Mini TightRope® CMC - Ankle Tightrope Syndesmosis fixation

Mini TightRope ® CMC
Surgical Technique
Mini TightRope CMC

Mini TightRope CMC Fixation
The Mini TightRope provides a unique means
to suspend the thumb metacarpal after trapezial
resection or removal for treatment of CMC arthritis,
thumb CMC instability and in case of revision with
proximal migration after failed tendon reconstruction.
The Mini TightRope uses a pulley principle to help
reduce the thumb and index metacarpals into proper
relationship, that is maintained through healing. This
construct consists of four passes of #2 FiberWire ®
through two stainless steel buttons – one oblong for
passage through bone tunnels and one round for
cortical fixation.
The trapezial space may be left empty, or filled with
an allograft anchovy spacer.
Ordering Information
2
Mini TightRope Repair Kit (AR-8911DS), sterile, single use
includes:
1 - Guidewire, 0.45"
1 - Cannulated Drill Bit
1 - TightRope
Place .045" Guidewire from radial to ulnar starting 2-3 mm distal to
the carpal/metacarpal joint on the thumb metacarpal and through
the base of the index metacarpal. Verify correct positioning of the
Guidewire with fluoroscopy (AP and in motion). Place a hemostat
distally on the Guidewire to maintain position during drilling.
1
Create a 3-4 cm dorsoradial skin incision over the trapezium
metacarpal joint. Safely retract the radial artery by means of a vessel
loop, and take care to protect the various branches of the radial
nerve. Make a longitudinal incision on the capsule and sharply dissect
through the abductor/adductor pollicis, which is attached to the
radial base of the thumb metacarpal.
Resect or remove the trapezium to eliminate the bone-on-bone
contact that causes the pain.
Make a small 3-4 mm incision between the 2nd and 3rd metacarpal
bases to view the ulnar base of the index metacarpal – the eventual
exit point of the drill.
3
Overdrill the .045" Guidewire with a 2.7 mm Cannulated Drill Bit.
Take care to keep the Guidewire in place.

Ulnar to Radial
4 5
Pass the 1.6 mm guide pin with pull-through suture from ulnar to
radial along the Guidewire. Once the inserter needle is through
both bones, remove the Guidewire.
Optional: A Micro SutureLasso TM
or suture passing wire may also be
used to help shuttle the Mini TightRope through the metacarpals.
6 7
Once the correct anatomic position of the thumb metacarpal-to-
index-metacarpal base is fluoroscopically confirmed, the trailing
round button is tightened down by applying gradual tension on
the trailing two strands of FiberWire.
Apply ulnar tension on the blue suture just behind the oblong
button. This will help the oblong button to lie sideways and pass
easily through both bone tunnels.
The oblong button is flipped upon exiting the radial side of the
thumb metacarpal. Apply ulnar tension on the blue suture. This
will help seat the oblong button against the cortex.
Tie five square knots and cut the FiberWire about 1 cm long to
allow the knot and suture to lie down, reducing knot prominence.
The white pull-through suture is cut and removed.
Post-Op Protocol
Immobilize the thumb for four weeks in a Rhizo-Splint. Follow up
with physical therapy. Allow partial mobilization of up to 50% of
grip power between four and eight weeks. Increase mobilization
steadily and equably until week 12. Afterwards, allow full
mobilization.

Radial to Ulnar (repeat steps one, two and three)
4a 5a
Remove Guidewire and follow with
inserter needle.
Optional: A Micro SutureLasso TM
or suture
passing wire may also be used to help
shuttle the Mini TightRope through the
metacarpals.
6a
Once the correct anatomic position of the thumb metacarpal-to-
index-metacarpal base is fluoroscopically confirmed, the trailing
round button is tightened down by applying gradual tension on
the trailing two strands of FiberWire.
Apply ulnar tension on the blue suture, just behind the oblong
button. This will help the oblong button to lie sideways and pass
easily through both bone tunnels.
The oblong button is flipped upon exiting the ulnar side of the
index metacarpal. Apply radial tension on the blue suture. This will
help seat the oblong button against the cortex.
7a
Surgical Technique
Tie square knots and cut the FiberWire about 1 cm long to allow
the knot and suture to lie down, reducing knot prominence. The
white pull-through suture is cut and removed.
Post-Op Protocol
Immobilize the thumb for four weeks in a Rhizo-Splint. Follow up
with physical therapy. Allow partial mobilization of up to 50% of
grip power between four and eight weeks. Increase mobilization
steadily and equably until week 12. Afterwards, allow full
mobilization.

Advantages:
• No tendon harvest required
• Less morbidity and surgical time
• May allow earlier rehabilitation
• Maintenance of trapezial space
• FiberWire has little stretch
• Promotes scarring with micromotion
• Flexible suture-based fixation
Mini TightRope
Guidewire
Cannulated Drill Bit
Mini TightRope application for thumb CMC instability

This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals
in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use
their professional judgment in making any final determinations in product usage and technique.
In doing so, the medical professional should rely on their own training and experience and should conduct
a thorough review of pertinent medical literature and the product’s Directions For Use.
Developed in conjunction with Heidi Baader, M.D., and Andreas W. Cornet, M.D., Landau a. d. Isar/Germany;
Jeffrey A. Baker, M.D., Carolina Spine & Hand Center, NC; and Emery L. Kim, M.D., Baltimore, M.D.
© 2008, Arthrex Inc. All rights reserved. LT0427B