THE ACL RECONSTRUCTION SYSTEM

Table of Content

The POSITION ACL Reconstruction System The Transplants POSITION Operative Technique
Transplant Removal Semitendinosus Tendon (STS) Mid-third of Patella Tendon (BTB) Bone Channel Tibial Channel Femoral Channel Transplant Preparation Preparation and aiming of the STS The Patella Tendon Pre-Tensioning the Transplant Knot Length K Pull Through Marking M Inserting the Graft

8 9

10 10

13 15 16 18 19 20

Femoral Fixation

20

Tibial Fixation

21

POSITION Two Channel Technique Postoperative Care Ordering Information

22

23

24

The POSITION ACL Reconstruction System

The POSITION ACL system is a complete instrument set for minimal invasive ACL reconstruction. The operative procedure allows you the freedom to choose the type of transplant, whilst the POSITION instrumentation allows reconstruction to be done transtibially without femoral incision. The POSITION Suture Board supports easy and simple transplant preparation. The freedom of choice between transplant types together with the special POSITION titanium implants Suture Plate (femoral) and Suture Disk (tibial) bring forth an essential advancement compared to fixation devices like intra- or extraarticular screws or staples.

POSITION Instrumentation
Functional with a good general overview Minimal invasive, transtibial joint entry Allows the possibility of using the one or two channel technique

POSITION Suture Board

Modular construction for the various stages during the procedure Securing clamps and measurement scales for tendon preparation Implants (Suture Plate and Suture Disc) are afixed to the transplant before tensioning

THE S YSTEM

POSITION Suture Plate

Femoral Transplant Anchoring
Less invasive as there is no lateral incision Easy revisions,as there are no intra-articular implants Exact channel positioning achieves a better isometry Freedom of choice as to which transplant may be used, high tensioning capability

POSITION Suture Disk

Tibial Transplant Anchoring
Better transplant integration due to the fact that the tendon position is more central in the drill channel Due to the drill channel being covered distally less bleeding is to be experienced No implant removal neccesary as the Suture Disk lies flush on the tibia whilst the knots are all taken up in the depression of the Suture Disk

POSITION Procedure Set

Complete steril package All components from B.Braun / Aesculap Tuned sutures and implants Sutures for One- and Two channel technique

The Transplants

Important achievements has lead to better results in the field of ACL reconstruction since the introduction of arthroscopic operative techniques and early physiotherapy to achieve immediate full extension. For a long time the use of the patella tendon was recognized as being the gold standard in cruciate ligament reconstruction. By introducing the quadruple technique regarding the

semitendinosus tendon together with the new femoral anchoring method, without lateral incision, a higher tension strength has been achieved than has been possible in the past with the patella tendon. As an aid to sellecting the correct transplant, a list of the advantages and disadvantages for the two tendons has been drawn up.

Patella Tendon
Advantages
Variability of the transplant width Easier to obtain graft Stable primary fixation Preserves active internal rotation Ligamentisation slow but proven Weakens the antagonists Good long-term results published

Semitendinosus Tendon
Advantages
Smaller skin incision in non movement area No disturbance to the extensors No problems associated with kneeling Good blood supply to the four tendon strips Modulus of elasticity similar to the anterior cruciate ligament Desired reconstruction of the antero-medial and postero-lateral bundels possible

Disadvantages
Problems with the donor site defect Disturbance of the extensors Approx 15% loss of function from quadriceps Anterior knee pain Problems associated with kneeling Slow ligamentisation with transplant maturation Very stiff implant Increased risk of cyclopse syndrome arthrofibrosis Patella fractures Skin incision in area of movement, with tendency to form keloids Drilled channels are filled with tendon material and not bone so that synovial fluid can seep into the holes which may cause cysts Disturbance of lateral proprioception

Disadvantages
Disturbance of internal rotation Bleeding from the graft removal site Ligamentisation and rebuilding process not yet very well documented Longer preparation time Weakening of the agonists

THE T RANSPLANTS

Without doubt both the patellar tendon as well as the semitendinosus tendon provide good transplants for replacing the anterior cruciate ligament. However the semitendinosus tendon is preferred in the following cases:

Patients whose professions involve kneeling Patella infera Morbus Osgood Schlatter disease Tibial intramedullary nailing Injury to the patella or patellar tendon

In order to reduce these problems, operative techniques were sought in which a lateral incision was no longer necessary. The femoral fixing technique using a locking screw as central femoral fixation is well known. When using the locking screw as central fixation, there is a tendency for the drill channels to be drilled too far anteriorly due to a 1 to 2 mm thicker posterior wall being needed for safety reasons to prevent breakage (blow out) as a result of the fixation method. The central locking screw may give rise to additional problems such as:

Damage to the transplant Screw or bone defect after revision

Advantages and disadvantages also need to be observed when choosing the fixation devices. Femoral transplant fixation for instance, using staples or cancellous bone screws, show problems due to the necessary femoral incision. Other possible problems of which one should be aware of may be:

It may be difficult to remove the locking screw during revision, which normally leaves a hole or bone defect once removed. In this situation it is frequently necessary to carry out a two-stage operation, in which the defect left by the locking screw is subsequently filled with a cortical/cancellous bone graft in order to achieve ultimate stability. It should be recognised however that every operative technique should be designed to facilitate reoperation. The following description of the operative technique with the POSITION Reconstruction System observes the above mentioned advantages and disadvantages with regard to the two techniques: free choice of transplant, for transtibial technique without lateral incision and extraarticular implants for transplant fixation.

Injury to the caplan fibres Haematoma in the popliteal fossa Disturbance of postero-lateral proprioception Persistant problems with the iliotibial tract and biceps femoris

Transplant Removal
Semitendinosus Tendon (STS)

The skin incision for obtaining the semitendinosus tendon is approximately 3 to 4 cm long, beginning medially to the tibial tuberosity.

The gracilis is retracted using a Kocher clamp and the two tendons can be identified from their deep surfaces. If there is any scar formation, the tendons can be separated using a pledget. Once the semitendinosus tendon has been identified, it can be hooked forward with a leahy clamp and transfixed with a stay suture.

STS

During subcutaneous dissection care must be taken not to damage the aponeurosis of the sartorius tendon as this is sometimes only marginally thicker than the subcutaneous fascia. The aponeurosis of the sartorius tendon lies over the semitendinosus and the gracilis tendon. The gracilis tendon can be palpated as the thickest tendon of the pes aneurous. The semitendinosus tendon lies inferior to this thicker tendon.

The tendon is prepared by taking the periosteum up to the tibial crest below the tubercle. This is to obtain an additional length of approximately 2 cm and secondly the periosteum does improve tendon attachment in the tibial drill hole.

Identification is made easier when the sartorial

Tip
8

fascia proximal to the gracilis tendon is split for 3 to 4 cm along the length of the tendon.

THE

O P-TECHNIQUE

Mid-third of the Patellar Tendon (BTB)

The patellar tendon can be harvested using either the singleincision or the two-incision technique. The advantages of the two-incision technique is a better cosmetic result and the preservation of the infra patellar branch of the saphenous nerve. The advantage of the single incision technique is a cleaner preparation of the tendon. This tends to reduce anterior scar formation. Here the incision extends from the distal patella pole to a point medial to the tibial tuberosity. The transplant is removed with the patella bone block being approximately 2 cm long, the tibial bone block 2.5 cm long. The fat pad is identified. Experience has shown that there is no difference between the purely arthroscopic technique or one where the approach is through the divided infrapatella fat pad.

To strip the tendon, it is standard to use a 6 mm tendon stripper (FO 023 R). With thicker tendons one may use the tendon stripper (FO 024 R) which has a diameter of 7 mm. Both instruments have a measuring scale on their shafts so that one may see how much tendon has already been harvested for transplant purposes. Before the tendon stripper is used, careful attention must be paid to releasing the connections of the medial head of the gastrocnemius, gracilis and the semimembranosus tendon to the semitendinosus. If this is not done the tendon stripper can slide across the semitendinosus tendon dividing it too early. Harvesting of the semitendinosus tendon is made much easier if good muscle relaxation is ensured. The harvested tendon is usually between 24 and 34 cm in length. The gracilis tendon should only be used in exceptional circumstances, as this may result in too much functional disturbance of the pes aneurous.

An additional periosteal flap is obtained from below the donor area of the semitendinosus tendon and this is sewn on to the area of the transplanted tendon that is going to lie in the femoral tunnel.
9

Bone Channels

Before reconstruction of the cruciate ligament, the articular surfaces and menisci are inspected and treated arthroscopically if neccesary. As part of the preparation, the inter-condular fossa is freed of as much remaining scar tissue so that a large piece of the distal stump remains for orientation purposes.

Using the tibial drill guide (FR 500 R) a 2.5 mm Kirschner wire (LX 045 S) is inserted. The distance of the hook of the tibial drill guide to the entrance of the K-wire is exactly 7mm.

Tibial Channel

The drill guide is removed and using a series of cannulated drills the tibial tunnel is formed. Drilling in stages has the advantages that subtle corrections to the tunnel can be obtained and thermal damage to the cancellous bone is minimised.

The intra-articular location of the tibial drill hole is determined by using the remaining distal stump. If this is not present then the drill hole should enter the knee medial to the lateral tibial spine and directly anterior to the posterior cruciate ligament.

During the final phase of drilling, the drill is

Tip

switched in to reverse mode whilst pushing into the fossa to prevent damage to the posterior cruciate ligament. The drill is left in situ and the knee fully flexed and streched. This will determine whether there is any impingement and whether the notch needs to be extended either cranially or laterally.

10

THE

O P-TECHNIQUE

Femoral Channel
Patella Tendon Transplant
The tibial tunnel should be made with a 6 mm trephine in order to obtain a cylinder of cancellous bone which can be used to fill the defects left in the patella and tibial tuberosity. The final tunnel can be obtained by enlarging the hole with cannulated drills. It is very important that with long transplants

The Position
The femoral drill hole doing the one-channel-technique is made with the help of the transtibial drill guide (FO 010 R). The off-set hook is 5 mm.

Tip

the tunnel should not be too vertical in order to avoid injury to the pes anserinus. Were this to occur revision using the semitendinosus tendon might prove impossible.

In doing this the knee should be flexed to 90 (plus or minus 5). If the knee is excessively bent there is a risk that the femoral Suture Plate will end up in the supra patella pouch which could cause a problem. With a knee that is insufficiently flexed the tourniquet cuff may get in the way of the passage of the pullout pin.

5 mm

The transtibial aiming device is positioned accordingly at the back edge of the fossa and the drill and pulloutpin (FO 025 R) is drilled through the lateral femoral cortex.

11

Drill Channels
Drill Depth B
To determine the drill depth B the length of the prepared graft needs to be known. This graft is usually between 6 and 8 cm long.
total transplant length (ex.: 70 mm) femoral A 23 mm intra-articular 24 mm tibial A 23 mm

There must be at least 19 mm of tendon in each tunnel if a semitendinosus graft is used, to be sure to have a proper ingrowth of the tendon. When using the patella method, it should be ensured that the whole bone blocks are situated within the drill channels. The depth (B) of the tunnel in the femur should be at least 7 mm longer than the length of tendon that is to lie in the tunnel to allow for turning of the Suture Plate.

xample:
70 mm (graft length) 24 mm (intra-articulare length) = 46 mm : 2 = 23 mm (tendon portion A in the femoral resp. tibial channel)

First of all, the transplant portion is determined which is to lie in the femoral drill channel (A). In calculating this length, it must be born in mind that 22 24 mm is necessary for the intra-articular length. The femoral tunnel (B) is drilled arthroscopically using the reamers with the scale markings (FO 016 R FO 021 R). The diameter of the drill channel should correspond to the diameter of the transplant. If the tunnel is in the correct position, then the posterior 3 to 4 mm of the distal femoral tunnel should be composed of periosteum.

C
7

The last 10 mm of the femoral tunnel should

Tip
A

be drilled by hand, not using motor power in order to avoid breaking through the lateral cortex. After removal of the drill the edges of the tunnel are smoothed using a rasp or reamer.

mm

xample:
23 mm (tendon portion A in the femoral resp. tibial channel) + 7 mm (Flipradius) = 30 mm (minimal drilling depth B)

Completion of the Femoral Drill Channel

A further hole C is drilled from the tip of the femoral tunnel to the lateral cortex of the femur over the pullout pin using a cannulated 4.5 mm drill (FO 026 R). This is to allow the Suture Plate to be pulled through onto the lateral cortex of the femur. Preferably a second surgical team should do the tendon preparation and suturing so as to reduce the total operation time.

12

THE

O P-TECHNIQUE

Transplant Preparation
Preparation and Arming of the STS

tendon clamps

work surface

scales

Preparation of the Semitendinosus Tendon

When the semitendinosus is used as a single strand, previous experience has shown that it tends to stretch, over a period of 2 to 5 years. Thus it is inadequate for cruciate ligament reconstruction. For this reason at least three strands of semitendinosus tendon are used and where possible four. Four strands of semitendinosus tendon are much stronger than a comparable patella tendon.

After harvesting the graft the useful length of the semitendinosus tendon is measured using the measure on the Suture Board. A curette, rasp or knife is used to remove the muscle tissue which is still attached to the proximal aponeurosis.

13

Transplant Preparation
Suturing the Semitendinosus Tendon

QuadrupelTechnique

TripleTechnique

In order to use the Quadruple technique, a length of at least 24 cm is required to achieve a transplant length of 6 cm. If the usable tendon length is less than 24 cm, then the technique must be adapted to use three strands of tendon. This is the Triple technique. For the Quadruple technique the transplant must be cut in the middle and the two halves folded double. The transplant for the triple technique is prepared as illustrated.

Next the transplant halves 15 mm (Quadruple Technique) or the three strips (Triple Technique) are loaded in the atraumatic tendon clamps, and lightly tensioned. Each end is now sutured with no. 2 non-absorbable suture material. When reinforcing the tendon it is important to take care that, about 15 mm of each tendon is sutured, that the sutures are initially already tightly drawn, and that the gap between the sutures is large enough, so that ingrowth of the tendon in the bone channel is not prevented.

The total tendon thickness is determined with the help of the tissue protection sleeves by passing the tendon through the appropriate drill guide until a close fit is obtained. This diameter dictates the size of the drills required for preparing the femoral and the tibial tunnels.

14

THE

O P-TECHNIQUE

The Patellar Tendon Transplant

The graft should be cleared of all loose tendon material that is not firmly attached to the bone blocks. Two sutures are passed through the drill holes in the bone blocks.

The free strip of periosteum obtained from the tibia is now sewn onto the femoral part of the graft in order to have an additional piece of periosteum within the femoral tunnel to stimulate healing of the graft into the bone tunnel.

Once the transplant tendon has been sutured, its effective diameter may increase slightly and it should be re-measured. It may be neccesary to correct the tibial tunnel to account for this increase in thickness. When using the Quadruple Technique the

Tip

threads of the better transplant components close to the tibia are marked with a single knot and the sutures of the somewhat weaker components closer to the muscles of the semitendinosus tendon are marked with two knots indicating the transplant shank.

15

Transplant Preparation
Pre-tensioning the Transplant

Pre-Tensioning Device, Femoral Suture Plate Holder Measure rule to determine Knot Length

Suture Disk Holder

Pre-Tensioning Device, Tibial Suture Holder Spring Scale Rule Spring

Movable Slide on Track

The tendon clamps are replaced with the suture and implant holders on the Suture Board.

16

THE

O P-TECHNIQUE

Affixing the Implants

Polyester Tape

The Suture Plate through which the suture material is threaded is placed in the suture plate holder with the polyester tape being fixed using an artery clamp. The tibial sutures are fed through the tibial Suture Disk, wrapped around the thread holder and secured with a small mosquito clamp (BH 104).

Pull Suture

The amount of pre-tensioning can be measured using the spring balance on the suture board. Tension is adjusted using the moveable implant holder.

Flip Suture

With the Quadrupel Technique the transplant ends are placed together to form a loop whilst a polyester tape is threaded through the loop. The femoral sutures (e.g. PET) are fed through the middle two holes of the femoral suture plate and also fixed with a clamp.

The outer two holes are threaded with two further sutures (a pull and a flip suture). The pull suture should be strong enough to resist breaking when the graft is pulled through and into the femoral tunnel. A lot of force is required as there is very little tolerance between transplant and drill channel. The flip suture can be of any material as it is only used to flip the Suture Plate onto the lateral cortex of the femur.

For both transplant methods pretentioning needs to be maintained for at least 5 minutes. The transplant and the sutures are stretched and the suture loops are tightened.

17

Transplant Preparation
Knot Length K
After pre-tensioning the graft, the necessary knot length is determined and fixed.

) mm 64 ( G

For determining the knot length K, which determines the distance from the Suture Plate to the graft, the total length of the femoral channel is measured using the measuring scale on the depth gauge (FO 027 R). From this the transplant length A which will come to lie in the femoral channel is subtracted.

) mm 41 ( K
) mm 23 ( A

Suture Plate

G, 64 mm

xample:
64 mm (total length G) 23 mm (tendon portion A in the femoral drill channel) = 41 mm (knot length K)

The knot length (example: 41 mm) is now adjusted on the femoral implant holder of the Suture Board and the distance is fixed under tension by knots.

18

THE

O P-TECHNIQUE

Pull Through Marking M

The graft is then marked with a surgical pen. This mark shows intraarticularly, when the Suture Plate has exited the femur and is to be flipped. This ensures that the femoral plate is not pulled too far into the muscles of the thigh thereby running the risk of trapping tissue between itself and the bone when the graft is pulled back into the knee. This could lead to a loss of tension in the system once the trapped tissue is broken down and disappears.

K
23 ( A

30 ( M

) mm

) mm

E
A
7 mm

xample:
23 mm (tendon portion A) + 7 mm (flip radius) 30 mm (marking M)

The position of the surgical pen marking depends upon the length of the graft in the femoral channel (A) plus an extra 7 mm to allow for the Suture Plate to be turned (flipped) after it has exited from the femur. M is corresponding to the femoral tunnel B.

19

THE T WO CHANNEL TECHNIQUE

Inserting and Fixation of the Graft
Inserting the Graft
The pull- and flip sutures are pulled through the eye of the pullout pin. tendon is used, the bone block must be orientated such that the cancellous surface is facing anteriorly.

A suture passed through the eye of the pin

Tip

and then tied makes it easier to capture the femoral sutures.

The graft is pulled through until the mark on the tendon is just at the entrance to the femoral channel.

Femoral Fixation

The pullout pins (FO 025 R) are inserted through the drill channels and out through the skin of the thigh. The tension suture is used to pull the graft into the knee under arthroscopic observaillance. The pull suture must be the first to enter the femoral channel. If patella

When the graft has been pulled through the knee to the mark on the tendon, the flip suture is pulled and this turns the Suture Plate parallel to the femur. This can be felt as a slight giving sensation on the flip suture. By pulling on the tibial sutures, the graft can be pulled back 7 mm, so that the Suture Plate will lie firm on the lateral cortex.

20

THE

O P-TECHNIQUE

Tibial Fixation
The secondary knots can be tied with the aid of the knot pusher (FO 028) ensuring slippage does not occur which might lead to loss of graft tension.

Before fixing the Suture Disk, the surface on which the disk comes to lie is prepared using a ball electrode. Using the Quadrupel Technique the transplant shanks are identified with the help of the knots. The suture ends marked with one knot are tied with the knee flexed at 40, and the suture ends with two knots tied at full extension. The graft is tensioned by pulling on the appropriate marked threads.

The Suture Disk has the advantage that it closes the end of the tibial channel, thus reducing blood loss, with the knots lying in the depression of the disk and so seated flush with the bone. Thus resulting in less tissue irritation. Once distal fixation is complete, the tension and flip sutures are removed by cutting one part of each thread close to the skin and then pulling the remainder out. The sartorius fascia is repaired and the wound closed with a subcutanous suture.

21

THE

O P-TECHNIQUE

The Two Channel Technique

If the semitendinosus graft is more than 9 mm in diameter, a femoral two channel technique is used. A prerequisit for the femoral two channel technique ist, that the semitendinosus tendon is long enough to do a Quadrupel Technique.

antero-medial

postero-lateral channel

postero-lateral

However, each tendon shank is separately connected to a Suture Plate. Doing the double channel technique two Suture Plates for femoral fixation are used, with following executed for both the anterior-medial and the posterior-lateral bundel.

Determination of the transplant diameter Calculation of the drill depth B

antero-medial channel

Determination of the knotlength Transplant marking

The advantages are that a deliberate reconstruction of the antero-medial and postero-lateral bundles of the cruciate is made, there is an improved contact between the tendon and the bone and the blood supply to the four pieces of tendon is facilitated.

Position of the anterior-medial drill channel

The antero-medial tunnel is drilled as for the single tunnel technique using the femoral drill guide (FO 012 R, off-set 3 mm) with the knee at 90.

Following the operative steps of the double channel technique are described which are different to the single channel technique:

Position of the posterior-lateral drill channel

As the postero-lateral bundle attachment shifts anteriorly, the second tunnel is made with the knee at 100 using the two tunnel drill guide (FO 011 R).

Tibial Channel
The tibial channel is drilled to a diameter of 8 mm, being made oval on the dorsal interarticular exit with a rasp or reamer.

Preparation of the Semitendinosus Tendon

Tendon preparation is exactly the same as the single channel technique regarding the suturing.

22

THE POST O PERATIVE CARE Post Operative Care

Positioning the two Ligament Bundles
After surgery the patient is placed in a splint in full extension for 5 days. A bandage may be incorporated. The minimal exposure, as well as excellent pain relief in the splint means that most patients may be treated as out patients. The knee is only moved passively for the first five days. Physiotherapy starts on the 6th day and consists of active flexion, proprioception, and muscle strengthening exercises. A brace of the Bledsoe type may be used for the first eight weeks.

It is advisable to insert both pullout pins before either graft is placed inside the knee otherwise the presence of the posterolateral graft can prevent the insertion of the second pin.

23

Ordering Information
Suture Board
FO 029 Suture Board
incl. 2 Tendon Clamps Implant Holders Pre-Tensioning Devices Small Mosquito Clamp (BH 104)

FO 031 Suture Board

2-channel technique (in addition to FO 029)

Implants
FO 030 T Suture Plate
Titanium Alloy, 4 x 12 mm

FO 035 T Suture Disk

Pure Titanium, 14 mm

FO 034 T Suture Disk

With rotation lock Pure Titanium, 14 mm

FO 039 Procedure-Set containing:

1x FO 030 T, Suture Plate 1x FO 034 T, Suture Disk 4x Synthofil, USP2, HRT 37, 75 cm 1x Dagrofil, USP6, 150 cm 1x Dagrofil, USP2, 150 cm 1x Surgical Loop, 4 mm, 75 cm

FO 040 Procedure-Set containing:

1x FO 030 T, Suture Plate 1x FO 035 T, Suture Disk 4x Synthofil, USP2, HRT 37, 75 cm 1x Dagrofil, USP6, 150 cm 1x Dagrofil, USP2, 150 cm 1x Surgical Loop, 4 mm, 75 cm

24

Instrumentation
Aiming Devices:
off-set

FO 010 R Transtibial Aiming Device

One channel technique femoral, standard (5 mm off-set)

FO 012 R Transtibial Aiming Device

2-channel technique femoral, anterior-medial channel 3 mm off-set

FO 011 R Transtibial Aiming Device

2-channel technique femoral, posterio-lateral channel

FR 500 R Tibial Aiming Device

Tendon Stripper
usable length: 340 mm, with measuring scale

FO 023: inner diameter 6 mm FO 024: inner diameter 7 mm

FO 027 Depth Probe

usable length: 230 mm

FO 028 Knot Pusher

FO 014 Notch Gauge FO 037 R Twister for FO 034 T

25

Instrumentation
Head Reamer
cannulated (2,6 mm), triangular shank length: 180 mm FO 055 R: 5,5 mm FO 016 R: 6 mm FO 056 R: 6,5 mm FO 017 R: 7 mm FO 057 R: 7,5 mm FO 018 R: 8 mm FO 058 R: 8,5 mm FO 019 R: 9 mm FO 059 R: 9,5 mm FO 020 R: 10 mm FO 060 R: 10,5 mm FO 021 R: 11 mm length: 205 mm, triangular shank FO 054 R: 4,5 mm length: 205 mm, round shank FO 026 R: 4,5 mm

Drill, tibial
cannulated (2,6 mm), triangular shank FR 565 R: 5,5 mm FR 516 R: 6 mm FR 566 R: 6,5 mm FR 517 R: 7 mm FR 567 R: 7,5 mm FR 518 R: 8 mm FR 568 R: 8,5 mm FR 519 R: 9 mm FR 569 R: 9,5 mm FR 520 R: 10 mm FR 571 R: 10,5 mm FR 521 R: 11 mm

Tissue Protection Sleeves

(not illustrated) e.g. for determining graft thickness inner diam.: FR 705 S: 5,5 mm FR 576 S: 6 mm FR 706 S: 6,5 mm FR 577 S: 7 mm FR 707 S: 7,5 mm FR 578 S: 8 mm FR 708 S: 8,5 mm FR 579 S: 9 mm FR 709 S: 9,5 mm FR 580 S: 10 mm FR 710 S: 10,5 mm FR 581 S: 11 mm
26

Instrumentation
K-wires FO 025
Drill- and Pullout-Pin Total length: 380 mm, shaft diam.: 2,4 mm, tip diam.: 2,7 mm

FO 036 R
Drill- and Pullout-Pin Total length: 380 mm, shaft diam.: 2,5 mm

LX 045 S (not illustrated)

K-wires, Total length: 310 mm, diam 2,5 mm

Additional instrumentation
OG 335 R
Micro-Forceps, Jaw straight 5 x1 mm

BM 016 R
Durogrip Crile-Wood Needle Holder 145 mm (not illustrated)

27

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