Articomed Ltd. Biological Solutions for Bone Surgery

Articomed Ltd. Biological Solutions for Bone Surgery Articomed is a forward looking firm from Germany which is involved in the development of new in...
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Articomed Ltd.

Biological Solutions for Bone Surgery Articomed is a forward looking firm from Germany which is involved in the development of new innovative technologies for Bone Surgery and Bone Management. Articomed is providing new developments in BoneCartilage-Transplantations and Foreign-Material-Free reconstruction of Ligaments. Articomed is cooperating with opinon leaders in sportsmedicine and university clinics. Several new products have resulted from research and development cooperation with those institutions. Articomed is active in the field of Orthopedics as well as in Oral-Maxillo-Facial surgery and Implantology.

System Arthrosurge/Diasurge DBCS® – Diamond Bone Cutting System The Diamond Bone Cutting System (DBCS®) was developed to provide a less traumatic cutting and grinding of bone. Up to now more traumatic instruments such as trephines and saws are still used. Diamond core reaming is based on the principle of non-traumatic wet grinding of bones, with which can be obtained an artefact-free vital transplant cylinder and an intact implant support. The method is – as opposed to, for example, bone wedges – reproduceable and systematic because uses clearly defined sizes of instruments which are matched to each other. The method can be done completely autologous or with bone substitution materials, for example, Tutobone. In this way harvested bone cylinders can be used in many different cases, for example, bone cartilage transplantations, removal of nonunions and bone tumors, as well as for bioosteosynthesis. In the last mentioned it is possible to replace screws in some cases. New research, for example from Prof. Claus Mattheck from the Research Center in Karlsruhe, Germany, has shown that in nature trees and bones respect the “Axiom of constant tension”. That means that hard tissues such as trees and bones are growing so that the tensions are constantly distributed across the surface. He also found out that the trabecules of the cancellous bone grow according to that law and can carry the load. Because any foreign material with a different elasticity module disturbs this rule, by not using foreign materials the tensions are distributed in a natural way and ensure better healing.

... by Nature

... by Ancient Egyptians

... by Articomed !

DBCS® – revolutionary method, simple usage, biological The basic procedure of the DBCS® System is harvesting a bone cylinder or a bone-cartilage cylinder from the iliac crest or in the case of an Osteochondral Autograft Transfer (OAT) superior or lateral from the patellar groove or above the sulcus terminalis. This bone cylinder is transplanted into the recipient area which could be, for example, the knee condyle or a bone fragment which should be fixed. The donor cylinder is usually in a defined ratio bigger than the recipient socket. This provides very good inhealing of the transplanted bone cylinder as is shown by many studies. It also gives rapid stability and has immediate strength for excercise. New research from Dr. Zinser (Dinslaken, Germany) shows, for example, also very good results with using DBCS® together with application of MACI (Matrix Associated Chondrocyte Implantation).

Indications: • • •





Bone biopsies Harvesting of autologous bone material Osteocartilage Defects (Single-and composite grafts), for example: º Osteochondrosis dissecans º Traumatical cartilageulcus º Unilateral Gonarthrosis Osteosynthetical Treatments (Fracture Dowelling) º Flake fracture/Osteochondral fractures º Fractures of the joint with bone-cartilagefragments for refixation º Fractures of the condyles º Head of the Femur Necroses (Avascular Necroses of the Bone) º Metaphyseal Fractures º Spondylodeses º Arthrodeses of Symphysis, upper and lower jump joint, Root of the foot (TaloNavicular Tarso-metatarsal-I-Joint, Metarsophalane Joint) º Fractures and Nonunions of the Scaphoid and Talus Treatment of osteochondral defects with bone grafting in combination with matrix-induced ACT

Differences to other methods

Advantages:

Puzzle Technique •

Advantage: Stable complete integration of bonecartilage-cylinders – fast ingrowth through very good imbedding into the bony bearing. Core reaming with thinwalled DBCS® and additional Press-Fit-Transplantation of the harvested bone cylinder into the defect bearing ensures firm integration and fast ingrowth of the cylinder. No fibrotic or connecting tissue is formed. Rapid stability. Short stay in the clinic.

• • • •

Replacement of a defect by normal, autologous joint surface able to fully withstand transmission of loads and to integrate into surrounding tissues. No immunologic reaction given the autologous provenance of the graft. No risk of transmission of viral diseases. Suitable for circumscribed articular cartilage defects measuring 1–9 cm2 of various etiologies. Harvesting causing minimal trauma.

Mosaic Plasty

The harvesting of a bone-cartilage cylinder is provided by a punch or a conventional trephine. The difference to the DBCS®- Puzzle technic is that the defect is not filled through one or several large cylinders locked in each other (like a puzzle) but by several small blocks placed side by side. The void area is filled by fibrocartilage only, and the thin implants might dislocate under load.

Ingrowth of implant with surrounding tissue

standard trephine

• • • • •

Picture shows ingrowth of an implant 30 days after operation done by Press Fit in the patellar groove. Core reaming/grinding with DBCS® does not damage living bone cells and primary bone healing is ensured.

Diasurge diamond grinder

Press-Fit anchorage of cylinder allowing primary cancellous bone healing. Exact adaptation of surface to surrounding cartilage thanks to a procedure under direct vision. Snug fit of transplant not possible with other punches that leave gaps such as the mosaicplasty of Hangody et al (see left figure). Full weight bearing. Less expensive than procedures using disposable instruments for cartilage transplantation, and chondrocyte transplantation or total joint replacement.

New – ACL reconstruction without foreign material

The Diamond ACL Transplantation System (DATS®) in Bottom-To-Top (BTT®) All Press-Fit technique by Dr. Felmet is used for ACL reconstruction. When tendon transplant is fixed with autologous bone dowel, screws, pins or clamps are not needed. Thanks to this method the ingrowth of the bone cylinder is faster and rehabilitation is shortened. This method from Dr. Felmet is revolutionary in solidly anchoring the tendon endings in femur and tibia bone without any foreign material. All problems with ACL reconstruction have so far been solved with this method. Precise diamond core reamers are used for ALL-PRESS-FIT fixation of bone dowels in implantation channels. A specially designed target device allows exact location and conduction of implantation channels in the tibia and femur. Thanks to the BTT® Method (Bottom-To-Top) it is now possible to stretch transplantate intraarticulary and fix it close to the joint (bone dowels are pressed through tendon in place of grinded channels in tibia and femur). Using biomechanics of the knee joint the transplant is stretched naturally in extension of the knee. Implantation channels and all harvested places are filled with the rest of the bone material. ALL-PRESS-FIT reconstruction of the ACL with the Arthrosurge instruments has been used in clinics for many years.

Problems and risks connected with methods used so far • • • • • • •

“Bungee cord effect” – loosening of implant during flexion or extension of the knee “Windshield wiper effect” Synovial leaks into the tunnel Tunnel widening of the tibial channel Screws and fixing material need to be taken away from tissue, all instruments are damaging bone Using of conventional trepanation drills are traumatic for tissue and bone Interference screws can influence the early transplant remodelling and may inhibit the tunnel/graft healing due to the high pressure within the tunnel

Advantages of the Arthrosurge DATS® System for ACL reconstruction • • • • • • • • • • •

applicable with all ligaments such as BTB, STG etc. Arthroscopic ALL-PRESS-FIT technique Simple technic with a few instruments (fast learning curve) Precise use of instruments Close to the joint fixation, thus anatomically correct Sensitive and accurate grinding of the bone dowels Biological support of healing Immediately stable for exercises Easy control of results (e.g. MRI) Simple revision Cost saving

Strenght of the fixation methods*

* - Implant free Tibial Press Fit Fixation of the hamstring tendons for ACL-Reconstruction; Jagodzinski, M; Scheunemann, K; Knobloch, K; Albrecht, K; Krettek, C; Zeichen, J; Hurschler, C; Trauma Department, Hannover Medical School, Germany

Diamond Core Grinders The head of the hollow grinder is covered both internally and externally with a coating of fine diamonds which insures an atraumatic and precise grinding of the bones. The galvanic bonding of the diamonds guarantees long life with low wear if handled correctly.

Extractors The extractors, recognized by their inner profiles are used to extract the cylinders cut out of the bone. Each extractor is assigned to its corresponding diamond grinder. The top is ground sharp in order to make the cutting of cartilage tissue possible. At the end there is a hole for the extractor handle.

Applicators The applicator is used for inserting the bone cylinder into the bearing of the defect.

Push Rods Toggles in the extractors in order to twist off bone dowels with the extractors.

Drill

A drill with inner flushing and a speed of 900-1000 rpm is recommended for the procedure.

DBCS® – Diamond Bone Cutting System Set

TSM (Transplantation Set Mini)

TSS (Transplantation Set Standard)

TSX (Transplantation Set Maxi)

Sizes

1 to 5

6 to 13

14 to 17

Indications

• All kinds of foot and hand interventions • Biopsies • Open knee surgery • Trepanation • Oral and maxillofacial surgery • Sternotomies • Costal interventions • Fracture dowelling of osteocartilage fragments • Non-Unions and fractures of the scaphoid and other small bones • Removing of old Herbert Screws

• Anatomical reconstruction of joint surfaces in the knee, tibial head and ankle joint when there is an osteochondral defect or an OD • Oral- and maxillofacial surgery • Elbow and shoulder surgery • Trepanation • All kinds of foot and hand interventions • Press-Fit Collateral Ligament Fixation • AOT Autologous Osteochondral Transplantations • Mosaic Plastic • Harvesting of bone cylinders for therapy in combination with ACT

• Anatomical reconstruction of joint surfaces in the knee • Tibial head • Open knee surgery • Open surgery of the shoulder • Oral- and maxillofacial surgery • Open femoral head • Intervention to mastoid • Joints of the hand, distal surfaces of the radiusjoint and metaphysis • Mega AOT

Contains

D01 Grinder Ø 3,6/2,8 mm x 50 mm D02 Grinder Ø 4,5/3,7 mm x 50 mm D03 Grinder Ø 5,4/4,6 mm x 50 mm D04 Grinder Ø 6,3/5,5 mm x 50 mm D05 Grinder Ø 7,3/6,4 mm x 50 mm E01 Extractor Ø 2,8 mm x 50 mm E02 Extractor Ø 3,7 mm x 50 mm E03 Extractor Ø 4,6 mm x 50 mm E04 Extractor Ø 5,5 mm x 50 mm E05 Extractor Ø 6,4 mm x 50 mm S1 Push rod Ø 1,5 mm x 85 mm S2 Push rod Ø 3,3 mm x 85 mm

D06 Grinder Ø 8,35/7,45 mm x 70 mm D07 Grinder Ø 9,40/8,50 mm x 70 mm D08 Grinder Ø 10,45/9,55 mm x 70 mm D09 Grinder Ø 11,5/10,60 mm x 70 mm D10 Grinder Ø 12,7/11,65 mm x 70 mm D11 Grinder Ø 13,9/12,85 mm x 70 mm D12 Grinder Ø 15,1/14,05 mm x 70 mm D13 Grinder Ø 16,3/15,25 mm x 70 mm E06 Extractor Ø 7,45 mm x 70 mm E07 Extractor Ø 8,50 mm x 70 mm E08 Extractor Ø 9,55 mm x 70 mm E09 Extractor Ø 10,60 mm x 70 mm E10 Extractor Ø 11,65 mm x 70 mm E11 Extractor Ø 12,85 mm x 70 mm E12 Extractor Ø 14,05 mm x 70 mm E13 Extractor Ø 15,25 mm x 70 mm S06/08 Push rod Ø 6,0 mm S09/10 Push rod Ø 9,0 mm S11/13 Push rod Ø 11,25 mm A07 Applicator Ø 8,5 mm A08 Applicator Ø 9,55 mm A09 Applicator Ø 10,6 mm A10 Applicator Ø 11,65 mm A11 Applicator Ø 12,85 mm A12 Applicator Ø 14,05 mm A13 Applicator Ø 15,25 mm

D14 Grinder Ø 17,5/16,45 mm x 70 mm D15 Grinder Ø 18,7/17,65 mm x 70 mm D16 Grinder Ø 19,9/18,85 mm x 70 mm D17 Grinder Ø 21,1/20,05 mm x 70 mm E14 Extractor Ø 16,45 mm x 70 mm E15 Extractor Ø 17,65 mm x 70 mm E16 Extractor Ø 18,85 mm x 70 mm E17 Extractor Ø 20,05 mm x 70 mm S14/17 Push rod Ø 14,5 mm A14 Applicator Ø 16,45 mm A15 Applicator Ø 17,65 mm A16 Applicator Ø 18,85 mm A17 Applicator Ø 20,05 mm

DATS® – Diamond ACL Transplantation System Set

ACL Transplantation Set

Indications

ACL - DATS Instruments for foreign material free ALL PRESS FIT Reconstruction of the ACL with Semitendinosus-Gracilis, Quadriceps or BTB.

Contains

• ZGT Tibial Target Device • ZGF Femoral Target Device (with protection for soft parts) • ZD4W Protection for soft parts for ZD4 (incl. reamer ZD4 for conical boreholes) • ZD1A Reamer (11,25 /10,15 mm) • ZD1B Reamer (10,25 / 9,15 mm) • ZD2A Reamer (9,25 / 8,15 mm) with extension and tibial target device • ZD2B Reamer (8,25 / 7,15 mm) with extension and tibial target device • ZD3 Reamer (8,25 / 7,15 mm) with femoral target device • ZD4 Taper milling device (profiling of an internal cone) • ZGV Extension (together with ZD2A, ZD2B) (application with tibial target device) • ZS1-2-3 Ram (extract bone dowel from ZD1A, ZD1B, ZD2A, ZD2B, ZD3) • ZSG Locking handle for assembly and dismantling of ZD2 onto/from the extension • ZSS Tightening disk for assembly and dismantling of ZD2 onto/from the extension

*also available single-use reamers in the sizes of ZD1 until ZD3

In case of insufficient autogenic bone or filling of defects from the harvesting site we recommend Tutobone® Dowels from Tutogen Medical GmbH, Neunkirchen a.B., Germany. Tu t o b o n e ® – x e n o g e n i c c a n c e l l o u s b o n e - Sterile - Non-immunogenic - Exceptional compressional strength: ø 18 MPa - Allows for complete remodelling Selected Publications available

• ZE1A Extractor (10,15 mm), extracts bone dowel, application acc. to ZD1A • ZE1B Extractor (9,15 mm), extracts bone dowel, application acc. to ZD1B • ZE2 Extractor (8,15 mm), extracts bone dowel, application acc. to ZD2A • ZE3 Extractor (7,15 mm), extract bone dowel, application acc. to ZD2B resp. ZD3 • ZK Handle, toggles in the extractors in order to twist off bone dowels with the extractors • ZA2 Applicator (8,15 mm), applies bone dowel • ZA3 Applicator (7,15 mm), applies bone dowel • ZT1 Impactor, to drive in and compress the transplant • ZT2 Impactor, to drive in and compress the transplant • ZT3 Impactor, to drive in and compress the transplant • SL1 Tendon template

www.articomed.com Producer: ARTICOmed Ltd.

Am Mühlgraben 6 D-36381 Schlüchtern GERMANY tel.: +49 6661 911764 e-mail: [email protected]

All rights of distribution, also by photocopy, reprint (also in the form of extracts) or storing and recovery in any kind of data processing device are reserved and require our written approval. BTT®, DBCS® and DATS® are brands from Articomed Ltd., Schlüchtern

11/2007 created by: [email protected]

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