BTB ACL Reconstruction

Unpack a RIGIDLOOP™ BTB Adjustable Cortical System - Standard. Grasp it with two fingers, as shown, to avoid pulling the black relay loops out of the assembly.

Hold the preparation card flat against a table.

Insert the femoral bone plug flush against the graft clamp on the button’s preparation card. The drill holes must be oriented as shown.

Completely unravel one of the two white tensioning sutures. It doesn’t matter which side is chosen.

Using a suture passing device such as a CHIA PERCPASSER^® Suture Passer  or a free needle with kite, pass the  white tensioning suture through the  proximal bone plug hole and the  opposing black relay loop.

Note: “Proximal” in this context means the bone plug hole that is closest to the button.

Pull the corresponding black relay loop gently in a plane horizontal with the graft. Exercise slight counter-tension on the white suture, and once the white suture has entered the splice in the button, apply slow lateral movements (“wiggles”) to the end of the temporary black relay loop. Do this until the suture has fully exited the splice.

Pull the tensioning suture to eliminate slack in the loop. Wind the excess length of the tensioning suture around the winder and wedge it in the notch to lock it.

Unwind the second white tensioning suture. Pass it through the distal drill hole in the opposite direction of the first tensioning suture. “Wiggle” it through the splice using the same technique utilized for the proximal suture.

Insert two sutures into the tibial bone plug drill holes. These sutures will be used to control placement of the tibial bone plug.

Drill the tibial tunnel from the outside-in using a fluted reamer. Reamer size and tunnel location should be chosen according to surgeon preference.

Use a shaver or rasp to chamfer the edges of the socket entrance and ease bone block passage into the socket.

Remove the RIGIDLOOP™ BTB Adjustable Cortical System and graft from the preparation card. Unwind all sutures from the button preparation card. Remove the button from the card by lifting up all the sutures. Pull on the femoral bone plug to remove it from the clip on the preparation card.

Gently pull on each of the two suture loops to lengthen the distance from the underside of the button to the beginning of the femoral bone plug to 6cm or more.

Mark the femoral socket length on the femoral side suture loop. This mark is an indication of where to  flip the button.

Use the relay suture to pull the RIGIDLOOP™ BTB Adjustable Cortical System sutures through the  femoral socket.

Pull the RIGIDLOOP™ BTB Adjustable Cortical System into the joint space. Pull lightly on the blue/white suture to position the button near the entrance of the femoral socket. Use the blue/white suture to pull the button through the socket, and lightly pull other sutures, as needed, to avoid tangles. Switching the arthroscope to the AM portal may allow for a clearer view of the button and may facilitate passage of the button and bone block into the femoral socket.

Flip the button by pulling on the green flipping suture.

Alternately pull on the green suture and the blue/white suture to confirm the button is on the cortex and has successfully flipped.

Throughout the process of flipping the button and testing for flip success, maintain counter tension on the graft to ensure the button stays on the cortex.

Pull alternately on the white tensioning sutures of the button until the bone plug is at the entrance of the femoral socket. Use a probe to help position the bone plug. When the bone plug is positioned to surgeon preference, alternately pull on the white tensioning sutures until the bone plug is fully seated in the femoral socket.