide pin is anatomically positioned by
referencing a point 7 mm anterior of the PCL base with the PCL
referencing tibial guide marking hook. The tibial tunnel length
of at least 40 mm can be determined prior to guide pin place-
ment with the calibrated guide sleeve. The tibial tunnel is drilled
to a diameter 1 to 2 mm less than the graft diameter and dilators
impacted to create the final tunnel diameter equal to the graft
diameter.
The TransFix II Tunnel Hook that matches the tunnel diameter
is assembled with the TransFix II Drill Guide. The tunnel hook
is inserted through the tibial tunnel and positioned into the
femoral socket. The Guide Pin Sleeve is positioned on the skin
of the lateral thigh, a small incision is made and the sleeve
advanced to bone.
a
4 5
b a
housing indicates the need for a 50 mm Bio-TransFix Implant.
The 3 mm Drill Pin is drilled through the guide sleeve and the
tunnel hook, exiting the femur medially.
The 5 mm broach (b), with depth stop collar, is drilled over
the 3 mm guide pin to broach the cortex for the Bio-TransFix
Implant. The depth of the soft tissue is measured with the
graduations on the drill shaft and used as a secondary control
of subsequent implant insertion depth.
a TransFix Implant, 3 mm x 50 mm AR-1351L
6 b
Pass the end of a #2 FiberWire suture into the loop of the TransFix
wire.(a) Shuttle the suture out of the tibial tunnel by pulling on the
TransFix wire distally.
Remove the suture from the loop and thread the wire through the
hole in the graft (cortical side first). Reconnect the suture to the wire by
tying the end of the FiberWire around the suture loop. (b) Advance the
suture up and out of the medial knee so the connection is now outside
the knee.
The Nitinol Graft Passing Wire is hooked into the 3 mm guide
pin slot. The Guide Pin is pulled medially drawing the Nitinol
wire through the 3 mm pilot hole and the TransFix II Tunnel
Hook.
The Tunnel Hook is extracted, pulling the Graft Passing
Wire out of the tibial tunnel (a).
7 10
Cut the suture off of the TransWix wire. Simultaneously pull the
wire ends of the looped wire away from the knee to advance the
graft up through the tibial tunnel.
8 9
As the proximal bone dowel is pulled into the joint
(before pulled into the femoral socket) slight tension should
be applied to the graft distally to insure proper graft
orientation. Continue to pull the graft up into the femoral
socket. After graft passage, unrestricted back and forth
motion of the graft passing wire confirms accurate insertion
of the graft.
Secure tibial fixation is obtained with a 28 mm Full Thread Bio-
Interference Screw. A tunnel notcher should be used to create
a superior notch in the rim to ease screw insertion.
The screw may be inserted with the Torque Measurement
Device to quantify insertion torque and subsequent fixation
strength.
The 40 or 50 mm implant is hand-inserted over the Nitinol
wire. The appropriate driver is inserted over the wire until the
implant is engaged. The wire should be secured with a needle
holder at the handle exit. With combined impaction and medi-
al pulling of the wire, the implant is inserted until the driver
flange, aligned anteriorly, contacts the cortical bone surface.
Depth markings on the driver should match the prior
broach depth mark to secondarily confirm proper implant
insertion depth.
Ordering Information:
TransFix II ACL Reconstruction Set (AR-1817TS)
BTB TransFix Implants & Disposables (single use & sterile):
Bone Tendon Bio-TransFix, 3 mm x 40 mm AR-135IBT
Bone Tendon Bio-TransFix, 3 mm x 50 mm AR-1351LBT
Transtibial ACL Disposables Kit, w/o Saw Blade AR-1898S
TransFix Implants & Disposables:
Bio-TransFix Implant, 5 mm x 40 mm AR-1351B
Bio-TransFix Implant, 5 mm x 50 mm AR-1351LB
TransFix Implant, 3 mm x 40 mm AR-1351
TransFix Screw, 3 mm x 40 mm AR-1363
TransFix Screw, 3 mm x 50 mm AR-1363L
TransFix II Pin & Graft Passing Wire Set AR-1978S
Delta Screw Tibial Fixation Instrumentation:
Ratcheting Screwdriver Handle AR-1999
Cannulated Short Screwdriver Shaft
for Bio-Interference Screws AR-1997SH
Torque Measurement Device AR-1990
Tibial Fixation Implants:
Full Thread Bio-Interference Screw, 7 mm x 28 mm
Full Thread Bio-Interference Screw, 8 mm x 28 mm
AR-1370TB
AR-1380TB
Full Thread Bio-Interference Screw, 9 mm x 28 mm AR-1390TB
Full Thread Bio-Interference Screw, 10 mm x 28 mm AR-1400TB
Full Thread Bio-Interference Screw, 11 mm x 28 mm AR-1403TB
Full Thread Bio-Interference Screw, 12 mm x 28 mm AR-1404TB
Femoral and Tibial Tunnel Placement Instrumentation:
ACL Cruciate Reconstruction ToolBox Set AR-1900S
Transtibial ACL Reconstruction Set AR-1817AS
Recommended Suture:
#2 FiberLoop w/Straight Needle AR-7234
#2 TigerLoop w/Straight Needle AR-7234T
 BTB TransFix ACL Reconstruction
Bone Tendon Bone Bio-TransFix® II
ACL Reconstruction

Surgical Technique

Actual size of Bone Tendon

Bio-TransFix Implant

Actual size of 7 mm x 28 mm
Full Thread Bio-Interference Screw

This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals
in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use
their professional judgment in making any final determinations in product usage and technique.
In doing so, the medical professional should rely on their own training and experience and should conduct
a thorough review of pertinent medical literature and the product’s Directions For Use.

Actual size of metal

TransFix Implant

U.S. PATENT NOS. 5,895,425; 5,918,604; 6,132,433; 6,371,124; 6,537,319; 6,544,281; 6,623,524;
6,629,977; 6,733,529; 6,875,216; 6,974,477; 7,066,956; 7,077,863; 7,306,626 and PATENTS PENDING

© 2009, Arthrex Inc. All rights reserved. LT0125C