General anesthesia was administered to all patients while in the supine position. The injured knee was placed with an unsterile tourniquet around the upper thigh which allowed greater than 120 degree of knee flexion. The semitendinosus and gracilis tendons were harvested with a tendon stripper (Delta Medical). The residual soft tissue was cleaned from the tendons. The distal free ends of the tendons were armed with No. 6 Ethibond sutures using a whipstitch technique. Then the semitendinosus and gracilis tendons were folded in half and looped over Delta Medical's EndoButton in group 1 and Smith & Nephew's EndoButton in group 2. The diameter of the graft was ~7.0–9.0 mm. All the grafts were pretensioned under 20 pounds for 20 min and marked with absorbable suture 2 cm at both ends (Figures 1A–C ).
Endobutton
Manufactured by Smith & Nephew
Sourced in United States, United Kingdom
The Endobutton is a piece of medical equipment used in surgical procedures. It is designed to secure soft tissue to bone during the repair of certain injuries or conditions. The Endobutton serves as an anchor point to facilitate the attachment of the tissue to the bone.
Automatically generated - may contain errors
Lab products found in correlation
Biorci ha, by Smith & Nephew (8 mentions)
Biosure pk, by Smith & Nephew (5 mentions)
Clancy anatomic cruciate guide, by Smith & Nephew (3 mentions)
Vicryl, by Johnson & Johnson (2 mentions)
Ethibond, by Johnson & Johnson (2 mentions)
Rci screw, by Smith & Nephew (2 mentions)
Toggleloc, by Zimmer Biomet (1 mentions)
Tightrope, by Arthrex (1 mentions)
Fiberloop, by Arthrex (1 mentions)
Interference screw, by Smith & Nephew (1 mentions)
Transfix, by Arthrex (1 mentions)
Interference screw, by Arthrex (1 mentions)
Tightrope rt, by Arthrex (1 mentions)
Biosure, by Smith & Nephew (1 mentions)
Endotack, by Storz (1 mentions)
No 2 fiberwire, by Arthrex (1 mentions)
41 protocols using endobutton
1
Semitendinosus and Gracilis Tendon Harvest
2
Arthroscopic ACL Reconstruction with Quadriceps or Hamstring Grafts
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ACL rupture was confirmed by performing routine diagnostic arthroscopy in all patients. Utmost care was taken to preserve the tibial and femoral ACL footprint. QT-A was obtained using a minimally invasive harvesting technique previously described by Fink et al. [2] (link). Through a 2-3 cm long transverse skin incision placed over the proximal border of the patella, a 6-8 cm long, 10-12 mm wide and 5 mm thick soft-tissue or bone-tendon QT-strip was obtained. After graft preparation, a flip button device (e.g. EndoButton™ [Smith & Nephew, Andover, USA]) was attached to either the bone block or the periosteal strip using a No. 2 FiberWire™ suture (Arthrex Inc).
Alternatively, HT-A was harvested in a standard manner through a 3 cm anteromedial, oblique incision and armed using a No.2 FiberWire™ (Arthrex Inc.) suture in Krackow stitch technique. Again, the proximal fixation was achieved using a flip button device (e.g. EndoButton™ [Smith & Nephew, Andover, USA]).
Femoral and tibial tunnels were drilled through an anteromedial portal corresponding to the size of the graft. Bioabsorbable interference screws of either 23 mm or 28 mm length and of the same diameter as the bone tunnel were used for tibial fixation in both grafts. For additional fixation sutures were tied over a small fragment screw or an extracortical button Endotack® (Karl Storz, Tuttlingen, Germany).
Alternatively, HT-A was harvested in a standard manner through a 3 cm anteromedial, oblique incision and armed using a No.2 FiberWire™ (Arthrex Inc.) suture in Krackow stitch technique. Again, the proximal fixation was achieved using a flip button device (e.g. EndoButton™ [Smith & Nephew, Andover, USA]).
Femoral and tibial tunnels were drilled through an anteromedial portal corresponding to the size of the graft. Bioabsorbable interference screws of either 23 mm or 28 mm length and of the same diameter as the bone tunnel were used for tibial fixation in both grafts. For additional fixation sutures were tied over a small fragment screw or an extracortical button Endotack® (Karl Storz, Tuttlingen, Germany).
3
Suture-Button vs. Syndesmosis Screw Fixation
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Example 2
Patients with Weber C ankle fractures who had suture-button fixation, were compound with a cohort of patients who had syndesmosis screw fixation.
Methods
8 patients had suture-button fixation. The buttons used in Example 2 were conventional buttons supplied by Smith & Nephew Inc. and marketed under Endo-Button®. A retrospective cohort of 8 patients with similar Weber C fractures, treated using syndesmosis screw fixation, were recalled for clinical and radiological evaluation. Outcome was assessed using the American Orthopaedic Foot and Ankle Surgeons (AOFAS) score on a 100-point scale.
Results
Patients with screw fixation had a mean AOFAS score of 79 (range: 61-100) at an average follow-up of four months (range: 3-6 months). The suture-button group had a mean score of 92 (range: 76-100) at three-month review (p=0.02, unpaired t-test). Six of the screw group required further surgery for implant removal, compared to none of the suture-button group (p=0.007, Fisher's exact test).
4
Suture Button for Tendon Transfer in Clubfoot
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After ethics approval was obtained, TATT cases were identified from the case logs of 2 local senior surgeons between the year 2011 and 2016. We included TATT as a sole procedure or done in conjunction with other foot reconstruction procedures such as Achilles tendon lengthening, posterior release, and/or corrective osteotomies. The main indication for this procedure was the same as the traditional tendon transfer technique—dynamic supination seen in recurrent idiopathic clubfoot.13 (link)
The use of a suture button (EndoButton; Smith & Nephew Endoscopy, Andover, MA) was confirmed with both operative records and postoperative radiographs showing its placement. Upon confirmation of the procedure, patients’ follow-up visit clinic notes and radiographs were reviewed to screen for any postoperative complications. Patients with follow-up less than 12 weeks were excluded.
A total of 23 patients (34 feet) underwent the index procedure since August 2011 when we first used the suture button for the TATT procedure. The mean age of the patient at the time of operation was 6 years 2 months (28-193 months, SD 40 months), and the average follow-up was 67.1 weeks (12.1-249 weeks, SD 72 weeks).
The use of a suture button (EndoButton; Smith & Nephew Endoscopy, Andover, MA) was confirmed with both operative records and postoperative radiographs showing its placement. Upon confirmation of the procedure, patients’ follow-up visit clinic notes and radiographs were reviewed to screen for any postoperative complications. Patients with follow-up less than 12 weeks were excluded.
A total of 23 patients (34 feet) underwent the index procedure since August 2011 when we first used the suture button for the TATT procedure. The mean age of the patient at the time of operation was 6 years 2 months (28-193 months, SD 40 months), and the average follow-up was 67.1 weeks (12.1-249 weeks, SD 72 weeks).
5
Graft Fixation and Injury Factors in ACL Reconstruction
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The following 5 variables were investigated: femoral graft fixation, tibial graft fixation, the time interval between the injury and the surgical procedure, and the presence of a meniscal injury and a cartilage injury. Femoral fixation was classified into cortical fixation (for example, ENDOBUTTON [Smith & Nephew], TightRope [Arthrex], ToggleLoc [Zimmer Biomet]), and RIGIDFIX Cross Pin System (DePuy Synthes), metal interference screw, and bioabsorbable interference screw. Tibial fixation was classified into cortical fixation, post fixation, RIGIDFIX Cross Pin, metal interference screw, and bioabsorbable interference screw. The timing of the surgical procedure was analyzed for all grafts and separately for hamstring tendon autografts and patellar tendon autografts.
All registered injuries to cartilage or menisci were investigated, but no attempt was made to classify the severity or location of the injuries.
All registered injuries to cartilage or menisci were investigated, but no attempt was made to classify the severity or location of the injuries.
6
Arthroscopic BEAR ACL Repair Procedure
7
Bridge-Enhanced ACL Repair Technique
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The BEAR procedure was performed arthroscopically, with 4 mm tunnels drilled in the femur and tibia. First, the tibial stump was secured with a #2 absorbable suture (Vicryl; Ethicon) using a whip stitch. A cortical button (Endobutton; Smith & Nephew) with #2 nonabsorbable sutures (Ethibond; Ethicon) and the previous #2 absorbable sutures were passed through the femoral tunnel and secured to the proximal femoral cortex. The BEAR implant, composed of bovine-derived extracellular matrix proteins, was delivered via mini-arthrotomy, and secured by the #2 nonabsorbable sutures. The implant was then saturated with 5-10mL of autologous blood, and the ends of the torn ACL were passed through the implant. [30, (link)32] (link)
8
Anatomical ACL Reconstruction Technique
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Arthroscopically anatomical ACLR using a central third autologous patella tendon was performed by the transportal technique via the far anteromedial portal. An ACL graft was inserted around the femoral and tibial tunnel with a diameter of 8 to 10 mm and fixed by the ENDOBUTTON (Smith & Nephew) at the femoral side and DSP (double spike plate; Meira Corporation, Aichi, Japan) plate at the tibial side. Silicone drainage catheters were inserted at 2 sites, the intercondylar notch and beside the distal outlet of the tibial tunnel, for 2 days.
9
Suspensory Fixation Technique for ACL Reconstruction
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The UCL, tunnels, and dissection were performed using the same technique listed for the docking technique up until the final, singular bone tunnel. For the final tunnel, a 3.2-mm drill bit (Arthrex, Naples, FL, USA) was used to penetrate the far cortex and a passing suture was placed for later graft passage.
The same-size graft was prepared and tensioned using the same method as stated in the docking technique section, up until the final passing of the graft through the singular tunnel. Here, the anterior limb of the graft was then passed through the humeral tunnel. The elbow was then flexed to 30° and varus stress was applied. Individually, one limb of the Fiberloop (Arthrex, Naples, FL, USA) from each end of the graft was tied with 7 alternating half hitches, which ended up with a total of two knots over a 4 mm × 12 mm Endobutton (Smith & Nephew, Memphis, TN, USA). Due to the use of a free hand tying over the button, tensioning the knots is crucial. The finished technique is shown inFigure 2 .![]()
The same-size graft was prepared and tensioned using the same method as stated in the docking technique section, up until the final passing of the graft through the singular tunnel. Here, the anterior limb of the graft was then passed through the humeral tunnel. The elbow was then flexed to 30° and varus stress was applied. Individually, one limb of the Fiberloop (Arthrex, Naples, FL, USA) from each end of the graft was tied with 7 alternating half hitches, which ended up with a total of two knots over a 4 mm × 12 mm Endobutton (Smith & Nephew, Memphis, TN, USA). Due to the use of a free hand tying over the button, tensioning the knots is crucial. The finished technique is shown in
PST suspensory fixation technique.
10
Arthroscopic ACL Reconstruction Outcomes
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All ACL reconstruction surgeries were performed arthroscopically. The most common graft source was a hamstring tendon autograft (n = 1414), and the remaining patients were treated with patellar tendon autograft (n = 8) or the Ligament Augmentation and Reconstruction System (LARS; Corin) (n = 18). For hamstring and patellar tendon grafts, femoral fixation was by means of an Endobutton (Smith & Nephew) and tibial fixation by means of an interference screw. For the LARS devices, interference screw fixation was used for both sides. The average time between injury and surgery was 11 months (SD, 20 months). Postoperatively, all patients underwent the same rehabilitation protocol, with the early focus on recovery of full active knee extension and quadriceps function. Weightbearing was allowed as tolerated from the first postoperative day. The minimum requirements for an RTS were no effusion, an essentially full range of motion, good quadriceps strength and control of a single-legged squat, normal running and landing, and at least 4 weeks of unrestricted training.
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