FIGURE 3:Torn ATFL & incompetentsoft tissues

FIGURE 2:Obvious clinical instability

FIGURE 1:Stress radiographs

FIGURE 1:Stress radiographs

References1. Gisselfalt et al, Biomacromolecules 2002, 3, 951-958.2. Liljensten et al, J. Biomater. Sci: Materials in Medicine 13 (2002) 351-3593. Peterson et al, Knee Surg Sports Traumatol Arthrosc (2014) 22:2109–2120.4. Peterson et al., The Anterior Cruciate Ligament: Reconstruction and Basic Science. 2nd ed., Elsevier 2018.5. Gretzer et al, J. Biomater. Sci. Polymer Edn, Vol. 17, No. 6, pp. 669–687 (2006)6. Gersoff et al, J Knee Surg. 2018 Apr 27.

TECHNOLOGY OVERVIEWArtelon is a Dynamic Matrix™ for tendon and ligamentreconstruction. It mimics the body's natural healingmatrices to create repairs that are both strong and highlyelastic.1 These features have been proven2,3,4 to:

• Restore kinematics

• Resist failure from necrosis

• Regenerate native tissue through load sharing

Artelon is extremely inert, and less reactive than commonbiomaterials such as titanium, polystyrene and suture.5 Itintegrates into the repair site and scaffolds new tissue growth. Its high compliance permits load sharing, which stimulates rapid tissue remodeling through mechanotransduction.6 Artelon maintains its properties for �ve years, then dissolves in water and is eliminated from the body.

The current case involves a patient with chronic lateral ankle instability demonstrating torn, elongated, and incompetent ligaments requiring reconstruction.

CLINICAL HISTORYAn 18-year-old healthy female volleyball player presented with long-standing ankle instability resulting from multiple ankle sprains over the years. Stress X-rays (Figure 1) showed obvious ankle instability while physical exam and MRI con�rmed chronically torn lateral ankle ligaments. Conservative treatment including bracing, taping, and extensive physical therapy had failed, therefore, she elected to undergo surgical treatment in order to return to competitive sports.

INTRAOPERATIVE FINDINGS:Intraoperatively, the ankle joint could be manually dislocated easily due to the lack of ligamentous stability(Figure 2). Examination of the lateral structures revealed the anterior talo�bular ligament (ATFL) was torn and remaining soft tissues had become lax (Figure 3).

CLINICAL CASE STUDYANKLE LIGAMENT RECONSTRUCTION (MODIFIED BROSTROM)USING AN ARTELON® MATRIX FOR DYNAMIC AUGMENTATION

Steven K. Neufeld, MD, Orthopedic Surgeon, Centers for Advanced Orthopaedics (CAO), Falls Church, VA

© 2018 Artelon. All rights reserved. Protected under US and foreign patents.4000024 Rev. A

2252 Northwest Pkwy SE, Suite G, Marietta, GA 30067 800.610.3446 customerservice@artelon.com

FOLLOW UPImmediately post-op, the patient had a short leg splint placed. At her 1-week follow-up, she was placed in an ankle brace, started early range of motion, early weight bearing and physical therapy. She continued to rehab well and at 10 weeks returned to competitive volleyball with a stable and pain-free ankle.

FIGURE 4:Lateral incision over the �bula

FIGURE 5:Anchor placed in Talus ATFL origin

FIGURE 7:Repair native ATFL remnants under the Artelon FlexBand

FIGURE 8:Tension and secure Artelon FlexBand (over the ATFL repair) into �bula with an anchor

FIGURE 9:Final; secured and tensioned Artelon FlexBand

FIGURE 10:Extensor retinaculum advanced over the Artelon FlexBand and ATFL reconstruction

FIGURE 6:Artelon FlexBand secured to Talus with Anchor

CLINICAL CASE STUDYANKLE LIGAMENT RECONSTRUCTION (MODIFIED BROSTROM)USING AN ARTELON® MATRIX FOR DYNAMIC AUGMENTATION

Steven K. Neufeld, MD, Orthopedic Surgeon, Centers for Advanced Orthopaedics (CAO), Falls Church, VA

SURGICAL INTERVENTIONAn incision was made over the fibula and the talar origin of the ATFL identified. An anchor was inserted into the talus and sutured to the 0.5x8cm Artelon FlexBand™ device (Figure 4,5,6). The remnants of the ATFL were then repaired and advanced to the anterior margin of the fibula (Figure 7). An anchor was placed in the fibula insertion; the ATFL was tensioned and secured. The unattached end of the Artelon FlexBand was pulled into 10-20% tension and secured directly on top of the ATFL (Figure 8,9). The extensor retinaculum was then sewn over the graft and repair (Figure 10) prior to closure.

CONCLUSIONThis 19-year-old athlete with chronic ankle instability underwent a successful lateral ankle ligament reconstruction utilizing Artelon FlexBand augmentation. Through the procedure, we achieved a strong and reliable repair, which allowed her an early return to competitive volleyball. Lateral ligament reconstruction including Artelon’s dynamic matrix technology is safe and effective, with the capability of supporting an early return to sports and activities in active patients.