Chapter 1 - Veterinary Instrumentation

1 JOINT SURGERYChapter 1Management of CranialCruciate DiseaseRupture of the Canine Cruciate Ligament (CrCL) remains, by a significantmargin, the most commonly encountered veterinary orthopaedic condition inboth general and referral practice.It is now generally agreed that most ruptures of the Cranial Cruciate Ligament(CrCL) in the dog are part of a degenerative process rather than a purelytraumatic condition. Trauma may be involved at the point of rupture but theligament is largely degenerate at this stage. This is particularly true of young,large and giant breeds. This is a very different situation to cruciate ligamentrupture in man and how things used to be in veterinary surgery 30 years agowhen a cruciate rupture was something which occurred when a dog caughtits hind leg in a hole whilst running.Early, partial CrCL ruptures may be recognised and if managedappropriately, complete rupture may be avoided.This change in circumstance makes it difficult for us to compare outcomes ofthe various techniques which have been practiced for the past 50 years. Thechoice of techniques is huge, suggesting that none are perfect. They may bedivided broadly into two groups. Those which attempt to replace the anatomyor function of the original ligament and those which seek to moderate theeffects of a cruciate deficient stifle.Techniques which replace either the physical ligament or its function include:• Patsaama• Over the Top Technique• DeAngelis lateral suture and derivatives• TightRope and similar techniques.All of the above attempt to stabilise the stifle by replacing the ligament or itsfunction.Techniques which moderate the effects of the cruciate deficient stifle byaltering the dynamics of the forces acting on it include:• Tibial Plateau Levelling Osteotomy (TPLO) Radial cut• Tibial Plateau Levelling Osteotomy (TPLO) Wedge cut• Tibial Tubercle Advancement (TTA)• Triple Tibial Osteotomy (TTO)• MMT• TTA Rapid.All of the above alter the forces acting on the stifle to make it stable under‘load’. Normal canine activity creates a huge variety of loads and thesetechniques do not create stability in all circumstances, leaving the meniscusvulnerable.Which is the best?On the basis of published work to date, there are few scientific grounds, interms of outcome, to choose between any of the available techniques. In thehands of a competent surgeon the likely outcome is ‘good’. It seems that thedifferences between surgeons is as great as the difference betweentechniques. However, there are many differences between the varioustechniques in terms of expertise required, necessary equipment and cost.Without the relevant data many surgeons elect to have ‘faith with the theory’pending definitive results.There seems to be concensus on certain points. Small dogs appear torespond well to extra-capsular techniques whereas some kind of tibialgeometry altering technique is perhaps preferable to a lateral suture in largeand working dogs. This appears to be backed up by the experience ofphysiotherapists working to rehabilitate dogs.Having said that the techniques are not mutually exclusive. A commonindication for a tibial plateau technique is a failed lateral suture. The reverseis not true. A failed tibial plateau technique is unlikely to respond to a lateralsuture. Currently there are no published techniques which combine a tibialplateau altering procedure with one which stabilises the stifle. Late meniscalinjuries are always a risk in an unstable stifle.Ultimately it will be a decision for the individual surgeon as to whichtechniques will be offered to the client. The client will make their choicebased on their own circumstances.We have taken the view that until there is evidence to the contrary we willsupport all the available techniques by the provision of training materials,instrumentation and implants.Cruciate TrainingThe best training in any of the available techniques is by attending anorganised training course ideally followed by hands on training in thecompany of an experienced surgeon. Veterinary Instrumentation run somelabs as do our training partners. Please check our training page on thewebsite www.vetinst.com for available courses. BSAVA, ECVS, ESVOTand other bodies also run cruciate labs.However, we do appreciate that access to courses is not always possibleand we do therefore offer a training DVD free of cost to provide guidance.Included on each technique is:Video.A colour pictoral Step by Step Guide.Frequently asked questions on the technique.Instrument and implant check lists.All are very much a personal view but may be of interest. In addition hardpaper copy guides are also available for most techniques. Again see belowfor availability. Most videos are also available via the web atwww.vetinst.com but the quality will be lower than the disc version.It is recommended that cadaver work or further observation is carried outprior to performing any new technique on clinical cases.When we have updates they will be posted on www.vetinst.comCRUCIATE MANAGEMENT TRAINING MATERIALDVDALLDVD includes information on Over the Top, Lateral SutureSystem. TPLO by Closing Wedge, FiberWire, TTA, TTO £FOCBRLIGAISO Step by Step guide to LigaFiba Iso Toggle Suture £FOCBRTPLO Step by Step guide to TPLO by Radial Cut £FOCBRTTA Step by Step guide to TTA £FOCBRTTARAP Step by Step guide to TTA Rapid £FOCBRTTO Step by Step guide to TTO £FOCBR LATSUT Step by Step guide to CCL Lateral Suture £FOCBR LBS Step by Step guide to Lateral Button Suture £FOC12

1 JOINT SURGERYLateral SutureLateral Suture Step by Step SummaryDetailed step by step guides of this and other cruciate techniques areavailable free of charge on request from Veterinary Instrumentation ormay be downloaded from www.vetinst.com. An introduction is givenhere.Management of the ruptured Cranial Cruciate Ligament (CrCL) byplacing a non-absorbable suture between the lateral fabella and theproximal, cranial tibia has been routine since DeAngelis first reported thetechnique in 1970. Today it remains the most common extra-capsulartechnique.Drill hole (2.5 to 3.5mm diameter) in the proximal tibia close to the insertionof the straight patella ligament with a bone tunnel borer or drill. The holeshould be as cranial and proximal as possible to maximise isometry.The lateral fabella is exposed.Passing the nylon suture behind the fabella appears to be the mostdifficult part of the procedure.The nylon may be passed around the fabella using either dedicatedcruciate/fabella needles or appropriate graft passers. By walking theneedle tip over the caudal edge of the fabella it is possible to locate andpenetrate the femorofabella ligament.Avoid placing the suture distal to the fabella.Keep the needle as close as possible to the fabella.The top strand of the nylon is passed through the distal patella ligament inthe lateral to medial direction. The needle should pass through the distalinsertion to firmly locate it close to the hole in the proximal tibia.One free end of the nylon is passed through crimp tube. The other freeend is fed through the other end of crimp tube. The crimp is free to slideat this time.A single strand of monofilament nylon is pulled through. If the nylon is inthe correct place it should be possible to virtually lift the dog up from thetable without tearing through. Test the loop thoroughly.14Gently crimp middle of tube so that nylon can be pulled through with somedifficulty (about 60% of a full crimp). Pulling the free ends through willcreate tension on the loop.

www.vetinst.comJOINT SURGERY 1VI Starter KitsIf you are new to the lateral suture systemour kits represent the most economicalmeans. All kits include a procedural DVD.Pull the nylon suture tight enough to eliminate anterior drawer and checkfor full range of motion.Take care not to create an outward rotation of the tibia on the femur. Toomuch tension is as great a technical error as too little.VI STARTER KITS091154091154 CCL Suture System (Swaged on) Basic Kit. Crimping forceps,2 x each size nylon/needle/crimp sterile packs £175.00The crimp is oval in shape. It is important that the crimp is crimped acrossthe wide part i.e. at right angles to the two strands of nylon.In addition care should be taken to make sure that all the crimps are in thesame plane on the tube, otherwise the crimps neutralise each other.Tensioning the loop tends to pull the crimp flat to the soft tissues. In orderto crimp across the wide part it helpful to pull one strand of nylon to tip thecrimp to give the crimper access to the wide part of the crimp.091150VI STARTER KITS091150 CCL Suture System (Swaged on) Compound Action Kit,2 x each size nylon/needle/crimp sterile packs £195.00Squeeze the crimp hard in middle and both ends. Do not crimp too close tothe end of the tube. Leave around 1mm uncrimped.Cut off the free ends close to the crimp. The crimp should sit over thetibialis cranialis muscle close to the tibia. The illustration shows a crimptube correctly crimped and in the correct postion.VI STARTER KITS091151091151 CCL Suture System (Swaged on) Basic Kit Plus.Forceps, 2 x each size nylon/needle/crimp sterile packsplus Heavy Duty needleholders £195.0015

1 JOINT SURGERYImplantsFabella (Cruciate) NeedlesMost surgeons now use our sterile procedure packs which includeswaged on needle and appropriate crimps. However, if you wish tosterilise your own nylon we offer appropriate needles. They are shownbelow approximately actual size. Bear in mind that leader line passedthrough a regular needle creates more damage as it passes through thefemoro-fabella ligament. It is this ligament which is relied on for theholding power of the suture. Cruciate needles will pass through a holecreated with a 2.7mm bone tunnel borer into the tibial crest.Double Leader Line Loop on NeedleMcKee/Miller Self Locking KnotFor use with McKee/Miller knotfabella(cruciate) needlesActual SizeDOUBLE LEADER LINE + NEEDLE091160 50lb Double line (500mm x 2 as loop) onv small fabella needle £16.50091161 80lb Double line (800mm x 2 as loop)on small fabella needle £17.50091162 100lb Double line (800mm x 2 as loop)on medium fabella needle £18.50InstrumentsCrimping ForcepsFABELLA (CRUCIATE) NEEDLES091144VS Fabella Needle, Very Small - Pack of 6Has regular eye £11.00091144 Fabella Needle, Small - Pack of 6. Has regular eye £11.00091145 Fabella Needle, Medium - Pack of 6. Has regular eye £11.00091146 Fabella Needle, Large - Pack of 6. Has regular eye £11.00Sterile Leader Line + CrimpFor use with separate Fabella (cruciate) needlesSTERILE LEADER LINE + CRIMP091142 10mm Tube Crimp + 500mm x 50lb nylon (sterile pack) £13.50091137 12mm Tube Crimp + 800mm x 80lb nylon (sterile pack) £14.50091147 12mm Tube Crimp + 800mm x 100lb nylon (sterile pack) £15.50Dedicated crimping forceps arerequired to avoid over-crimping orunder-crimping, both of which willlead to early implant failure.CRIMPING FORCEPS091135 Crimping Forceps 195mm £125.00Compound Action CrimperSterile Nylon Leader LineAlso useful for other ligament replacement procedures, e.g. hip toggle,collateral ligament repair.STERILE NYLON LEADER LINE091141 500mm x 50lb nylon (sterile pack) £7.25091139 800mm x 80lb nylon (sterile pack) £7.75091148 800mm x 100lb nylon (sterile pack) £8.25CRIMPS091140 10mm Tube Crimp for 50lb line (non sterile) £7.50091136 12mm Tube Crimp for 80lb + 100lb line (non sterile) £7.50091133 14mm Tube Crimp (non sterile)Suitable for nylon over 100lb £7.50091140/10 10mm Tube Crimp for 50lb line (non sterile) 10 Pack £50.00091136/10 12mm Tube Crimp for 80lb+100lb line (non sterile) 10 Pack £50.00091133/10 14mm Tube Crimp (non sterile)Suitable for nylon over 100lb 10 Pack £50.00The compound action crimper delivers a more powerful and controlled crimpthan our simple action device. The angle of the jaws gives the surgeon abetter view than straight variants. The handles sit almost parallel to the tablesurface which is more comfortable. In the relaxed postion the compoundaction crimper sits more easily in the hand than market alternatives.COMPOUND ACTION CRIMPER091135C Compound Action Crimper 230mm £175.0016

www.vetinst.comJOINT SURGERY 1Heavy Duty Needle DriverCountersinking Bone Tunnel BorerBone Tunnel BorerBone Tunnel Borer - Close UpIn order to minimise the stress and abrasion of the nylon as it passesthrough the bone tunnel, countersinking the hole is advisable. To reducetime and instrumentation the self-countersinking instrument incorporates acountersink on the shaft.COUNTERSINKING BONE TUNNEL BORER001075 Bone Tunnel Borer with Countersink 2.5mm 165mm £57.50Loop Tension DevicesPrior to crimping it is suggested that the loop be tensioned sufficiently toeliminate the anterior draw, but not enough to create an outward rotation.This may be achieved by a number of methods:a) Partial crimp - see video, does not require additional instrumentationb) Simple tension device requiring a pair of gelpis 091132c) A dedicated loop tensioner 091132ACCL Tensioning Device091132 - Tensioning Device(gelpis not included)CCL LOOP TENSIONER091132 CCL Tensioning Device (pair - gelpis not included) £62.50Cruciate needles are large. Most needleholders are designed for usewith skin suture needles and will be damaged locking onto the biggerneedle. It is cost effective to purchase a dedicated cruciate needle driverfor your cruciate kit rather than keep replacing your standardneedleholders. The TC inserts ensure maximum lock on giving youcontrol over the trickiest part of the procedure.CCL Loop TensioningHEAVY DUTY NEEDLE DRIVER091153 Heavy Duty Needle Driver with Tungsten jaws 195mm £67.50Bone Tunnel Borerdetail in use091132A-CCLLoop-TensionerLeader line gripped by thumbscrew.Bone tunnels are required in many procedures, e.g. tension wire banding,hip toggling and embrocation techniques. The Bone Tunnel Borer is asimple hand instrument which causes minimal soft tissue damage andminimal fuss in setting up compared with orthopaedic drills.BONE TUNNEL BORER001070 Bone Tunnel Borer 2mm 160mm £47.50001073 Bone Tunnel Borer 2.5mm 165mm £47.50001071 Bone Tunnel Borer 2.7mm 165mm £47.50001072 Bone Tunnel Borer 3.5mm 180mm £47.50Does not require use of extra crimps - less wasteful.Speed lock type action gives more ‘feel’ than ratchet type.Jaws designed specifically for crimping system.The literature tells us little about the correct tension. We recommend thatthe anterior draw is eliminated but that an outward rotation of the tibia isnot created.Remember over tensioning is as big a technical error as under tensioning!Instructions on use on www.vetinst.comCCL LOOP TENSIONER091132A CCL Loop Tensioner 175mm £160.0017

1 JOINT SURGERYLigaFiba®LigaFiba ® is a new, extremely strong surgical suture material. It iscomposed entirely of Ultra High Molecular Weight Polyethylene, thesame hard wearing material from which we make acetabular cups. Untilnow it has not been possible to spin it fine enough to produce flexiblestrands that are easily tied.LigaFiba ® Lateral Suture withCrimp Starter KitWeight for weight it is 15 x stronger than steel and 2.5 x stronger thannylon. It has very good abrasion characteristics which is important whenused in hostile environments such as lateral sutures and hip toggles.LigaFiba ® is available in four breaking strains.75lb (34kg)150lb (70kg)250lb (113kg)500lb (230kg)LigaFiba ® as a medial colateralrepair using suture screw

www.vetinst.comJOINT SURGERY 1LigaFiba ® Lateral Sutures with CrimpLigaFiba ® does knot securely but for maximum security requires 6throws which creates a rather bulky knot. Crimping creates a secure, lowprofile, radio-dense join between the free ends of LigaFiba ® . Forconvenience we now offer a lateral suture pack which includes anappropriate crimp. To make passing the LigaFiba ® through the crimp asimple process the 25mm of LigaFiba ®nearest the needle has been processed tominimise fraying. Always cut the lateralsuture near the needle. Supplied sterile.LIGAFIBA ® LATERAL SUTURES WITH CRIMPLFLSCR75 75lb LigaFiba ® Lateral Suture (300mm) + Crimp £25.50LFLSCR150 150lb LigaFiba ® Lateral Suture (500mm) + Crimp £24.50LFLSCR250 250lb LigaFiba ® Lateral Suture (500mm) + Crimp £24.50LFLSCR500 500lb LigaFiba ® Lateral Suture (600mm) + Crimp £24.50LFLSCR150/5 150lb LigaFiba ® Lateral Suture (500mm) + CrimpPack of 5 £110.00LFLSCR250/5 250lb LigaFiba ® Lateral Suture (500mm) + CrimpPack of 5 £110.00LFLSCR500/5 500lb LigaFiba ® Lateral Suture (600mm) + CrimpPack of 5 £110.00LFLSCRSET5 of each LigaFiba ® Lateral Suture + Crimp pack(150, 250, 500lb) 15 in total. £275.00LigaFiba ® Lateral SuturesExtreme strength, minimalstretch and good abrasioncharacteristics makeLigaFiba ® an idealmaterial for lateralsutures. The loop may beeither tied or crimped atthe end of the procedure.LigaFiba ® for any givendiameter is more thantwice as strong asmonofilament nylon.Lateral sutures aresupplied sterile with sizeappropriate cruciateneedle on one end and a straight round bodied needle at the other.Supplied Sterile.LIGAFIBA ® LATERAL SUTURESLFLS75 75lb LigaFiba ® Lateral Suture (300mm) £20.50LFLS150 150lb LigaFiba ® Lateral Suture (500mm) £19.50LFLS250 250lb LigaFiba ® Lateral Suture (500mm) £19.50LFLS500 500lb LigaFiba ® Lateral Suture (600mm) £19.50Double LigaFiba ® Lateral SutureDouble LigaFiba ® Lateral Sutures with CrimpThe 500lb LigaFiba ® is quite bulky and many surgeons prefer to use adouble strand of 250lb LigaFiba ® for dogs over 30kg(66lb) Use of twoseparate 250lb lateral sutures on separate needles increases the traumaaround the fabella and risks damaging the first LigaFiba ® loop. To savetime and minimise trauma to both implants and patient there is nowavailable a double strand of 250lb LigaFiba ® swaged onto standardcurved and straight needles. Supplied Sterile.DOUBLE LIGAFIBA ® LATERAL SUTURESLFLS250D Double 250lb LigaFiba ® Lateral Suture (500mm) £24.50The 500lb LigaFiba ® is quite bulky and many surgeons prefer to use adouble strand of 250lb LigaFiba ® for dogs over 30kg(66lb) Use of twoseparate 250lb lateral sutures on separate needles increases the traumaaround the fabella and risks damaging the first LigaFiba ® loop. To savetime and minimise trauma to both implants and patient there is nowavailable a double strand of 250lb LigaFiba ® swaged onto standardcurved and straight needles. Supplied with two crimps. Supplied Sterile.DOUBLE LIGAFIBA ® LATERAL SUTURESLFLSCR250DDouble 250lb LigaFiba ® Lateral Suture (500mm)with 2 Crimps £28.50LigaFiba ® CrimpsLigaFiba ® ties very well but manysurgeons prefer the low profile, securityand speed of crimps to complete lateralsutures. Crimps are available for allsizes of LigaFiba ® . Please note that onlythe LigaFiba ® Crimper is powerfulenough for LigaFiba ® Crimps.LIGAFIBA ® CRIMPSLFCRIMP75 Crimp for 75lb LigaFiba ® £8.00LFCRIMP150 Crimp for 150lb LigaFiba ® £8.00LFCRIMP250 Crimp for 250lb LigaFiba ® £8.00LFCRIMP500 Crimp for 500lb LigaFiba ® £8.00091135M LigaFiba ® Compound Action Crimpers 245mm £185.0019

1 JOINT SURGERYLigaFiba ® Tendon and Ligament Sutures75lb (34kg) LigaFiba ® Lateral SuturesLigaFiba ® is available in sterile single lengths for use in conjunction withany suitable suture anchor system. A tendon repair suture is alsoavailable with a round bodied needle at either end. LigaFiba ® is so toughit is difficult to cut and will damage standard scissors. Use our specialT.C. Scissors with a custom cutting edge.LIGAFIBA ®LF150500 150lb LigaFiba ® x 500mm 30kg £14.50LFTRS150 150lb LigaFiba ® Tendon Repair Suture £19.50LFS140TC LigaFiba ® Scissors T.C. 145mm £85.00At less than 0.5mm in diameter the 75lb LigaFiba ® is as strong as nylon2.5 x as thick. Suitable for small dogs and cats weighing less than 5kg.LigaFiba ties very well with minimal creep and a resultant small softknot. Alternatively a dedicated crimp may be used with our standardLigaFiba ® Crimper 091135M.75LB (34KG) LIGAFIBA ® LATERAL SUTURESLFLS75 75lb LigaFiba ® Lateral Suture (300mm) £20.50LFLSCR75 75lb LigaFiba ® Lateral Suture (300mm) with crimp £25.50LFLBS7575lb LigaFiba ® Lateral Button Suture (300mm)with Button & crimp £28.50Compound Action Crimpers for LigaFiba®LigaFiba ® IsoToggle LockingInterference ScrewThe Iso Toggle suture is an extra-capsular suture placedisometrically through bone tunnels. Placement of thetunnels is illustrated on a free CD. The LigaFiba ® knotsvery well but there is now an alternative.IMPROVEDDESIGNThe Locking Interference Screw offers a secure, low profile alternative totying over a button. The Screw has a tapered, soft profile thread whichjams the LigaFiba ® into the bone tunnel without damaging the suture.The Screw may be partially introduced as a temporary measure toassess joint stability and range of movement. Once the surgeon issatisfied, the screw is driven home to lock the suture.The Compound Action Crimper delivers apre-measured crimp with minimal effort.The jaw cut outs prevent over crimping.These Crimpers require the least effort ofany Crimper available. The CompoundAction Crimper is suitable for all crimpsapart from the thin walled 50lb Ande crimpwhich suits the Standard Simple ActionCrimper.LIGAFIBA ® COMPOUND ACTION CRIMPERS091135M LigaFiba ® Compound Action Crimpers 245mm £185.00LigaFiba ® ScissorsLIGAFIBA ® ISO TOGGLE INTERFERENCE LOCKING SCREWSLFIS253518SS Interference Screw 3.5 Stainless 18mm £19.50LFIS253518Ti Interference Screw 3.5 Titanium 18mm £25.50LFIS354523SS Interference Screw 4.5 Stainless 23mm £19.50LFIS354523Ti Interference Screw 4.5 Titanium 23mm £25.50LigaFiba ® is so tough it is difficult to cut and will damage standardscissors. Use our special T.C. Scissors with a custom cutting edge.LIGAFIBA ® SCISSORSLFS140TC LigaFiba ® Scissors T.C. 145mm £85.0020

www.vetinst.comJOINT SURGERY 1InstrumentsLateral Suture Tension DeviceThis is the Standard Lateral Suture Tension Device in the USA. Ratchetbased it relies on the jaws pulling against crimps attached to the free endsof the loop. It is simple and effective but does require two extra crimpswhich are ultimately discarded. Remember, over tensioning loops createsas many problems as under tensioning.LATERAL SUTURE TENSIONER091158 Lateral Suture Tensioner 170mm £160.00Cannulated DrillsFor maximum control over the alignment of bone tunnelsuse of cannulated drills is preferred. A fine guide wire isdrilled through where the bonetunnel or screw hole is required.Only when the surgeon is satisfiedthat the guide wire is correctlypositioned is the drill driven along thewire to create the hole. The guidewire can be repositioned if necessarywithout causing undue trauma to thebone. Available for Jacobs chuck orAO Quickfit.CANNULATED DRILLSH090112CAN 2.5mm 130mm Long 1.1mm Cannulation £65.00H090104CAN 2.7mm 130mm Long 1.1mm Cannulation £65.00H090106CAN 3.5mm 130mm Long 1.1mm Cannulation £65.00S090112CAN 2.5mm 130mm Long 1.1mm Cannulation AO Quickfit £75.00S090104CAN 2.7mm 130mm Long 1.1mm Cannulation AO Quickfit £75.00S090106CAN 3.5mm 130mm Long 1.1mm Cannulation AO Quickfit £75.00090065 Guide Wire 1.1mm x 178mm (Pack of 10) £27.50PushPull Suture PasserPassing soft suture materials such as FiberWire orLigaFiba ® through bone tunnels can be a challengelikened to pushing a piece of string. Historically a pullingdevice was fashioned from suture wire. The PushPull SuturePasser hooks onto the suture material and may then be either pushedthrough a bone tunnel or pulled back through one.Diameter is 2.0mm therefore minimum bone tunnel size is 2.0 whenpulling and 2.0 plus at least twice the suture diameter when pushing.PUSHPULL SUTURE PASSER001050PP PushPull Suture Passer 235mm £62.5021

www.vetinst.comJOINT SURGERY 1LigaFiba ® Iso Toggle SuturesThe strength and flexibility of LigaFiba ® makes it an ideal material forextracapsular sutures. The Iso Toggle suture is placed via bone tunnelsacross the stifle at isometric points. The use of isometric pointsmaximises the range of movement of the stifle and protects the suturefrom repeated stretching and abrasion.The suture is anchored over buttons on the medial side.Available in all three sizes of LigaFiba ®150lb Dogs up to 15kg250lb Dogs 15-30kg500lb Dogs over 30kgFree DVD available showing the placement of the Iso Toggle Suture.The starter kit comprises 2 x 250lb sutures, 2 x 500lb sutures and therequired 2.5mm and 3.5mm antiskid drills.LIGAFIBA ® ISO TOGGLE SUTURESLFITS150 150lb Iso Toggle Suture Set £75.00LFITS250 250lb Iso Toggle Suture Set £75.00LFITS500 500lb Iso Toggle Suture Set £75.00LFISOKIT Iso Toggle Starter Kit (250 & 500lb) x 2 of each £275.00DVDALL Free Procedure DVD £FOCBRLIGAISOStep by Step guide to LigaFiba ® Iso Toggle Suture £FOCLigaFiba ® IsoToggle Suture Step by Step SummaryThe full IsoToggle Step by Step guide is available on request fromVeterinary Instrumentation or by download from www.vetinst.com. Anintroduction to the technique is given here.Placement of femoral bone tunnelThe tunnel must start just cranial to and just distal to the lateral fabella. Itshould exit through cortical bone avoiding the medial trochlea ridge anda breakout through the caudal aspect of the femur. Drill guides may beused to limit soft tissue issues.Placement of tibial bone tunnelThe tunnel passes from the Tubercle of Gerdy on the lateral aspect ofthe tibial plateau to exit from the middle of the medial proximal tibia.23Pass the suture through the tibial bone tunnelUsing the guide needle pass the loop end of the IsoToggle suturethrough the tibia from medial to lateral. Leave the button in situ on theend of the suture to prevent pull out. The suture is then passed underthe Long Digital Extensor, (some surgeons prefer to pass the sutureover the top of the LDE).Pass the suture through the femur, tension and tieUsing the guide needle the suture is passed through the femur fromlateral to medial. The exit hole in the femur should be cleared of softtissue as it is important that the toggle button sits on clean bone. Theslotted button is fed into the loop and and pulled down onto bone bywithdrawing excess LigaFiba ® from the lateral side of the stifle. TheIsoToggle suture is pulled tight from the medial aspect of the tibia andtied over the button. Care should be taken to ensure that there is noslack in the suture. The tension on the loop should be enough toeliminate the anterior drawer but not enough to cause rotation of the tibiaon the femur.Iso Toggle Aiming DevicePlacement of the tibial bone tunnel is straightforward but the femoral bone tunnel can be morechallenging. The tunnel must start just cranial toand just distal to the lateral fabella. It should exitthrough cortical bone avoiding the medialtrochlea ridge and a breakout through the caudalaspect of the femur. Some time should be spentjudging the angle of the drill. Alternatively theAdjustable Drill Guide (ADJDG2035) with anappropriately sized drill slider may be used topre-determine the line of the tunnel and offerprotection of the soft tissues. The arms of the guide have sufficient‘spring’ in them so if pre-stressed the guide is self retaining.Iso Toggle ConsumablesISO TOGGLE CONSUMABLESH090102AS 2.0mm Antiskid Drill (150lb) 100mm £24.50H090112AS 2.5mm Antiskid Drill (250lb) 115mm £24.50H090106SAS/L 3.5mm Antiskid Drill (500lb) 180mm £26.00090166/E Ormrod Button 6mm Sterile (150lb) £9.50090166/F Ormrod Button Slotted 6mm Sterile (150lb) £9.50090166/A Ormrod Button 9mm Sterile (250lb) £9.50090166/B Ormrod Button Slotted 9mm Sterile (250lb) £9.50090166/C Ormrod Button 11mm Sterile (500lb) £9.50090166/D Ormrod Button Slotted 11mm Sterile (500lb) £9.50ADJDG2035 Adjustable Drill Guide 175mm £185.00

1 JOINT SURGERYArthrex FiberWire Canine Cruciate Lateral SutureArthrex is a highly innovative global surgical company specialising in jointsurgery and arthroscopy products. Their veterinary division Arthrex VetSystems is introducing the most appropriate of the human products to theveterinary market. In addition Arthrex Veterinary Systems is working withleading veterinary surgeons, such as Jimi Cook, to develop innovativesolutions to veterinary joint surgery problems.Veterinary Instrumentation is very pleased to have been appointed UKdistributor for Arthrex joint surgery products.FiberWireMany Arthrex products are based around FiberWire, a new compositematerial consisting of a multi-stranded long chain ultra high molecularweight polyethylene core with a polyester braided jacket. Compared tomonofilament nylon, FiberWire is stronger, and does not stretch. Inaddition and very importantly FiberWire has much better wearcharacteristics. Most lateral suture loops fail by abrasion, usually at thefabella. Use of FibreWire extends the working life of the lateral suture.FiberWire is five times more resistant to abrasion than standardpolyester suture. FiberWire ties very well with a creep free soft knotwhich again compares very well with nylon.FiberWire is available in various presentations, such as free strands,swaged onto needles or attached to suture anchors.FiberTape is as the name suggests a broader, immensley strong versionof FiberWire and forms the basis of the TightRope cruciate technique.FIBERWIREAR-7200 #2 (M5) FiberWire with Tapered Needle (12) £180.00AR-7201 #2 (M5) FiberWire without Needles (12) £180.00AR-7202 #2 (M5) FiberWire with Reverse Cut Needles (12) £180.00AR-7205 #2 (M5) FiberWire - with two Tapered Needles (12) £410.00AR-7206 #2 (M5) FiberWire - with 1 /2 Circle Needles (12) £205.00AR-7210 #5 (M7) FiberWire without Needles (12) £205.00AR-7211 #5 (M7) FiberWire with Needles (12) £205.00AR-7220 2-0 FiberWire with Tapered Needles (12) £185.00AR-7237 FiberTape (6) £595.00BRFIBER FiberWire Literature £FOCNitinol Suture PassersNitinol is a highly sprungmaterial used in stents andother intravascular structures.Attached to a needle the loopsprings open making threadingvery easy and when pulledthrough causes less damage tothe soft tissues than regulareyed needles.Nitinol Flexible Suture PasserNITINOL SUTURE PASSERSNitinol Looped NeedlesPassing soft flexible sutures through bone tunnels can be a challenge.The Arthrex suture passer is 200 or 600mm long stiff yet flexible with anitinol loop at the tip which expands for easy passage of the suture c.f.suture wire loops.VAR-5000 Small Nitinol Looped Needle (5) £45.00VAR-1255-08 Nitinol Flexible Suture Passer (200mm) £55.00VAR-1255-18 Nitinol Flexible Suture Passer (600mm) £75.00FiberWire ties very well using anumber of knots including thestandard surgeons knot. It issometimes useful to intiallycreate a sliding knot which canbe used to create tension in theloop. The knot may be lockedusing 3 further half hitches.A special FiberWire lateral suture has been developed by Arthrex inconjunction with James L. Cook, DVM, PhD, at the ComparativeOrthopaedic Laboratory, University of Missouri, consisting of a swaged oncurved needle for fabella placement and a straight needle at the other endfor easy passage through the proximal tibia. The #5 FiberWire (7 metric)is for use in dogs 15kg to 50kg. The #2 FiberWire (5 metric) is used forsmaller patients.A step by step guide on how to use the new suture can be viewed ordownloaded as a pdf by visiting our web site www.vetinst.com. A video ofthe technique may also be viewed on the web site. Alternatively ask ourvet tech team for a free training pack which includes a step by stepbrochure, video and sample. If your suture tying technique needs revisionwe can send you a free CD rom on Arthroscopic Suture techniques.FIBERWIRE CANINE CRUCIATE LATERAL SUTUREVAR-2000 #5 (M7) FiberWire Lateral Suture (10) £345.00VAR-2002 #2 (M5) FiberWire Lateral Suture (10) £345.00BRCCLS FiberWire Lateral Suture Step by Step Guide £FOCDVDARTHREX Arthrex Multi DVD(contains all Arthrex Brochures)£FOC24

www.vetinst.comJOINT SURGERY 1Arthrex Isometric Lateral Suture Anchor SystemThe lateral fabella and the proximal tibial crest are not the ideal isometricpoints to substitute for the cranial cruciate liagament. They are usedbecause they are the nearest convenient points to pass a suture using aneedle. Using Arthrex FiberWire and Arthrex suture anchors it ispossible to place a lateral suture at the most isometric points. As the stifleflexes and extends the distance between theisometric points does not change.F1(lateral fabella) is isometric with T3 (posteriorwall of LDE sulcus).F2 (posteroventral femoral condyle) is isometricwith T2.In large dogs a suture may be placed at bothpairs of positions.A step by step guide is available by post or canbe downloaded from www.vetinst.com from the documents downloadpage. A video is also available on the website.Arthrex Suture AnchorsTightRope Surgical TechniqueThe start site for the femoral tunnel is just distal tolateral fabella-femoral condyle junction (ie. 2 mmfrom the caudal edge of the lateral femoral condyle).The tibial start site is located caudally within thegroove of the long digital extensor tendon.A guidewire is placed across the femur. TheCannulated Drill Bit is inserted onto theGuidewire and advanced until it exits throughthe medial side of the femur.Place the Guidewire followed by the cannulated drillwithin the tibial extensor groove proximally andresting against its caudal ridge. Advance theGuidewire through the tibia at a 45˚-60˚ angle to exitmedially within the footprint of the caudal sartoriusinsertion.Arthrex TightRope for CrCL RepairThe TightRope technique for CrCL repairtakes the best aspects of the lateral suturebut adds the benefits of isometric positioningand the use of the immensly stong ArthrexFiberTape. The isometric points are accessedby use of bone tunnels which create verysecure fixation points c.f. the lateral fabella.A full free step by step guide of the TightRopetechnique is available from VeterinaryInstrumentation or as a download fromwww.vetinst.com. The technique issummarised here.CorkscrewCancellous BoneFASTakCortical BoneCorkscrew suture anchors are designed for cancellous bone and are suppliedpre-loaded and sterile on a disposable screwdriver type applicator. Pre-drillingis not required. The Corkscrew anchor is supplied pre-loaded with either astrand of #5 FiberWire or two strands of #2 FiberWire. Additional, non sterilestand alone Corkscrew anchors are also available which may be insertedusing the same applicator. Should pre-drilling be necessary use a 2.5mm drill.FASTak ll suture anchors are designed for cortical bone. They are suppliedsterile pre-loaded with #2 (Metric 5 FiberWire) and are used in the Isometricprocedure. The anchor requires no pre-drilling and is inserted directly using thedisposable screwdriver handle applicator. Additional FASTak anchors areavailable which may be inserted using the same applicator.The applicator of both anchors is laser marked with an insertion line. Wheninserted to this line the eyelet of the anchor is below the bone surface.ARTHREX SUTURE ANCHORSVAR-2100Corkscrew Suture Anchor 5x15mm Screwdrivertype with one #5 (Metric 7) FiberWire (5 pack) £335.00VAR-2100/S As above - Single Pack £85.00VAR-2102 Corkscrew Suture Anchor 5x15mm £335.00Screwdriver type with one #2 (Metric 5)FiberWire and one #2 (Metric 5) TigerWire(5 pack)VAR-2102/S As above - Single Pack £85.00VAR-2200FASTak II with # 2 (Metric 5) FiberWiresin Screwdriver applicator (5 pack) £335.00VAR-2200/S As above - Single Pack £85.00VAR-2201 FASTak II anchor only (5 pack) £225.00VAR-2201/S As above - Single Pack £65.00BRCCLS Arthrex CCL Literature £FOC25The TightRope needle is inserted through the tibialtunnel in a medial to lateral direction. As tension isapplied to the needle and FiberTape, the toggle buttonwill lay down to allow it to advance through the tunnel.ARTHREX TIGHTROPEVAR-2800 TightRope CCL £185.00VAR-8920DC Cannulated Drill Bit 3.5mm £105.00VAR-8920P Guidewire for TightRope (Pack of 6) 1.2mm £65.00VAR-11796 FiberWire Scissors £245.00VAR-2800-MULTIAdvance the TightRope needlethrough the femoral tunnel in a lateralto medial direction.Once the toggle button has exited the femoraltunnel, the button is flipped by pulling the white suturein a slight upward direction and by pulling back on theFiberTape strands laterally. Ensure that the toggle isflipped and seated fully on medial femoral bone bydirect visualization or palpation.Seat the 4 hole button firmly and completely against themedial tibial bone. Advance the two blue strands ofFiberTape into the tensioner and tension to 10-12 lbs.Check drawer, internal rotation, and range of motion(ROM) of the stifle. Cycle the joint through a full ROM.Remove the blue strands from the tensioner, advance the twowhite strands of FiberTape into the tensioner and tension to10-12 lbs, confirm ROM, internal rotation, and drawer areoptimized. Put the stifle at a weightbearing angle (ie. ˜140˚)and tie a knot (single throw) with the bluestrands of FiberTape. Reinforce the knot with 4 to 5 throws.Remove the tensioner from the white strands of suture andrecheck the ROM, rotation and drawer. If satisfied, tie thewhite strands of FiberTape.FiberTape is a braided material but provided that standard asepticprotocols are followed infection rates are low. Try to minimise draggingFiberTape across skin. Do not unpack the TightRope until all the bonetunnels are complete.TightRope CCL 5 Pack withFREE Cannulated Drill Bit £925.00BRTIGHT TightRope Training Pack(guide + DVD) £FOCPlease note Veterinary Instrumentation cannot supply Arthrex productsoutside of the UK.

1 JOINT SURGERYMini TightRopePass a guide wire from site T3just caudal to LDE sulcus. Thewire should exit on caudomedialaspect of tibia. Follow throughwith the cannulated drillArthrex have produced a smaller version of the TightRope for dogs lessthan 18kg.The technique is the same as for the standard TightRope CCL but theguide wire and 2.7mm cannulated drills are smaller. Some users reportthat the Tensioner is more useful with the Mini TightRope (VAR-1529).The MiniTightRope also has an application in the management ofcoxofemoral luxations, see next page.ARTHREX MINI TIGHTROPEVAR-2801 Mini TightRope Single Set £135.00VAR-8911DC Cannulated Drill Bit 2.7mm (use with VAR-8920P) £105.00VAR-1529 Tensioner with Tensiometer £475.00VAR-8920P 1.2mm (0.049”) Guidewire (pack of 6) £65.00Arthrex SwiveLock AnchorKnotless CrCL TechniqueDon Hulse has developed the knotless SwiveLock technique of CrCLrepair based on his work on isometric points for the anchorage of lateralsutures. The system involves drilling a bone tunnel in the proximal tibiadrilled from point T3 (caudal to the LDE). A double strand of FiberTapeis secured on the medial tibia using a toggle. The FiberTape is tensionedand secured at point F2 just distal to the lateral fabella using the newSwiveLock anchor.Step by Step guide and brochure is available free of charge BRSWIVPass the nitinol suture passingwire through the tunnel toretrieve the FiberTape threadedonto the suture button.Pass both strands ofFiberTape through theSwiveLock and mark at blacklaser linePull button tight onto bone.No soft tissue should bebetween button and bone.Move the eyelet to the markand insert into blind tunneluntil edge of anchor is at thetunnel entrance.Tap the tunnel to the fulldepth indicated by blackmark on tapThe F2 site is drilled with theSpade Tip Drill creating ablind tunnel of fixed depth.Aim towards trochleaSWIVELOCK ANCHOR SYSTEMVAR-2323PSLGSwiveLock Kit includes VAR-2323PSLC,AR-7237 and VAR-8920G £210.00VAR-2323PSLC SwiveLock 5.5mm x 19.1mm Single £125.00AR-7237 FibreTape (6) £595.00VAR-8920G Suture Button £45.00Associated ProductsThe Fiber Tape is locked into position by screwingin the anchor. When a 1/4 of the way in test fortension and range of motion. Reposition eyelet ifnecessary and re-screw.VAR-1927CTB Tap for SwiveLock £195.00VAR-1530C-25 Cannulated Drill 2.5mm £105.00VAR-1255-08 Nitinol Flexible Suture Passer (200mm) £55.00VAR-1927D Spade Tip Drill for 5.5 SwiveLock £105.00VAR-1530K Guide Wire 1.04mm (0.041”) pack of x 4 £75.00BRSWIV SwiveLock Lateral Suture Step by Step Guide £FOC26

1 JOINT SURGERYArthrex ACP & ABPSAutologous Blood ProductsCollect whole bloodACP Autologous Conditioned PlasmaOutside the bloodstream, platelets become activated and releaseproliferative and morphogenic proteins relevant to healing in a variety oftissue types including bone, tendon and cartilage. Arthrex ACPsignificantly increases the levels of both platelets (x2) and growthfactors TGF, PDGF, EGF, VEGF, IGF-1 compared to whole blood. Invitro studies using cell cultures and ACP derived plasma hasdemonstrated increased proliferation of tenocytes, osteoblasts andchrondrocytes. Clinical studies comparing treatments using ACP with aHyaluronic Acid and Depomedrone combination are encouraging.An information pack on the use of ACP and ABPS which includespublished studies is available free on request.High concentrations of growth factors like those found in ACP have beenshown to have regenerative and modulating effects on impaired cartilageand tendons.Centrifuge for 5 minutesThe procedure requires the use of only 10ml of blood together with theArthrex double syringe primed with ACD-A which is then spun downusing a dedicated centrifuge and rotor. Depending on usage Arthrex willsupply the Centrifuge and Rotor on free loan.The Centrifuge is the same as is used with the Arthrex-ABPS system,with easily interchangeable rotors for users of bothDecant platelet richplasma (ACP)Free loan of Centrifuge and RotorProvided the surgeon is prepared to commit to an initial purchase of 2boxes (40 units) of syringes (£1,650) and an annual purchase of 5boxes, Arthrex is prepared to offer its Centrifuge with Rotor/accessories (value over £3,500) on free loan.Please call for details.ACP CONSUMABLESVABS-10014-20 Arthrex ACP Double Syringe x 20 £875.00VABS-10014 Arthrex ACP Double Syringe x 5 £275.00ABPS CONSUMABLESVAR-1011 ABPS Syringe (Single) £175.00ACP (PRP)in sub syringeACP/ ABPS EQUIPMENTABS-10019 Arthrex Centrifuge £3,025.00VAR-1021 Rotor for ABPS £650.00ABS-10021 Rotor for ACP £650.00VAR-1040 Arthrex Incubator £650.00ARTHREX CUE SYSTEMApply to target areaCanine Unicompartmental ElbowSystem for Medial CompartmentDisease.See Chapter 8 pages 230-231 formore information.Apply to target areaFirst UK course was heldDecember 2012. Courses will berunning periodically during 2013E-Mail info@vetinst.com to be keptinformed of dates.28

www.vetinst.comJOINT SURGERY 1Arthrex SynACartBefore1 2CollaVETVeterinary Instrumentation ispleased to announce that it hasbeen appointed exclusivedistributor in the UK and Europefor the CollaVET product rangefrom New Generation Devices.3 4AfterCollaVET consists of pure type 1 collagen, the most common of thecollagens found in veterbrates. As type 1 collagen of different species ishomologous, the body does not recognise it a a foreign material. Thereforethis collagen is highly biocompatible and is resorbed fully by the body.Indications:Localised drug delivery, for example carrying antibiotics as aresorbable alternative to PMMA beadsMRSA Infection post TPLODebridedSynACART is a new surgical treatment forOCD, developed by Noel Fitzpatrick and Arthrex.The procedure briefly involves debridement of thelesion, production of a suitable socket andimplantation of a suitable size SynACARTResurfacing Core. Implantation requiresidentifying a complete ring of viable hyalinecartilage which may require extreme flexion of thejoint if for example in the femur the lesion is morecaudal. For a brochure and surgical guide pleasecall 0845 130 9596, email info@vetinst.com orsee our website.ARTHREX SYNACARTVAR-2500-08 Resurfacing Core SynACART 8 mm x 8 mm £465.00VAR-2500-10 Resurfacing Core SynACART 10 mm x 8 mm £465.00VAR-2500-20 Resurfacing Core SynACART 20 mm x 8 mm £585.00VAR-2500-25 Resurfacing Core SynACART 25 mm x 8 mm £695.00VAR-2502-08DC Drill SynACART, Cannulated, 8 mm £110.00VAR-2502-10DC Drill SynACART, Cannulated, 10 mm £125.00VAR-2502-20DC Drill SynACART, Cannulated, 20 mm £145.00VAR-2502-25DC Drill SynACART, Cannulated, 25 mm £175.00VAR-2503-08 Guide SynACART, 8 mm £60.00VAR-2503-10 Guide SynACART, 10 mm £65.00VAR-2503-20 Guide SynACART, 20 mm £80.00VAR-2503-25 Guide SynACART, 25 mm £90.00VAR-2504-08 Implant Holder, SynACART, 8 mm £55.00VAR-2504-10 Implant Holder, SynACART, 10 mm £55.00AR-1250L Drill Tip Guide, 2.4mm (non-sterile) (Pack of 6) £79.50VAR-2500C SynACART Instrument Case £315.00BRSYNA Arthrex SynACART Literature £FOCCollagen & Antibiotic in situHaemostasis — intact collagen fibres have intrinsic haemostaticproperties when applied to the bleeding siteWound Healing — chronic and acute wounds, exudating wounds, ulcers,burns.Tendon repair — Tendomend *COMING SOON* collagen wrap protectsthe tendon from the formation of scar tissue and adhesionsSee also chapter 9, page 246CollaVETCVS-20403 CollaVET Sponge 20 x 40 x 3mm 10 Pack £195.00CVS-20403-Sin CollaVET Sponge 20 x 40 x 3mm Single £22.50CVS-223 CollaVET Sponge 2” x 2” x 3mm 5 Pack £175.00CVS-223-Sin CollaVET Sponge 2” x 2” x 3mm Single £40.00CVS-343 CollaVET Sponge 3” x 4” x 3mm 5 Pack £195.00CVS-343-Sin CollaVET Sponge 3” x 4” x 3mm Single £45.00CVS-25751 CollaVET Foam 25 x 75 x 1mm 10 Pack £235.00CVS-25751-Sin CollaVET Foam 25 x 75 x 1mm Single £25.00CVF-01 Fibrillar Collagen 15 Pack £295.00CVF-01-Sin Fibrillar Collagen Single £22.50CVP-1020 Collagen Plug 10 Pack £195.00CVP-1020-Sin Collagen Plug Single £22.50****Tenomend - coming soon****2 weeks later29

1 JOINT SURGERYSuture ScrewsSuture Screw SetSuture screws are a versatile,economic suture anchor. Usedtogether with LigaFiba®, suturescrews offer a solution to jointstabilisation. Sizes range from2.0mm up to 4.0mm to cover thefull range of patients. Suturescrews are now available as aboxed set including 2 of eachsuture screw (16) together withthe new universal introducerwhich fits all the screws.Applications include: shearinginjuries, isometric lateral sutures,medial collateral replacement.Also included in the kit isone of each LigaFiba ®sterile suturepacks:150lb, 250lb& 500lb.Suture Anchor PinIMPROVEDDESIGNSUTURE SCREW SETSSITKITSuture Screw Set(16 Screws + Introducer + 3 Suture Packs) £445.00SSITUN Insertion Tool for all Suture Screws 135mm £85.00A threaded suture anchor is machined into the tip of a trochar pin.Immediately proximal to the suture anchor is a narrow break off point. Theconstruct is stable during axial drilling of the pin into bone. Once in positionwith the hole of the anchor just above the surface of the bone the shaft ofthe pin is rocked to and fro. The stainless steel undergoes work hardeningand becomes very brittle, ultimately breaking off leaving the anchor inpostion ready for placement of sutures. The suture anchor pin is extremelyeasy to postion and place without pre-drilling. Length of pin into the bone is(approx) 2.5mm - 12mm, 3.0mm - 14mm and 4.0mm - 20mm.SUTURE ANCHOR PINSAP2.5 Suture Anchor Pin 2.5mm dia 1.0mm hole. £18.75SAP3 Suture Anchor Pin 3mm dia 1.0mm hole. £18.75SAP4 Suture Anchor Pin 4mm dia 2.0mm hole. £18.75Suture Anchor MaterialsIdeally the material selected should be strong with a high resistance toabrasion. FiberWire and braided polyethylene have these qualities butare braided and must, therefore, be used with care. Monofilamentmaterials cause less problems in infected areas (e.g. shearing injuries).Make sure that the material selected fits the anchor you have in mind.Suture ScrewsPresentation is a self-tapping screw with an eyed head. Use where a sutureanchor would seem appropriate.Thread forms are the same as equivalentAO type. Requires dedicated insertion tool(see price table below).SUTURE SCREWSPicture Jean-Benoit LefebvreSS2006 2.0mm dia 6mm long 1.0mm Hole Cortical £17.50SS2010 2.0mm dia 10mm long 1.0mm Hole Cortical £17.50SS2708 2.7mm dia 8mm long 1.5mm Hole Cortical £17.50SS2714 2.7mm dia 14mm long 1.5mm Hole Cortical £17.50SS3512 3.5mm dia 12mm long 2.0mm Hole Cortical £17.50SS3520 3.5mm dia 20mm long 2.0mm Hole Cortical £17.50SS4016 4.0mm dia 16mm long 2.0mm Hole Cancellous £17.50SS4024 4.0mm dia 24mm long 2.0mm Hole Cancellous £17.50SSITUN Universal Insertion Tool for all Suture Screws £85.00SUTURE ANCHOR MATERIALS091141 500mm x 50lb Nylon (Sterile Pack) £7.25091139 800mm x 80lb Nylon (Sterile Pack) £7.75LF150500 LigaFiba® 150lb (68kg) 0.6mm x 600mm £13.00LF250600 LigaFiba® 250lb (113kg) 1mm x 600mm £13.50LF500600 LigaFiba® 500lb (226kg) 1.5mm x 600mm £14.50AR-7201 FiberWire No 2 (12) £180.00AR-7210 FiberWire No 5 (12) £205.00BRFIBER FiberWire LiteratureBone Biter Suture Anchor SystemAvailable in two sizes the Bone Biter is small, easy to install, and able toresist forces equivalent to the breaking strength of a size 2 and a size 5braided suture. Also used with monofilament nylon, 50lb for the no. 2anchor and 80lb for the no. 5.BONE BITER SUTURE ANCHOR SYSTEM£FOC100001-00 Bone Biter Suture Anchor Size 2 £60.00100002-00 Bone Biter Suture Anchor Size 5 £60.00110001-00 Bone Biter Driver Set Size 2 (no anchors) £375.00110002-00 Bone Biter Driver Set Size 5 (no anchors) £375.0030

www.vetinst.comJOINT SURGERY 1Over The Top (OTT)Aneurism NeedlesCurved Graft Passerclose-up detailThe sharp tip of the angled graft passer is passed around the fabella byrotating the wrist. The eye is small and accepts all suture materials. Totallength 210mm.Photography: Hamish DennyThe repair of the cranial cruciate ligament (CCL) by the ‘Over the Top'technique requires a curved graft passer to pull the graft through the stiflejoint. This design of graft passer has been developed over many years to:1. minimise damage to intra - articular structures.2. feel right in use. The handle is comfortable.3. for graft insertion anterior to posterior or vice versa.This design is used by most recognised orthopaedic surgeons. Please seeour free DVD ‘Surgical Management of Canine Cranial Cruciate Disease’(Code: DVDALL) for details and video of the technique.The small eyed graft passers are appropriate for placement of lateral suturewire or monofilament nylon as described by M. L. Olmstead.CURVED GRAFT PASSER001051 Very Small Curved Graft Passer 2cm 165mm £55.00001052 Small Curved Graft Passer 3cm 175mm £55.00001053 Large Curved Graft Passer 4.5cm 185mm £55.00001054 Very Large Curved Graft Passer 6cm 205mm £55.00001055 Extra Large Curved Graft Passer 8cm 220mm £55.00001056 2cm Graft Passer with Small Eye 165mm £55.00001057 3cm Graft Passer with Small Eye 170mm £55.00001058 4.5cm Graft Passer with Small Eye 185mm £55.00001057AR Aneurism Needle 3cm Angled Right Small Eye £55.00ANEURISM NEEDLES001057AL Aneurism Needle 3cm Angled Left Small Eye £55.00001057AR Aneurism Needle 3cm Angled Right Small Eye £55.00001058AL Aneurism Needle 4.5cm Angled Left Small Eye £55.00001058AR Aneurism Needle 4.5cm Angled Right Small Eye £55.00CCL StaplesThe attachment of thefacia lata graft to the distalfemur is the weakest partof the OTT repair. Thesmall spikes under thehead of the staple aredesigned to engage thegraft and firmly fix it to theperiosteum. Also usefulfor re-attaching avulsedligaments and transfixingthe biceps tendon. Madefrom cobalt chrome.CCL STAPLES090125 6mm wide CCL Staple £34.50090126 8mm wide CCL Staple £34.50090127 11mm wide CCL Staple £34.50090128 16mm wide CCL Staple £34.50CCL Staple IntroducerStraight Graft PasserDesigned to pass through a 2.7mm hole, the straight graft passer is usefulfor pulling graft and nylon through bone tunnels.STRAIGHT GRAFT PASSER001050 Straight Graft Passer £52.50The staple introducer holds the staple to facilitate the initial insertion andalignment whilst being struck by a mallet. In case of difficulty starting thestaple, pre-drill with 2.0mm pin or drill bit. Accepts all sizes of CCL staple.CCL STAPLE INTRODUCER090129 Staple Introducer 130mm £165.00091130 CCL Kit in Stainless Box (introducer with 8 Staples) £395.0031

1 JOINT SURGERYLockingPlatesfine threads lock headinto platelarge core to resist bendingcoarser threads than headbut still finer than corticalscrew for max bone screwinterfaceStandard DCP or round hole plates are held into position by beingtrapped between the head of the screw and the bone. Tightening thescrew pulls the bone up to the plate. When the screw is tight the threadsof the screw pull against the bone holding the plate in position. Thesituation with locking screws and plates is very different. Although thethreads of the screw shaft engage the bone, the interface between boneand screw is not related to attachment of the plate. In locking plates andscrews it is the interface between the screw head and the plate whichattaches the plate to the screw. As the screw is tightened the bonemaintains its position relative to the plate, it is not drawn up to it. Thescrew head engages with the plate. This has a number of implications:Contouring of PlatesWith standard DCPs the plate must be contoured exactly. When thescrews are tightened the bone fragments will be pulled towards the plateand assume the contour of the plate. If the plate is not contoured correctlythe screws will pull the fragments out of alignment. Using a locking plateand screws once the plate is applied the bone fragments will be held inposition relative to one another as is the case with external fixation.Indeed locking plates are sometimes referred to as ‘internal, externalfixation’. Locking plates do not therefore require contouring in the sameway as DCP type plates. This has particular relevance in the TPLOprocedure where contouring the plate is very important and very timeconsuming. If a standard locking TPLO plate fits all TPLO osteotomiesthere are significant savings in terms of time and morbidity.TPLO Plates withLocking Screw HolesLocking TPLO plates benefit from two aspects of locking technology.The angular security conferred makes for a very rigid construct. Theminimal requirement for contouring saves times and minimisesmalalignment of the proximal segment. The pre-contouring alsominimises the risk of screw hole distortion and stress riser marks.Veterinary Instrumentation’s VILock TPLO plates have some significantadvantages over others currently available.The plate is designed to align with the osteotomy. The proximal screwsare placed along the line of the osteotomy. This means that the loadingof the screws is distributed evenly and allows a very proximal osteotomy.The screw configuration includes both converging and divergingangulation to maximise pull out resistance. Many of the locking TPLOplates currently available concentrate the screws in a very small areawhich can result in early failure.All VILock holes are ‘stacked’ which confers extreme rigidity asdescribed by Baroncelli etal, in his paper at ESVOT 2010 where theVILock system performed better than any other system tested. Thestacked hole does not allow compression but is extremely secure. TheVI TPLO locking plate allows compression via the DCP holes in the shaftof the plate. A novel angled DCP hole distally allows for additionalcompression of the cranial osteotomy if necessary. All holes accept bothstandard cortical screws and locking screws.When placing a VILock screw a dedicated drill guide is necessary to placethe pilot hole exactly at the correct angle to the plate.Screw Angulation and NumbersIn order to fit and lock into the plate the screw must be inserted at a fixedangle relative to the hole in the plate. Drill guides are provided whichscrew into the locking holes to ensure that this happens. It is not alwaysdesirable that the screws are at 90 degrees to the plate, particularly closeto joints. The angle of the screw is dictated by the plate not the surgeon.The rigid attachment of the screw to the plate gives any locking constructa high degree of angular rigidity relative to a DCP construct where aspherical screw head in an oval hole results in a relative flexibility. Thismeans in any given situation that to achieve the same rigidity as a DCPconstruct a locking construct needs less screws. Again this has particularimplications in terms of time and morbidity. It also offsets, to a degree, thehigher costs of locking screws and plates.Screw Diameter and StrengthThe increased angular rigidity places greater stresses onto the screw.Because we are not relying on the threads of the screw in the bone to pullthe plate to the bone they do not need to be as coarse as standardcortical screws. They need, only, to hold their position in the bone. Thusfor the same outside diameter of screw we can increase the corediameter without increasing the likelyhood of bone/screw interface failure.Increasing the diameter of the core hugely affects the AMI (resistance tobending) of the screw. The AMI of standard 3.5 cortical screws as used inSOP is 1.6, the AMI of standard locking screw is 2.6. A SOP screw isfar more likely to fail than is a standard locking screw. Screw failure is thetypical mode of failure of SOP constructs. Standard cortical screws arenot designed for use as locking screws.Minimally Invasive Plate Osteosynthesis (MIPO)MIPO aims to interfere with the patient’s natural respone to fracture aslittle as possible while establishing and maintaining stabilisation of thefracture. Locking plates do not need close contouring to the bone, indeedit is not necessary to have contact between the plate and the bone. Theperiosteum is therefore preserved and the fracture is not disturbed.Additionally the angular stability of locking screws coupled with the needfor fewer screws are desirable features in any MIPO procedure. Lockingscrews were developed for osteoporitic bone where standard DCPs andscrews tend to strip out. The bone screw interface is under far less stressusing locking technology. This is an important quality in juvenile bonealso. Veterinary MIPO candidates tend to be young.Head of broad 3.5locking TPLO plateLocking TPLO plate showing bothconverging and diverging locking screwsangled to avoid articular surfaces32

www.vetinst.comJOINT SURGERY 1Locking TPLO Starter SetThe VILock TPLO system is available as a start up kit offeringsubstantial discounts over regular pricing. The kit includes all that youwill need to offer locking TPLO to your clients.VI Locking TPLO PlatesLocking TPLO plate showing bothconverging and diverging lockingscrewsVILock TPLO plates are available in 3.5 broad, 3.5 and 2.7mm variantswhich covers the vast majority of TPLO patients.Each size allows the use of two different screw diameters. For examplethe standard 3.5 plate takes 3.5 screws with a 3.5 head and 2.7 screwswith a 3.5 head. Given that one of the downsides of locking technologyis that the angle of screw placement is pre-determined by the platerather than the surgeon, this is important.TPLO PLATES WITH LOCKING SCREW TECHNOLOGYTPLO27LPCL TPLO Plate Locking 2.7 Left £80.00TPLO27LPCR TPLO Plate Locking 2.7 Right £80.00TPLO35LPCL TPLO Plate Locking 3.5 Left £80.00TPLO35LPCR TPLO Plate Locking 3.5 Right £80.00TPLO35BLPCL TPLO Plate Broad Locking 3.5 Left £90.00TPLO35BLPCR TPLO Plate Broad Locking 3.5 Right £90.00LSDG2724 Locking Screw Drill Guide for small 2.7 £52.50LSDG35 3.5 Locking Screw Drill Guide £52.50For plate profiles see page 394TPLO353555 Locking PlatesThe VILock TPLO Starter Kit includes the following:TPLO Saw and Hose18, 24 & 30mm VI pattern TPLO BladesTPLO Basic JigTPLO Rotation ChartSlocum Rotation GaugesBone Scribe8 VILock TPLO plates (2x 2.7, 4x 3.5, 2x 3.5 Broad)DVD Step by step guidePlate acetatesAll Starter Kits are discounted by over 10% compared to the componentprice.VILOCK TPLO STARTER KITTPLOVILOCKKIT VILock TPLO Starter Kit £3,750.00Philip Moses of Brisbane, Australia developed the original Clover-leafTPLO353555. Seeing the advantages of using locking technologies, hehas now specified left and right pre-contoured locking-versions of thispopular plate. All the screws remain parallel to avoid the joint space andallow for optimal load sharing perpendicular to the screw shafts. Alllocking holes are stacked, allowing for use of either standard 3.5mmcortical screws or 3.5mm locking screws. There are two dynamiccompression holes in the shaft for compression.Available June 2013.TPLO 353555 LOCKING PLATESTPLO353555RL 3.5mm DCP 55mm Length Locking Right £80.00TPLO353555LL 3.5mm DCP 55mm Length Locking Left £80.00For plate profiles see page 393For plate profiles see page 39433

1 JOINT SURGERYLocking ScrewsLocking Screw TapsLocking Screw Hex Drive 3.5mmVI locking screws are an exact fit for standard locking TPLO plates bututilise the conventional hex drive rather than a star drive.LOCKING SCREW HEX DRIVE 3.5mm USE 2.7mm PILOT PLUS DRILL SLEEVELS3510 Locking 3.5 Screw Hex Drive 10mm £12.50LS3512 Locking 3.5 Screw Hex Drive 12mm £12.50LS3514 Locking 3.5 Screw Hex Drive 14mm £13.25LS3516 Locking 3.5 Screw Hex Drive 16mm £13.25LS3518 Locking 3.5 Screw Hex Drive 18mm £13.75LS3520 Locking 3.5 Screw Hex Drive 20mm £13.75LS3522 Locking 3.5 Screw Hex Drive 22mm £14.50LS3524 Locking 3.5 Screw Hex Drive 24mm £14.75LS3526 Locking 3.5 Screw Hex Drive 26mm £15.00LS3528 Locking 3.5 Screw Hex Drive 28mm £15.25LS3530 Locking 3.5 Screw Hex Drive 30mm £15.75LS3532 Locking 3.5 Screw Hex Drive 32mm £16.00LS3534 Locking 3.5 Screw Hex Drive 34mm £16.25LS3536 Locking 3.5 Screw Hex Drive 36mm £16.50LS3538 Locking 3.5 Screw Hex Drive 38mm £16.75LS3540 Locking 3.5 Screw Hex Drive 40mm £17.00LS3542 Locking 3.5 Screw Hex Drive 42mm £17.25LS3544 Locking 3.5 Screw Hex Drive 44mm £17.50LS3545 Locking 3.5 Screw Hex Drive 45mm £17.50LS3546 Locking 3.5 Screw Hex Drive 46mm £17.75LS3548 Locking 3.5 Screw Hex Drive 48mm £18.00LS3550 Locking 3.5 Screw Hex Drive 50mm £18.50LS3552 Locking 3.5 Screw Hex Drive 52mm £19.00LS3554 Locking 3.5 Screw Hex Drive 54mm £19.50LS3555 Locking 3.5 Screw Hex Drive 55mm £19.75LS3556 Locking 3.5 Screw Hex Drive 56mm £20.00LS3558 Locking 3.5 Screw Hex Drive 58mm £21.00LS3560 Locking 3.5 Screw Hex Drive 60mm £22.00LSDG35 3.5 Locking Screw Drill Guide £52.50H090104 2.7 Locking Screw Pilot Drill £20.50SHLS35 3.5 Locking Screwbox £135.00Locking PlugUse to protect locking holes during contouring and to fillvulnerable empty holes.IMPROVEDDESIGNSince the introduction of locking screws into veterinary orthopaedics wehave had the feedback that the self tapping feature works well inrelatively soft bone (e.g. proximal tibia for TPLO) but it is less effective indense cortical bone where getting the screw started can be a challenge.Starting the screw at any angle other than 90 degrees to the plate willhave serious consequences when the locking threads meet the plate. Inaddition if the screw does not tap the trans cortex efficiently a disc ofbone may be punched from the bone surface as the screw exits.LOCKING SCREW TAPTSLS35 Tap for 3.5 Locking Screws £82.50TSLS27 Tap for 2.7 Locking Screws £82.50TSLS24 Tap for 2.4 Locking Screws £82.50TSLS20 Tap for 2.0 Locking Screws £82.50QRCS01F Quick Release Tap Handle £145.00TSLSET Handle and Locking Tap Set (one of each tap) £425.00Star Drive Screwdriver SetAll VILock screws are available with the international ‘Torx’ style StarDrive. The interface between the screw head and screwdriver issignificantly stronger and the stripping of screw heads consequentlymuch rarer. The tip of the screwdriver is tapered and ‘picks up’ thescrews without the requirement for a screw holding sleeve.Many surgeons do not possess the relevant Star Drive screwdrivers sowe are pleased to offer a modular handle plus inserts for the standard3.5mm, 2.7/2.4mm and 2.0mm screws.The handle and inserts are available seperately but are cheaper as theset. The handle is made from white autoclavable Teflon which does not‘shed’ like the traditional fibre type. The cap revolves in the palm of thehand for extra comfort.STAR DRIVE SCREWDRIVER INSERTSDT1535 Star Drive Insert for 3.5 Locking screws £65.00SDT82427 Star Drive Insert for 2.7 (2.4 head) and 2.4 Locking Screws £65.00SDT620 Star Drive Insert for 2.0 Locking screws £65.00QRCS01F Quick Release Handle £145.00SDTSET Handle and Star Drive Insert set (one of each ) £325.00LOCKING PLUG HEX DRIVE 2.7/3.5mmLSP35 Locking Plug for LS35** and LS2735** screws £7.5034

www.vetinst.comJOINT SURGERY 1Locking Screw Star Drive 3.5mmAll VI locking screws are now also available with a star pattern head.Please see page 188 for further information.LOCKING SCREW STAR DRIVE 3.5mm USE 2.7mm PILOT PLUS DRILL SLEEVELS35STAR10 Locking 3.5 Screw Star Drive 10mm £12.50LS35STAR12 Locking 3.5 Screw Star Drive 12mm £12.50LS35STAR14 Locking 3.5 Screw Star Drive 14mm £13.25LS35STAR16 Locking 3.5 Screw Star Drive 16mm £13.25LS35STAR18 Locking 3.5 Screw Star Drive 18mm £13.75LS35STAR20 Locking 3.5 Screw Star Drive 20mm £13.75LS35STAR22 Locking 3.5 Screw Star Drive 22mm £14.50LS35STAR24 Locking 3.5 Screw Star Drive 24mm £14.75LS35STAR26 Locking 3.5 Screw Star Drive 26mm £15.00LS35STAR28 Locking 3.5 Screw Star Drive 28mm £15.25LS35STAR30 Locking 3.5 Screw Star Drive 30mm £15.75LS35STAR32 Locking 3.5 Screw Star Drive 32mm £16.00LS35STAR34 Locking 3.5 Screw Star Drive 34mm £16.25LS35STAR36 Locking 3.5 Screw Star Drive 36mm £16.50LS35STAR38 Locking 3.5 Screw Star Drive 38mm £16.75LS35STAR40 Locking 3.5 Screw Star Drive 40mm £17.00LS35STAR42 Locking 3.5 Screw Star Drive 42mm £17.25LS35STAR44 Locking 3.5 Screw Star Drive 44mm £17.50LS35STAR45 Locking 3.5 Screw Star Drive 45mm £17.50LS35STAR46 Locking 3.5 Screw Star Drive 46mm £17.75LS35STAR48 Locking 3.5 Screw Star Drive 48mm £18.00LS35STAR50 Locking 3.5 Screw Star Drive 50mm £18.50LS35STAR52 Locking 3.5 Screw Star Drive 52mm £19.00LS35STAR54 Locking 3.5 Screw Star Drive 54mm £19.50LS35STAR56 Locking 3.5 Screw Star Drive 56mm £20.00LS35STAR58 Locking 3.5 Screw Star Drive 58mm £21.00LS35STAR60 Locking 3.5 Screw Star Drive 60mm £22.00LSDG35 3.5 Locking Screw Drill Guide £52.50H090104 2.7 Locking Screw Pilot Drill £20.50SHLS35 3.5 Locking Screwbox £135.00Locking Screw Star Drive 2.7mm with 2.4mm HeadLOCKING SCREW STAR DRIVE 2.7MM WITH SMALL (2.4MM) HEADLS2724STAR06 Locking 2.7 (2.4 head) Screw Star Drive 6mm £12.00LS2724STAR08 Locking 2.7 (2.4 head) Screw Star Drive 8mm £12.00LS2724STAR10 Locking 2.7 (2.4 head) Screw Star Drive 10mm £12.50LS2724STAR12 Locking 2.7 (2.4 head) Screw Star Drive 12mm £13.00LS2724STAR14 Locking 2.7 (2.4 head) Screw Star Drive 14mm £13.25LS2724STAR16 Locking 2.7 (2.4 head) Screw Star Drive 16mm £13.25LS2724STAR18 Locking 2.7 (2.4 head) Screw Star Drive 18mm £13.75LS2724STAR20 Locking 2.7 (2.4 head) Screw Star Drive 20mm £13.75LS2724STAR22 Locking 2.7 (2.4 head) Screw Star Drive 22mm £14.50LS2724STAR24 Locking 2.7 (2.4 head) Screw Star Drive 24mm £14.75LS2724STAR26 Locking 2.7 (2.4 head) Screw Star Drive 26mm £15.00LS2724STAR28 Locking 2.7 (2.4 head) Screw Star Drive 28mm £15.25LS2724STAR30 Locking 2.7 (2.4 head) Screw Star Drive 30mm £15.75LS2724STAR32 Locking 2.7 (2.4 head) Screw Star Drive 32mm £16.00LS2724STAR34 Locking 2.7 (2.4 head) Screw Star Drive 34mm £16.25LS2724STAR36 Locking 2.7 (2.4 head) Screw Star Drive 36mm £16.50LS2724STAR38 Locking 2.7 (2.4 head) Screw Star Drive 38mm £16.75LS2724STAR40 Locking 2.7 (2.4 head) Screw Star Drive 40mm £17.00LSDG2724 Locking Screw Drill Guide for Small 2.7 £52.50H090102 2.0 Locking Screw Pilot Drill £20.00SHLS27 2.7 Locking Screwbox £135.00Locking Screw Star Drive 2.4mmThe 2.4 locking screw has the same head as the 2.7mm locking screw(LS2724** series) and may therefore be used in both 2.4 locking platesand 2.7 locking plates where desirable. The pilot drill is 1.8mm and aswith other locking screw sizes requires a dedicated drill sleeve.LOCKING SCREW STAR DRIVE 2.4MMLS2424STAR06 Locking 2.4 Screw Star Drive 6mm £12.00LS2424STAR08 Locking 2.4 Screw Star Drive 8mm £12.00LS2424STAR10 Locking 2.4 Screw Star Drive 10mm £12.50LS2424STAR12 Locking 2.4 Screw Star Drive 12mm £13.00LS2424STAR14 Locking 2.4 Screw Star Drive 14mm £13.25LS2424STAR16 Locking 2.4 Screw Star Drive 16mm £13.25LS2424STAR18 Locking 2.4 Screw Star Drive 18mm £13.75LS2424STAR20 Locking 2.4 Screw Star Drive 20mm £13.75LS2424STAR22 Locking 2.4 Screw Star Drive 22mm £14.50LS2424STAR24 Locking 2.4 Screw Star Drive 24mm £14.75LS2424STAR26 Locking 2.4 Screw Star Drive 26mm £14.75LS2424STAR28 Locking 2.4 Screw Star Drive 28mm £15.25LS2424STAR30 Locking 2.4 Screw Star Drive 30mm £15.75LS2424STAR32 Locking 2.4 Screw Star Drive 32mm £16.00LS2424STAR34 Locking 2.4 Screw Star Drive 34mm £16.25LS2424STAR36 Locking 2.4 Screw Star Drive 36mm £16.50LS2424STAR38 Locking 2.4 Screw Star Drive 38mm £16.75LS2424STAR40 Locking 2.4 Screw Star Drive 40mm £17.00LSDG2424 Locking Screw Drill Guide for small 2.4 £52.50H090208 1.8mm Pilot Drill £19.50SHLS24 2.4 Locking Screwbox £135.00Locking PlugUse to protect locking holes during contouring.LOCKING PLUG STAR DRIVE 2.7/3.5mmLSP35STAR Locking Plug for LS35STAR** Screws £7.50LSP24STAR Locking Plug for LS2724STAR** Screws £7.50Locking Screw SetsAvailable in both 3.5, 2.7mm (with2.4mm head), 2.4mm and 2.0mm.Supplied in a stainless steelscrewbox. Sets discounted byover 5% from component price.3.5 set includes 3 x 12-20mm, 4 x 24-26mm, 5 x 28-40mm, 4 x 42-50mm,3 x 52-58mm locking screws and 5 locking plugs2.7 and 2.4mm set includes 3 x 6-8mm, 4 x 10-16mm, 5 x 18-28mm,4 x 30-32mm, 3 x 34-40mm locking screws and 5 locking plugsLOCKING SCREW SETSLS35KIT 3.5 Locking Screw Set Hex Drive £1,495.00LS35STARKIT 3.5 Locking Screw Set Star Drive £1,495.00LS27STARKIT 2.7 Locking Screw Set Star Drive £995.00LS24STARKIT 2.4 Locking Screw Set Star Drive £995.00LS20STARKIT 2.0 Locking Screw Set Star Drive £995.0035

1 JOINT SURGERYTriple Tibial OsteotomyA cruciate management techniquecombining tibial plateau levelling andtibial tubercle advancement.Based on the work of Slocum, Tepic and Montavon, the Triple TibialOsteotomy has been developed by Dr Warrick Bruce to overcome some ofthe problems encountered in the Slocum TPLO technique, the MontavonTTA (Tibial Tubercle Advancement) and the closing wedge TPLOtechnique.Case Warrick Bruce90˚Osteometer and Saw guideSome of the problems include:Work by Tepic suggests that the tibial plateau should be perpendicular tothe patella ligament to minimise shear strain at the CrCL. The Slocumtechnique does not always address this issue.The bi-radial Slocum blade is inefficient and difficult to resharpen resultingin the generation of significant amounts of heat which leads to delayedhealing and other complications.The Montavon TTA technique creates a large defect in the cranial tibiawhich requires an expensive titanium cage and plate to prevent collapseduring the healing phase.The closing wedge TPLO shortens the tibia and creates a defect in thetibia which has to be protected from the pull of the straight patella ligamentby a figure of eight wire.Three OsteotomiesTriple Tibial OsteotomyTPLO + TTASome instrumentation is required to make the procedure easier and tominimise errors. Warrick Bruce’s original instrument set comprises a sawguide, measuring/marking gauge (osteometer) and a bone manipulationdevice (wedgie). The saw guide works with flat oscillating blades with amaximum cut thickness of 1mm (thickness at the teeth). See Chapter 5.The original set is very reasonably priced and offers the surgeon a verycost effective route to management of CrCL rupture by tibial plateaulevelling surgery. Warrick’s new, more sophisticated designs are shownbelow.The TTO technique deals with all of these problems:A long osteotomy is made in the tibial crest to allow the tibial tubercle tomove forward. The angle correction is made by making a small wedgeosteotomy in the caudal tibia which, when closed creates a small tibialtubercle advancement. A free instructional DVD is available which fullydescribes and explains the procedure through video, stills and text files.The DVD also includes an instrument check list.Multi SawOne of the advantages of the TTO (and TWO) procedure isthat it uses simple flat blades which are easily replaced whenthey become blunt. The TTO uses a saw guide to direct thesaw very accurately ensuring a‘good fit’ once the osteotomy iscomplete. Surgical air or batterydriven saws are ideal for theprocedure but the Multi Saw with asterile shroud and convertor worksvery well. Make sure that the bladeselected fits through the saw guide(cut thickness less than 1.0mm)See chapter 5 for more details onsaws and bladesTTO014Photograph ofImproved TTOinstrumentationTTO009TTO002TTO INSTRUMENTATIONTTO011TTO008 Basic TTO Instruments (3 items) kit price £245.00TTO006 Basic Osteometer £95.00TTO004 Saw Cutting Guide (Standard 62mm) £95.00TTO002 Wedgie segment manipulator £95.00TTO004L Saw Cutting Guide (Long 76mm) £95.00DVDALL DVD Illustrating the procedure £FOCBRTTO TTO Step by Step Guide £FOC36

www.vetinst.comJOINT SURGERY 1Improved TTO InstrumentationWarrick Bruce has designed two newinstruments to make the TTO procedureeasier and to eliminate some of thepractical difficulties encountered usingthe original instrumentation.IMPROVED TTO INSTRUMENTATION BY WARRICK BRUCETTO011 Improved Combination Osteometer/Sawguide £275.00TTO014 TTO Clasper £375.00TTO002 Wedgie segment manipulator £95.00TTO009 Enhanced TTO Instrument set (all of above) £675.00TTO Starter KitsTTO STARTER KITSCase Warrick BruceThe new combined osteometer and sawguide interlock to become a singleinstrument which is much easier tomanage than the original two separateinstruments. The thumbscrew locks theosteometer onto the saw guide for secure accurate osteotomies. Theosteometer still has holes for fixation to the tibia using 1.6 arthrodesiswires.Alternatively Warrick’s second new instrument ‘the Clasper’ may be usedto lock the osteometer onto the tibia prior to cutting. The ‘Clasper’ has anadditional role in that it is used to replace the kern bone holders in theoriginal technique. The ‘Clasper’ grasps the tibia crest prior to closure andincorporates location holes for the very large fragment forceps to lock into.The ‘wedgie’, used for manipulating the three osteotomies remainsunchanged.TTO Basic Starter Setplus Multi Saw KitTTO Basic Instrument SetVery Large Fragment ForcepsTissue Protector 2.0mm10 TTO plates (common sizes)Arthrodesis wire (1.6 x 10)Multi Saw Surgical Kit2 x Sagittal Saw BladesTTO DVD/Step by Step GuidePlate Overlay AcetateAn enhanced kit with the Improved TTO Osteometer and the new Clasperis also available. Both kits are available with or without the MultiSawSurgical Kit. All starter kits are discounted by at least 10% compared tothe component price.TTOBKIT TTO Starter Set Basic £925.00TTOAKIT TTO Starter Set Enhanced £1,350.00TTOBKITPOW TTO Starter Set Basic plus Multi Saw kit £1,450.00TTOAKITPOW TTO Starter Set Enhanced plus Multi Saw kit £1,775.00TTO PlatesThe standard TTO plate is a cloverleaf TPLO plate. Being positioned overthe caudal 2/3 of the tibia the plate selected is typically a little smaller thanis the case with a wedge TPLO. Use the free plate overlay for the finalselection. Thicker plates are harder to contour and a selection of precontouredplates are available.TTO AND TPLO BY WEDGE OSTEOTOMY PLATESTPLO202026 2.0mm DCP 26mm overall length £30.00TPLO202031 2.0mm DCP 31mm overall length £30.00TPLO242434 2.4mm DCP 34mm overall length £35.00TPLO242441 2.4mm DCP 41mm overall length £35.00TPLO272739 2.7mm DCP 39mm overall length £35.00TPLO272745 2.7mm DCP 45mm overall length £35.00TPLO2735392.7/3.5 DCP 39mm overall lengthAllows use of 3.5 cancellous screw in head £35.00TPLO273545 2.7/3.5 DCP 45mm overall length 2.5mm thick £39.00TPLO353555 3.5mm DCP 55mm overall length £49.00TPLO353557 3.5mm DCP 57mm overall length Heavy Duty £49.00TPLO353559 3.5mm DCP 59mm overall length £49.00TPLO353562 3.5mm DCP 62mm overall length £49.00TPLO353577 3.5mm DCP 77mm overall length £49.00TPLO353577X 3.5mm DCP 77mm overall length xtra shaft hole £49.00TPLO353579 3.5mm DCP 79mm overall length Heavy Duty £53.00TPLO3545793.5/4.5 DCP 79mm overall length Heavy DutyAllows 4.5 screws in head £53.00TPLO79mm overall length, Heavy Duty35456579 Allows 4.5/6.5 screws in head £58.00TPLO4.5mm DCP 90mm overall length45659030 Will accept 6.5 cancellous screws in head3.0mm thick £97.50TPLO4.5mm DCP 90mm overall length45659035 Will accept 6.5 cancellous screws in head3.5mm thick £97.50TPLO4.5mm DCP 90mm overall length45659045 Will accept 6.5 cancellous screws in head4.5mm thick £97.50TPLOO Angle Finder & Plate Overlay £FOCPRE CONTOURED TTO PLATESTPLO353555PCR 3.5 mm Plate 55mm overall length Right £60.00TPLO353555PCL 3.5 mm Plate 55mm overall length Left £60.00TPLO353557PCR 3.5 mm Plate 57mm overall length Right £60.00TPLO353557PCL 3.5 mm Plate 57mm overall length. Left £60.00TPLO353579PCR 3.5 mm Plate 79mm overall length Right £65.00TPLO353579PCL 3.5 mm Plate 79mm overall length Left £65.00TCO ClampTCO CLAMPAn alternative to the Kern boneholding clamp the TCO Clamp islighter with a smaller lever arm.The effect of this is to reduce thelikelyhood of a TCO fracture. TheTCO clamp incorporates locatingholes for the tips of the very largefragment forcepsTTO012 TCO Clamp 65mm £85.00For all screws see chapter 7. For suitable saw blades see chapter 5.37

1 JOINT SURGERYTibial Plateau Levelling byRadial OsteotomySlocumSlocum Style PlatesTPLOS35L Slocum StyleTPLOS27R Slocum StyleThe original cast Slocum plate met neither the current metallurgicalspecification nor the manufacturing process requirements for stainlesssteel implants. While we are allowed to use our judgement regardingimplants it would be relatively hard to defend the use of a non-standardimplant should anything go wrong.In view of the above we have produced a Slocum style plate, machinedfrom 316LVM. The only clear advantage of the cast Slocum plate was itsmalleability. Our plate has been modified in the head region to makecontouring easier, while retaining the stiffness of 316LVM elsewhere forstability and rapid healing. The lower profile makes closure easier.SLOCUM STYLE TPLO PLATESTPLOS35BL TPLO Plate Broad Slocum Style 3.5mm Left £75.00TPLOS35BR TPLO Plate Broad Slocum Style 3.5mm Right £75.00TPLOS35L TPLO Plate Slocum Style 3.5mm Left £75.00TPLOS35R TPLO Plate Slocum Style 3.5mm Right £75.00TPLOS27BL TPLO Plate Broad Slocum Style 2.7mm Left £75.00TPLOS27BR TPLO Plate Broad Slocum Style 2.7mm Right £75.00TPLOS27L TPLO Plate Slocum Style 2.7mm Left £55.00TPLOS27R TPLO Plate Slocum Style 2.7mm Right £55.00TPLOS24L TPLO Plate Slocum Style 2.4mm Left £55.00TPLOS24R TPLO Plate Slocum Style 2.4mm Right £55.00TPLOS20L TPLO Plate Slocum Style 2.0mm Left £55.00TPLOS20R TPLO Plate Slocum Style 2.0mm Right £55.00BRTPLO TPLO Radial Cut Step by Step Guide £FOCDelta Style TPLOPlates - ContouredPre-Contoured Slocum Style TPLO platesTPLO plates manufactured from implant specification stainless steel(ASTM F 138, ISO 5832-1) are extremely difficult to contour appropriatelywithout leaving stress riser marks in vulnerable places. Our pre-contouredplates are pre-bent and polished to leave no stress riser. A final intraoperative‘tweak’ may be necessary in individual cases.PRE-CONTOURED TPLO PLATESTPLOS35RPC 3.5 Right Slocum Style Pre-contoured Plate £82.50TPLOS35LPC 3.5 Left Slocum Style Pre-contoured Plate £82.50For plate profiles see page 392.Locking TPLO plates are also available. See page 33 for the complete range.XS TPLO JigDesigned by David Strong, this is our smallest TPLO jig to date. Thecranked design allows the arm to pass through a greater range of motionwithout obstructing access for creating the osteotomy or applying implants.The single hinge reduces instrument bulk. The teardrop shaped holesaccept 1.6mm and 2.0mm Ellis Pins. 2mm A-wires or K-wires are used asalignment bars. A 2.0mm Allen Key is provided. The main body is only60mm long. Available from June 2013.XS TPLO JIGTPLOJIGXS XS TPLO Jig 60mm £275.00TPLO JigVeterinary Instrumentation is now able to supply the familiar triangularTPLO range in all the standard sizes, 3.5 Broad, 3.5 Standard, 2.7, 2.7Band 2.4. These plates are not easy to contour so we offer only the precontouredoptions which may need a final clinical ‘tweak’.DELTA STYLE TPLO PLATESTPLODEL35BL 3.5 Broad Delta Plate Left £75.00TPLODEL35BR 3.5 Broad Delta Plate Right £75.00TPLODEL35L 3.5 Delta Plate Left £60.00TLPODEL35R 3.5 Delta Plate Right £60.00TPLODEL27BL 2.7 Broad Delta Plate Left £60.00TPLODEL27BR 2.7 Broad Delta Plate Right £60.00TPLODEL27L 2.7 Delta Plate Left £60.00TPLODEL27R 2.7 Delta Plate Right £60.00TPLODEL24L 2.4 Delta Plate Left £60.00TPLODEL24R 2.4 Delta Plate Right £60.00Once the radial cut is made in the proximal tibia the two parts areessentially unstable. The proximal segment has to be rotated whilemaintaining alignment. The jig is placed prior to the cut and keeps the twosegments under control until the rotation is complete and the two partsfixed internally. Supplied with a 2.5mm Allen Key.TPLO JIGTPLOJIG TPLO Jig 120mm £225.00TPLO32 Slocum Guide Pin 3.2mm, Thread 25mm £6.7538

www.vetinst.comJOINT SURGERY 1Standard Slocum Style TPLO JigSlocum TPLO Guide PinEnd threaded negative pin. Drive directly into the tibia for jig attachment.SLOCUM TPLO GUIDE PIN 3.2mmTPLO32 Slocum Guide Pin 3.2mm, thread 25mm £6.75TPLO24 Slocum Guide Pin 2.4mm, thread 20mm £6.75For screws see Chapter 7. For power tools and saw blades see Chapter 5.This jig is a replica of the well known TPLO Jig and includes alignmentbars. Available in two sizes 3.5mm plate size and 2.7mm plate size.Supplied with a 2.5mm Allen Key.SLOCUM STYLE TPLO JIGTPLOJIG/S Slocum Style Jig Standard (3.2 Pin) £295.00TPLO32 Slocum Guide Pin 3.2mm, Thread 25mm £6.75TPLOJIG/SS Slocum Style Jig Small (2.4 Pin) £295.00TPLO24 Slocum Guide Pin 2.4mm, Thread 20mm £6.75TPLOJIG/ROD35 Replacement Alignment Bars (set of 2) Standard £25.00TPLOJIG/ROD27 Replacement Alignment Bars (set of 2) Small £25.00Slocum Rotation GaugesDelta TPLO Plate Benders with Curved SlotsDELTA TPLO PLATE BENDERS WITH CURVED SLOTSPlate benders with slots tend to distortthe delta plate. The curved slots helpgrip and support the the plate during thebending process. In addition the plate ismuch less likely to end up on the floor.TPLODELBEND Delta TPLO Plate Benders (Pair) 230mm £130.00TPLO Starter KitThe rotation gauges simplify the rotation procedure. The correctmeasurement, in millimetres, is read from the table and the appropriategauge selected. The bone is marked using the scribe or an osteotome.No more fiddling around with rulers.SLOCUM TPLO ROTATION GAUGES 5 to 15mm001492 Slocum Rotation Gauges £87.50The DeltaTPLO Starter KitTPLO Rotation Gauge Divider TypeThis instrument is an alternative to the feeler gaugetype measuring system. Spring loaded, adjusting theset screw fixes the points at any predetermineddistance from 0-20 degrees as read from thescale.The tibial plateau may then be rotated thedistance between the points.TPLO ROTATION GAUGE DIVIDER TYPE001499 TPLO Rotation Gauge Divider Type 90mm £65.00TPLO Rotation ChartThe rotation data for blades 18mm, 21mm, 24mm, 27mm & 30mm aredisplayed on this double sided, laser marked, stainless steel gauge.Incorporates also a drill gauge and a ruler for measuring screws and rotation.TPLO ROTATION CHARTTPLOROT TPLO Rotation Chart £67.502 versions of the TPLO Starter Kit are available, with either Slocum Styleor Delta Style Plates.The Delta TPLO Starter Kit includes the following:TPLO Saw and Hose18, 24 & 30mm VI Pattern TPLO BladesTPLO Basic JigTPLO Rotation ChartSlocum Rotation GaugesBone Scribe10 Delta Style TPLO plates (2 x 2.7, 2 x 2.7 Broad, 4 x 3.5, 2 x 3.5Broad)DVD Step by Step GuidePlate AcetatesThe Slocum TPLO Starter Kit is the same except 10 TPLO SlocumStyle Plates are included rather than the Delta Plates.All Starter Kits are discounted by over 10% compared to the componentprice.TPLO STARTER KITTPLODKIT TPLO Starter Kit with Delta Style Plates £3,750.00TPLOSKIT TPLO Starter Kit with Slocum Style Plates £3,750.0039

1 JOINT SURGERYTPLO Wire Guide and Reduction ForcepsTPLO SawsOnce the osteotomy has been performed and the proximal segmentrotated it is essential that the construct is stabilised prior to plateapplication. As is often the case the ideal position for the initial,temporary, stabilisation and the semi-permanent wire are one and thesame.The new TPLO reduction forceps are designed to stabilise andcompress across the osteotomy site. At the tip is a wire guide tube whichallows a stabilising wire to be driven across the osteotomy at exactly thecorrect position without skidding or slippage at start up.The action is spinlock allowing the surgeon full flexibility on positioningand compression.The forceps are handed and significantly cheaper when purchased as aset.TPLO REDUCTION FORCEPS WITH WIRE GUIDEStabilisation WireTPLORFR TPLO Reduction Forceps with Wire Guide Right 215mm £125.00TPLORFL TPLO Reduction Forceps with Wire Guide Left 215mm £125.00TPLORFSET TPLO Reduction Forceps with Wire Guide Right & Left £210.00Ligaclip Re-usable Clip Appliers & Titanium ClipsSlocum TPLO blades create a patented bi radial cut which means that thetibial plateau segment fits the distal tibia section exactly with maximumbone contact. While this is a good thing the design of the blade does notcut very efficiently and needs regular hand sharpening if excess heat is notto be produced. Veterinary Instrumentation has been looking at TPLOblades for a number of years and is introducing a range of radial bladeswhich cut better and are cheaper to replace than the Slocum original. Theyhave the same triangular Stryker connection.TPLO SAWSTPLOSW TPLO Saw £2,350.00HALLHOSEVI VI Hose – Halls Fitting £445.00TPLO Saw Blades VI PatternWe have sold TPLOsaw blades fromvariousmanufacturers overthe years but havealways thought thatnone of them cut aswell as they should.In addition, some ofthe blade lengthsavailable did notmatch the clinicalrequirement. Wehave, therefore,designed our own.Severe haemorhage from the popliteal artery is at best very timeconsuming and at worst life threatening. Ligation by standard techniquesis made very difficult due the inaccessible location. Clips are the systemof choice and ‘Liga Clips’ are recognised as the industry standard.Veterinary Instrumentation is delighted to have been appointeddistributor for Ethicon speciality products.The clips are available in a range of sizes but the medium and largeseem to be most useful in this situation.Application is simple and achievable in very awkward situations withoutthe requirement for a massive dissection.The clips are manufactured from malleable titanium. Ligation is secureand permanent.LIGACLIP RE-USABLE CLIP APPLIERS AND TITANIUM CLIPSJJLX207 Ligaclip Applier Reusable 7.5” Med Clips £265.00JJLC307 Ligaclip Applier Reusable 7.5” Med/Lg Clips £275.00JJLC800 Ligaclip Clip Base - Stainless Steel £175.00JJLT200 Ligaclip Titanium Clips Medium 6 x 36 £250.00JJLT300 Ligaclip Titanium Clips Med / Lg 6 x 18 £185.00For further information regarding the Ligaclip range and for more sizessee page 236.Previously available blades either have no ‘set’ or a one sided ‘set’. The‘set’ of a saw is the way that alternate teeth protrude outside the blade ofthe saw. The set, which is found on most woodworking and metal workingsaws, is there to create a slot in the material, slightly larger than the bodyof the blade so that the blade does not produce friction in the slot. Frictioncreates heat which although not serious in either wood or metal is veryserious in bone. Thermal necrosis along the saw cut of TPLO osteotomiesis a common cause of delayed union and failure.In addition to heat, friction leads to jamming of the blade in the slot which isboth frustrating and destructive. VI TPLO Blades have a full bilateral set formaximum efficiency.TPLO SAW BLADES VI PATTERNTPLOVI15 TPLO Blades VI Pattern 15mm £255.00TPLOVI18 TPLO Blades VI Pattern 18mm £255.00TPLOVI21 TPLO Blades VI Pattern 21mm £255.00TPLOVI24 TPLO Blades VI Pattern 24mm £255.00TPLOVI27 TPLO Blades VI Pattern 27mm £255.00TPLOVI30 TPLO Blades VI Pattern 30mm £255.00For further information regarding the TPLO starter kit see pages 33 and39.40

www.vetinst.comJOINT SURGERY 1Tibial Plateau LevellingOperation by WedgeOsteotomyThe Tibial Plateau LevellingOsteotomy (TPLO) alters theanatomy of the stifle to moderate theeffect of the loss of the cranialcruciate ligament (CCL). The stifleremains unstable to manipulation butis stable as the dog bears weight. Itis claimed that following TPLO,degenerative joint disease changesare minimal compared with otherCCL procedures. The cranial closingwedge procedure was the techniquewhich Slocum used to prove thescience behind TPLO. Particularlyuseful in large dogs and dogs withtibial plateau deformation. See page393 for TPLO plate profiles. Our freeDVD illustrates and describes thetechnique. A simple acetate overlay to help you calculate the tibial plateauangle, from which you can easily calculate the size of the wedge to remove.Includes lines to indicate the normal tibial plateau angle and a 5˚ line which isregarded as the most appropriate post-op angle. Also included on the acetateare actual size outlines of our range of TPLO plates to help you select themost appropriate plate. See page 393 for actual size profiles.Set up costs are minimal requiring only an oscillating saw in addition to abasic plating set. See our multi saw on page 136.Further details of our TPLO by wedge osteotomy platesare shown on page 393.Wedge Osteotomy Gauge Set 9˚ to 30˚The wedge gauges simplify the markingand cutting of the appropriate wedge.The parallel marks on each gauge allowthe surgeon to mark and cuta wedge having equalborders proximallyand distally.With both borders the same lengththe resulting closure is better, bothfunctionally and cosmetically.Cadmus Plates and TemplatesCalvin Cadmus from Oakland California, as an early Slocum user,recognised that when the TPLO osteotomy was centred along the long axisof the tibia several advantages were seen over non-centred osteotomies.1) Increased accuracy in achieving the desired post-op tibial plateau angle.2) Significantly fewer tibial tubercle fractures. Decrease in screw pull out.3) Elimination of undesirable angular deformities (genu valgum).4) Lower long term DJD.Calvin has designed a template to ensure that your osteotomy is centred onthe long axis, and a range of plates which stabilise the osteotomy along thelong axis of the tibia.Ref. ‘Geometrical analysis evaluating the effect of TPLO position onpost-operative tibial plateau slope’ VCOT Jan 2004. M.P. Kowaleski. et al.Cadmus PlatesCadmus plates are surgeon friendly fitting the contour of the osteotomy andeliminating intra-articular screw placement. Pre-contoured to save time.Compression is created along the arc of the osteotomy. Hole designimproves screw security.CADMUS TPLOTPLOCAD18L Cadmus 2.7 TPLO Plate 18mm Left £90.00TPLOCAD18R Cadmus 2.7 TPLO Plate 18mm Right £90.00TPLOCAD24L Cadmus 3.5 TPLO Plate 24mm Left £90.00TPLOCAD24R Cadmus 3.5 TPLO Plate 24mm Right £90.00TPLOCAD24LB Cadmus 3.5 Broad TPLO Plate 24mm Left £100.00TPLOCAD24RB Cadmus 3.5 Broad TPLO Plate 24mm Right £100.00TPLOCAD30L Cadmus 3.5 TPLO Plate 30mm Left £90.00TPLOCAD30R Cadmus 3.5 TPLO Plate 30mm Right £90.00LNDGCAD27 Cadmus Load/ Neutral Guide 2.7mm £175.00LNDGCAD35 Cadmus Load/ Neutral Guide 3.5mm £175.00DVDTPLOCAD DVD Illustrating use of Cadmus Plate & Template £FOC .Accurate placement of the screws in the head is facilitated by use of adedicated load and neutral guide which places the pilot hole away from theosteotomy. As the screw is tightened into the hole there is a compressingmovement of the screw and bone. The spherical head of the screw thenlocks into the round hole giving secure full circumferential contact unlike astandard DCP hole. It is easy to create a single compressing movementaround the arc of the osteotomy using round holes with the added bonus ofextra screw security.Cadmus TemplatesWEDGE OSTEOTOMY GAUGE SET - 9˚to 30˚001493 Wedge Osteotomy Gauge Set £115.00Bone ScribeA very sharp marking point with an easy to hold handle enables the surgeonto mark bone prior to cutting or rotating (Slocum procedure).BONE SCRIBE001494 Bone Scribe 195mm £24.00CADMUS TEMPLATESTPLOTEM18 Cadmus Centering Template - 18mm £65.00TPLOTEM24 Cadmus Centering Template - 24mm £65.00TPLOTEM30 Cadmus Centering Template - 30mm £65.0041

1 JOINT SURGERYTibial TuberosityAdvancement (TTA)TTA Starter KitThe TTA procedure developed by Tepic and Montavon is designed to bringthe tibial plateau to sit at 90˚ to the straight patella ligament. This effectivelyneutralises the shear forces within the stifle under loading, making the stiflestable.This is achieved by advancing the tibial tubercle and stabilising the createddefect using a titanium cage and plate. The cage is selected for boththickness and width. The implants are secured using titanium screws.Titanium is very osteoconductive resulting in rapid healing. The use ofstainless steel implants is not recommended.TTA ProcedureThe TTA procedure is best learnt byattending recognised training course.However, where this is not possible, carefulstudy of our step by step guide to TTA andthe video presentation will prepare thesurgeon for a surgery on plastic bonesfollowed by cadaver surgery before finallyprogressing to a clinical case.The free DVD includes both video footage, astep by step guide and some frequentlyasked questions on the TTA procedure.The free Step by Step guide is aphotographic sequence of a TTA casebeginning with assessment of theradiographs and following the procedure in 28 steps.The Starter Kit represents a cost effective solution to setting up for TTA.The Starter Kit contains the following:TTA Instrument SetTTA Drill Guide (4 Hole)TTA Drill Guide (8 hole)TTA Fork HolderTTA Spreader + InsertsTTA Plate BenderTTA 2.4 Cross Head ScrewdriverTTA Plate and Fork OverlayTTA MalletDepth GaugeTTA Cage ForcepsBlock End Serrated Dissecting Forceps2.5 Hex Screwdriver and SleeveTTA ForcepsPremium Equipment Box1.8mm, 2.0mm, 2.5mm Drills hardTTA Implant set (Titanium)One of each Cage (3, 4.5, 6, 7.5, 9, 10.5 & 12),One of each ForkOne of each PlateTTA Titanium Screw set in a screw box2.4 self tapping screws12mm — 38mm4 of each2.7 self tapping screws12mm — 28mm3.5 self tapping screws16mm — 36mm3 of each3 of eachThe TTA Starter Kit saves over 10% compared to the component price.Call or email for a copy to be sent or download at www.vetinst.comTTA PROCEDUREDVDALL TTA Procedural DVD £FOCBRTTA TTA Step by Step Guide £FOCTTA SETSTTAPREM TTA Starter Set in a Premium Aluminium Box £3,750.00TTAINST TTA Instrument Set in a Stainless Box £995.00TTASCR TTA Screw Set in a Stainless Box £995.0042

www.vetinst.comJOINT SURGERY 1TTA InstrumentationTTA Cage ForcepsManipulating the TTA cage intothe correct position can be anawkward part of the procedure,particularly the smaller sizes. TheTTA cage forceps grasp the cagefirmly along the spine allowing it tobe extracted from the case andplaced into the tibial crestosteotomy.The TTA procedure does require some essential instruments. Positioningof the fork and cage is impossible without the following instruments. Theset is less expensive than buying the instruments individually.TTA INSTRUMENTATIONTTA554 TTA Drill Guide (4 Hole) £145.00TTA555 TTA Drill Guide (8 Hole) £155.00TTA666 TTA Fork Holder £110.00TTA444 TTA Spreader and 3, 6, 9, 12 & 15mm Inserts £175.00TTA445 4.5, 7.5 &10.5mm Insert set £70.00TTA333 TTA Plate Bender £110.00TTA777 1.9mm Pins (set of two) £20.00TTA24 TTA 2.4 Cross Head Screwdriver £115.00TTAPFO TTA Plate and Fork Overlay £FOCTTATAN Common Tangent TTA/MMT Advancement Overlay £FOC001323 TTA Mallet (140g) £50.00TTAFCP TTA Cage Forceps £70.00SDHS35F 2.5mm Hex Screwdriver and Sleeve £85.00H090208 1.8mm Drill Bit Hard £19.50H090102 2.0mm Drill Bit Hard £20.00H090112 2.5mm Drill Bit Hard £20.50TTAINST TTA Set (Includes all of the above in a box) £995.00DG242735 Depth Gauge for 2.4, 2.7 & 3.5 Ti Screws £105.00TTA CAGE FORCEPSTTAFCP TTA Cage Forceps £70.00TTA MalletThe TTA Fork needs to begently tapped home formaximum stability. The140gram mallet is the idealweight.TTA MALLET001323 TTA Mallet 140g 155mm £50.00Premium TTA CaseTTA Saw GuideCreating the TTA osteotomy freehand issomething of a challenge. The position andplane of the saw cut are critical to the rest of theprocedure. The TTA Saw Guide is a usefulassistant to the surgeon in that the guide maybe positioned securely in the correct place sothat the surgeon can concentrate on the sawwithout having to constantly worry about the cut.The instrument serves both left and right sides and is secured usingstandard pointed reduction forceps. The TTA cut is not straight along itslength but curves proximally at the distal end. The straight section is cutusing the guide. The guide is then removed and the less critical distalcurve is cut freehand.TTA SAW GUIDETTA999 TTA Saw Guide £140.00The TTA procedure involves a large number of instruments and implants.Organising the kit so that the appropriate instrument or implant is readilyaccessible can be a challenge. Veterinary Instrumentation’s Premium TTACase has a designated space for each instrument and implant. In additionto providing space for standard TTA instruments, positions for usefuladditional items such as the mallet, cage forceps and depth gauge are alsoincluded. Setting up for a procedure is therefore a simple process.The screw rack has space for 3.5, 2.7 and 2.4 screws of appropriatelengths. The plates and cages are to be found on the free standing lowertrays while the basic instrumentation is located on the top tray.Like all our premium boxes the TTA case is constructed from anodisedaluminium and includes integral reusable filters. If sterilised on an opentray the case may be placed directly from the autoclave onto the operatingtable. Alternatively the bagged case may be sterilised and stored. Whenrequired the outer bag is removed and the case tipped fully sterile onto thetable. NB No TTA implants, instruments or screws are included.PREMIUM TTA CASETTABOX Premium TTA Case (Box and insert only) £375.0043

1 JOINT SURGERYTTA ImplantsSee page 397 for TTA implant profilesTTA PLATES AND CAGES TITANIUMTTAC310 Cage 3 x 10mm Titanium 2.4mm Screw £55.00TTAC313 Cage 3 x 13mm Titanium 2.4mm Screw £55.00TTAC316 Cage 3 x 16mm Titanium 2.4mm Screw £55.00TTAC4512 Cage 4.5 x 12mm Titanium 2.4mm Screw £56.50TTAC4515 Cage 4.5 x 15mm Titanium 2.4mm Screw £56.50TTAC4518 Cage 4.5 x 18mm Titanium 2.4mm Screw £56.50TTAC616 Cage 6 x 16mm Titanium 2.4mm Screw £57.50TTAC619 Cage 6 x 19mm Titanium 2.4mm Screw £57.50TTAC622 Cage 6 x 22mm Titanium 2.4mm Screw £57.50TTAC7513 Cage 7.5 x 13mm Titanium 2.4mm Screw £60.00TTAC7516 Cage 7.5 x 16mm Titanium 2.4mm Screw £60.00TTAC7519 Cage 7.5 x 19mm Titanium 2.4mm Screw £60.00TTAC919 Cage 9 x 19mm Titanium 2.4mm Screw £62.50TTAC922 Cage 9 x 22mm Titanium 2.4mm Screw £62.50TTAC925 Cage 9 x 25mm Titanium 2.4mm Screw £62.50TTAC10519 Cage 10.5 x 19mm Titanium 2.4mm Screw £65.00TTAC10522 Cage 10.5 x 22mm Titanium 2.4mm Screw £65.00TTAC10525 Cage 10.5 x 25mm Titanium 2.4mm Screw £65.00TTAC1222 Cage 12 x 22mm Titanium 2.4mm Screw £67.50TTAC1225 Cage 12 x 25mm Titanium 2.4mm Screw £67.50TTAC1228 Cage 12 x 28mm Titanium 2.4mm Screw £67.50TTAC1522 Cage 15 x 22mm Titanium 2.4mm Screw £72.50TTAC1525 Cage 15 x 25mm Titanium 2.4mm Screw £72.50TTAC1528 Cage 15 x 28mm Titanium 2.4mm Screw £72.50TTAC1531 Cage 15 x 31mm Titanium 2.4mm Screw £72.50TTAP2 Plate 2 Hole Titanium 2.4mm Screw £25.00TTAP3 Plate 3 Hole Titanium 2.4 + 2.7mm Screw £25.00TTAP4 Plate 4 Hole Titanium 2.4 + 2.7mm Screw £25.00TTAP5 Plate 5 Hole Titanium 2.7mm Screw £25.00TTAP6 Plate 6 Hole Titanium 2.7 + 3.5mm Screw £32.00TTAP7 Plate 7 Hole Titanium 3.5mm Screw £32.00TTAP8 Plate 8 Hole Titanium 3.5mm Screw £32.00TTAF2 Fork 2 Prong Titanium £32.00TTAF3 Fork 3 Prong Titanium £32.00TTAF4 Fork 4 Prong Titanium £32.00TTAF5 Fork 5 Prong Titanium £32.00TTAF6 Fork 6 Prong Titanium £36.50TTAF7 Fork 7 Prong Titanium £36.50TTAF8 Fork 8 Prong Titanium £36.50Titanium ScrewsTitanium screws andplates are very commonlyused in man particularly for faciomaxillary repairs. The most importantbenefit in this application is that Titanium does not interfere with MRIscans. Compared to stainless steel, Titanium is lighter and much moreosteo compatible. The major application in veterinary orthopaedics is inconjunction with the TTA cruciate procedure.TITANIUM SCREWS 2.4MM CRUCIATE HEAD 1.8MM PILOTTICS2410 Titanium 2.4 Self Tapping Cortical Screw 10mm £7.00TICS2412 Titanium 2.4 Self Tapping Cortical Screw 12mm £7.00TICS2414 Titanium 2.4 Self Tapping Cortical Screw 14mm £7.00TICS2416 Titanium 2.4 Self Tapping Cortical Screw 16mm £7.00TICS2418 Titanium 2.4 Self Tapping Cortical Screw 18mm £7.00TICS2420 Titanium 2.4 Self Tapping Cortical Screw 20mm £7.00TICS2422 Titanium 2.4 Self Tapping Cortical Screw 22mm £7.00TICS2424 Titanium 2.4 Self Tapping Cortical Screw 24mm £7.00TICS2426 Titanium 2.4 Self Tapping Cortical Screw 26mm £7.00TICS2428 Titanium 2.4 Self Tapping Cortical Screw 28mm £7.00TICS2430 Titanium 2.4 Self Tapping Cortical Screw 30mm £7.00TICS2432 Titanium 2.4 Self Tapping Cortical Screw 32mm £7.00TICS2434 Titanium 2.4 Self Tapping Cortical Screw 34mm £7.00TICS2436 Titanium 2.4 Self Tapping Cortical Screw 36mm £7.00TICS2438 Titanium 2.4 Self Tapping Cortical Screw 38mm £7.00TICS2440 Titanium 2.4 Self Tapping Cortical Screw 40mm £7.00TITANIUM SCREWS 2.7MM HEX HEAD 2.0MM PILOTTICS2706 Titanium 2.7 Self Tapping Cortical Screw 6mm £7.00TICS2708 Titanium 2.7 Self Tapping Cortical Screw 8mm £7.00TICS2710 Titanium 2.7 Self Tapping Cortical Screw 10mm £7.00TICS2712 Titanium 2.7 Self Tapping Cortical Screw 12mm £7.00TICS2714 Titanium 2.7 Self Tapping Cortical Screw 14mm £7.00TICS2716 Titanium 2.7 Self Tapping Cortical Screw 16mm £7.00TICS2718 Titanium 2.7 Self Tapping Cortical Screw 18mm £7.00TICS2720 Titanium 2.7 Self Tapping Cortical Screw 20mm £7.00TICS2722 Titanium 2.7 Self Tapping Cortical Screw 22mm £7.00TICS2724 Titanium 2.7 Self Tapping Cortical Screw 24mm £7.00TICS2726 Titanium 2.7 Self Tapping Cortical Screw 26mm £7.00TICS2728 Titanium 2.7 Self Tapping Cortical Screw 28mm £7.00TICS2730 Titanium 2.7 Self Tapping Cortical Screw 30mm £7.00TICS2732 Titanium 2.7 Self Tapping Cortical Screw 32mm £7.00TITANIUM SCREWS 3.5MM HEX HEAD 2.5MM PILOTTICS3516 Titanium 3.5 Self Tapping Cortical Screw 16mm £7.00TICS3518 Titanium 3.5 Self Tapping Cortical Screw 18mm £7.00TICS3520 Titanium 3.5 Self Tapping Cortical Screw 20mm £7.00TICS3522 Titanium 3.5 Self Tapping Cortical Screw 22mm £7.00TICS3524 Titanium 3.5 Self Tapping Cortical Screw 24mm £7.00TICS3526 Titanium 3.5 Self Tapping Cortical Screw 26mm £7.00TICS3528 Titanium 3.5 Self Tapping Cortical Screw 28mm £7.00TICS3530 Titanium 3.5 Self Tapping Cortical Screw 30mm £7.00TICS3532 Titanium 3.5 Self Tapping Cortical Screw 32mm £7.00TICS3534 Titanium 3.5 Self Tapping Cortical Screw 34mm £7.00TICS3536 Titanium 3.5 Self Tapping Cortical Screw 36mm £7.00DRILL BITS - Stainless Steel 420 HardH090208 1.8 (dia mm) 80 (length mm) £19.50H090102 2.0 100 £20.00H090112 2.5 115 £20.50TTA SCREW SETTTASCR TTA Screw Set in a Stainless Box £995.0044

www.vetinst.comJOINT SURGERY 1Forkless TTA PlatesStandard TTA Plates rely on a barbed forksystem for attachment onto the tibial crest.Many surgeons consider that the hardest part ofthe TTA procedure is preparing for and placingthe fork. Forkless TTA Plates are screwed ontothe tibial crest using 2.4mm screws. The distalpart of the Forkless Plate is secured using 2.7 or3.5mm screws as appropriate. The rest of theprocedure is as per the standard technique.Starter Set (one of each size) is discounted byover 15%.FORKLESS TTA PLATESTTAX42 Forkless TTA Plate (same length as TTAP3) £28.50TTAX52 Forkless TTA Plate (same length as TTAP4) £28.50TTAX65 Forkless TTA Plate (same length as TTAP5) £28.50TTAX78 Forkless TTA Plate (same length as TTAP6) £35.50TTAX91 Forkless TTA Plate (same length as TTAP7) £35.50TTAX104 Forkless TTA Plate (same length as TTAP8) £35.50TTAXSET Forkless TTA Plate Set - one of each size £155.00Forkless Plate ForcepsHolding the Forkless TTA Plate in position presents some challengesparticulary once the osteotomy has been made. Some surgeons preferto place the proximal screw first and swing the plate cranial beforemaking the osteotomy. A variant on the plate holding drill guide forcepshas been developed specifically for the thin TTA Plates. The Forcepshold the plate in position and allow the surgeon to drill the pilot holethrough the guide in exactly the right position.FORKLESS TTA PLATE FORCEPSTTAXFCP Forkless TTA Plate Forceps (145mm) £115.00TTA SpinlockReduction ForcepsRegardless of style of plate used itis desirable to compress the distalpart of the osteotomised tibialtubercle against the tibial shaftwhile applying the plate. This willincrease stability of the repair andreduce healing times. ‘Soft ratchet’type forceps are very nice but veryexpensive and prone to wear. Thespinlock reduction forceps are theright size and have the correctdegree of spread for most TTAprocedures.TTA SPINLOCK REDUCTION FORCEPSPhoto Alex Li001245SL TTA Spinlock Reduction Forceps 180mm £105.00Cuttable CagesAs the range of cage widths increases it becomes more difficult tomanage a full inventory of conventional cages. We currently stock 24different variants. Use of cuttable cages allows the surgeon to select therequired advancement and trim the cage to length intra-operatively usingthe dedicated cutters. The cages may be trimmed by 2mm increments.If you purchase one of each cuttable cage (8 cages) we can offer thecutters free of charge. Value £165.00TTA CUTTABLE CAGESTTACUT316 Cuttable Cage 3 x 16mm £55.00TTACUT4518 Cuttable Cage 4.5 x 18mm £56.50TTACUT622 Cuttable Cage 6 x 22mm £57.50TTACUT7522 Cuttable Cage 7.5 x 22mm £60.00TTACUT926 Cuttable Cage 9 x 26mm £62.50TTACUT10526 Cuttable Cage 10.5 x 26mm £65.00TTACUT1228 Cuttable Cage 12 x 28mm £67.50TTACUT1532 Cuttable Cage 15 x 32mm £72.50TTACACUT Cuttable Cage Cutter £165.00TTACUT1 Cuttable Cage Set (8) with FREE Cage Cutters £495.00TTA SpacersThe standard TTA procedure assumes that there is no co-existing patellaissues. The tibial tubercle is simply advanced.In cases where there is patella luxation in addition to cranial cruciaterupture it is possible to move the tibial tubercle either laterally or mediallyto help re-align the quadricepsmechanism. This is achieved byadding spacers or washers (seebelow) to either the cranial screwor the caudal cage screw. Thewidthspacers are placed between thecage and the tibia to effectivelypush the tibial tubercle laterally (cranial screw) or push the tibial tuberclemedially (caudal screw). It is suggested that the tibial tubercle is moved amaximum of 50% of its width.Spacers are more expensive than washers but are much easier to use andresult in a more stable construct. Available in 2, 4, 6 and 8mm widths.Available in Titanium only.TTA SPACERS TITANIUMTTASP2 TTA Spacer Titanium 2mm £11.00TTASP4 TTA Spacer Titanium 4mm £11.00TTASP6 TTA Spacer Titanium 6mm £11.00TTASP8 TTA Spacer Titanium 8mm £11.00TTA WashersTTA WASHERS - TITANIUMAn alternative to the use ofTitanium Spacers is the useof Titanium Washers.Each Washer adds 1.0mmof translation. Lessexpensive but less easy touse.PW24TI 2.4mm TTA Washer - Titanium £10.0045

1 JOINT SURGERYModified Maquet Technique(MMT)IntroductionThe Modified Maquet Technique(MMT) is a variation on the TTAand TTO techniques of cruciate management in that it aims tobring the tibial plateau to sit at right angles to the straight patellaligament. By creating an incomplete tibial crest osteotomy theplacement of a TTA advancementcage alone creates sufficient postoperative stability for rapid healing tooccur. The technique preserves softtissue, requires a minimum ofimplants and saves time andmorbidity. The Maquet technique isdescribed in man as a technique toreduce patellofemoral pressure. TheMMT technique described here is thatpresented by SebastienEtchepareborde to ECVS in 2010 andpublished in VCOT 2011.3.Preoperative EvaluationThe advancement required is calculated as in the TTA techniqueusing either the traditional or the common tangent method.Transparent overlays for both are available free of charge onrequest.Surgical TechniqueThe entire procedure may be performed with the dog in lateralrecumbency, but surgeons may find Clearing sitethat internal examination of the stifle for hinge holemay be more easily performed withthe dog in dorsal recumbency. Thedog is then flipped onto the lateralside for the MMT surgery .The full limb is aseptically prepared.Sterile bandaging of the foot allowsthe surgeon to fully manipulate thelimb throughout the procedure.Exploration of the stifle joint isperformed using the surgeon’spreferred method. Meniscal injuriesare dealt with and optionally ameniscal release may be performed. Clearing siteThe craniomedial aspect of the tibia for osteotomyis approached via a craniomedial skinincision. Without dissecting thesubcutaneous tissues a straightlongitudinal incision is made to boneapproximately 10mm caudal to thetibial crest and extended to 20mmbeyond the extent of the tibial crest.The soft tissues at the distal end ofthe incision are cleared using aperiosteal elevator (001271 orsimilar). The site of the tibial crestosteotomy (TCO) is minimally clearedusing a narrow elevator (7350/05, Freer or similar).A 3.5mm hole is drilled immediately caudal to the cranial cortexapproximately 5-15mm distal to distal extent of the tibial crest.This will act as a hinge once the tibial crest incision is complete.Sebastien Etchepareborde has demonstrated (VCOT 2010.6)that a relatively large hole such as 3.5mm spreads appliedstress and is lesslikely to result inhinge fracture than asmall 2.0mm hole.The tibial crestosteotomy isperformedperpendicularly tothe sagittal plane ofthe tibia. A sawguide is available toassist if requiredwhich will protect the patella ligament and direct the plane of thesaw. Alternatively a pair of artery forceps may be pushedthrough the jointfrom medial tolateral just caudal tothe straight patellaligament to act as amarker and protectthe ligament.The osteotomy runsfrom a point cranialto the long digitalextensor (LDE) tothe previously drilled hinge hole.The position of the LDE may begauged by palpating the tubercleof Gerdy laterally and passing a‘K’ wire through from the medialside as a marker.The osteotomy is best createdusing a power saw and bladeapproximately 10-15 mm wideand less than 1mm thick. All themodular air and electricalsurgical saws are suitable.Where funds are limited thebattery powered Multi Saw(001708) works very well.The osteotomy is carefully easedopen to allow placement of thepredetermined cage.Experience with the TTOprocedure suggests thatincremental opening of theosteotomy using the‘wedgie’(TTO002) minimiseshinge fracture. The osteotomymay be finally opened to thecorrect width for the Titaniumcage using the TTA spreader.(TTA444). This item hasdedicated blades for each cagesize.46

www.vetinst.comJOINT SURGERY 1The cage is placed as shown in the image below, close to theproximal end of the TCO. The cage is secured using two 2.4mmtitanium screws. The ‘ears’ of the cage should be contoured asfollows: cranial ear down, caudal ear up.If the hinge fails during surgery a tension band wire (TBW) maybe placed bridging the distal end of the TCO as shown. If thehinge remains intact at the end of surgery there is no need for aTBW. It should be appreciated that even if the bone cracks theperiosteum remains intact providing support.Once again, the TTO experience shows that even when thehinge fails the tibial crest typically remains in place despitehaving no fixation. The TTA cage in the MMT procedureprovides significant additional fixation so migration is unlikely.A bone graft (autologous or allograft) may be added if desired.In the Etchepareborde series a Robert Jones Dressing (RJD)was applied for one week post operatively. Analgesia asnecessary, oral Cefazolin and Carprofen were administered forseven days postoperatively.It is suggested that the dogshould be restricted to leashexercise until the six week checkradiograph by which time boneinfill should be very visible.Physiotherapy will speed therecovery process and maximisemobility.Special thanks toSebastienEtchepareborde for hisassistance andpermission to use hisimages.2 MonthsPost OpTTA PLATES AND CAGES TITANIUMTTAC310 Cage 3 x 10mm Titanium 2.4mm Screw £55.00TTAC313 Cage 3 x 13mm Titanium 2.4mm Screw £55.00TTAC316 Cage 3 x 16mm Titanium 2.4mm Screw £55.00TTAC4512 Cage 4.5 x 12mm Titanium 2.4mm Screw £56.50TTAC4515 Cage 4.5 x 15mm Titanium 2.4mm Screw £56.50TTAC4518 Cage 4.5 x 18mm Titanium 2.4mm Screw £56.50TTAC616 Cage 6 x 16mm Titanium 2.4mm Screw £57.50TTAC619 Cage 6 x 19mm Titanium 2.4mm Screw £57.50TTAC622 Cage 6 x 22mm Titanium 2.4mm Screw £57.50TTAC7513 Cage 7.5 x 13mm Titanium 2.4mm Screw £60.00TTAC7516 Cage 7.5 x 16mm Titanium 2.4mm Screw £60.00TTAC7519 Cage 7.5 x 19mm Titanium 2.4mm Screw £60.00TTAC919 Cage 9 x 19mm Titanium 2.4mm Screw £62.50TTAC922 Cage 9 x 22mm Titanium 2.4mm Screw £62.50TTAC925 Cage 9 x 25mm Titanium 2.4mm Screw £62.50TTAC10519 Cage 10.5 x 19mm Titanium 2.4mm Screw £65.00TTAC10522 Cage 10.5 x 22mm Titanium 2.4mm Screw £65.00TTAC10525 Cage 10.5 x 25mm Titanium 2.4mm Screw £65.00TTAC1222 Cage 12 x 22mm Titanium 2.4mm Screw £67.50TTAC1225 Cage 12 x 25mm Titanium 2.4mm Screw £67.50TTAC1228 Cage 12 x 28mm Titanium 2.4mm Screw £67.50TTAC1522 Cage 15 x 22mm Titanium 2.4mm Screw £72.50TTAC1525 Cage 15 x 25mm Titanium 2.4mm Screw £72.50TTAC1528 Cage 15 x 28mm Titanium 2.4mm Screw £72.50TTAC1531 Cage 15 x 31mm Titanium 2.4mm Screw £72.50TITANIUM SCREWS 2.4MM CRUCIATE HEAD 1.8MM PILOTTICS2410 Titanium 2.4 Self Tapping Cortical Screw 10mm £7.00TICS2412 Titanium 2.4 Self Tapping Cortical Screw 12mm £7.00TICS2414 Titanium 2.4 Self Tapping Cortical Screw 14mm £7.00TICS2416 Titanium 2.4 Self Tapping Cortical Screw 16mm £7.00TICS2418 Titanium 2.4 Self Tapping Cortical Screw 18mm £7.00TICS2420 Titanium 2.4 Self Tapping Cortical Screw 20mm £7.00TICS2422 Titanium 2.4 Self Tapping Cortical Screw 22mm £7.00TICS2424 Titanium 2.4 Self Tapping Cortical Screw 24mm £7.00TICS2426 Titanium 2.4 Self Tapping Cortical Screw 26mm £7.00TICS2428 Titanium 2.4 Self Tapping Cortical Screw 28mm £7.00TICS2430 Titanium 2.4 Self Tapping Cortical Screw 30mm £7.00TICS2432 Titanium 2.4 Self Tapping Cortical Screw 32mm £7.00TICS2434 Titanium 2.4 Self Tapping Cortical Screw 34mm £7.00TICS2436 Titanium 2.4 Self Tapping Cortical Screw 36mm £7.00TICS2438 Titanium 2.4 Self Tapping Cortical Screw 38mm £7.00TICS2440 Titanium 2.4 Self Tapping Cortical Screw 40mm £7.00MMT INSTRUMENTATIONTTA24 2.4 Screwdriver (Crosshead) £115.00H090208 1.8mm Pilot Drill for 2.4 Screw £19.50H090106S 3.5mm Drill for Hinge Hole £22.50001271 Periosteal Elevator 6mm AO Type 180mm £47.507350/05 Freer Periosteal Elevator £45.00TTA444 TTA Spreader and 3, 6, 9, 12 & 15mm Inserts £175.00001708 MultiSaw Surgical Kit £495.00TTA999 MMT Saw Guide £140.00TTO002 ‘Wedgie’ Osteotomy Spreader £95.00TTAFCP TTA Cage Forceps £70.00DG242735 Depth Gauge for 2.4, 2.7 & 3.5 Ti Screws £105.00TTAPFO Traditional TTA/ MMT Advancement Overlay £FOCTTATAN Common Tangent TTA/ MMT Advancement Overlay £FOC47

1 JOINT SURGERYTTA RAPID (patent pending)Tibial Tuberosity Advancement(TTA) is a technique that hasgained increasing popularity inrecent years. As we continue tolearn more, an increasingnumber of new techniques havebecome available designed toaddress the pitfalls of theoriginal TTA technique, makingthe procedure more user friendlyand further improve on alreadylow complication rates.TTA Rapid is the newestadvancement technique around,only becoming available withadvances in manufacturingtechnology. Utilising a 3D printing technology known as selective lasersintering (SLS), layers of the purest medical grade titanium are built upto form a macro-porous anatomically shaped 3D matrix. The structuralouter casing provides additional strength and has integrated screw holesfor a very rigid primary fixation. The macro-porous structure allows verylittle inhibition to vascularisation optimising the healing process.Adoption of the technique should be intuitive to those who haveperformed similar surgeries in the past and indications are that thelearning curve is short even for those new to tibial advancements withinstrumentation. There are multiple advancements and widths of cageavailable to help tailor cage size to the individual. Cages are available inall standard TTA widths and lengths.TTA Rapid Summary Surgical InstructionsA summary of the Surgery Instructions for TTA Rapid follows. A fullversion of this is available from Veterinary Instrumentation on-line atwww.vetinst.com or call 0845 130 9596 for a printed version.Advancement CalculationUsing the Drill GuideAdvancement calculation can be performedusing your method of choice — classic TTA,common tangent etc. However none areperfect so critical evaluation is advised. Usingthe template, select the appropriate cagewidth. Adjust the template until the cage sitsapproximately 3mm below the proximal cortexon its caudal edge. Measure and note thethickness of the cortex in the area of theMaquet hole. Note the cage size selected.Final depth of implant will be confirmed duringsurgery.Approach is medial.Insert a 1.25mm ‘K’ Wire behind the patellarligament in the region of the distal infrapatellarbursa. This pin indicates the positionof the proximal extent of the cage relative tothe bone.The Drill Guide is dropped over the pin usingone of the numbered holes in the vertical arm,corresponding with the size of the cagemeasured during pre-operative planning.The technique andinstrumentation have the inbuiltflexibility to allow surgeons to usetheir preferred method forcalculating advancement. Thereis still quite a lot of controversyover where exactly to place theMaquet hole. The TTA Rapid DrillGuide gives you the flexibility toadjust the cranio-caudal positionas you like and with repeatableresults. However, we wouldadvise avoiding disruption of thecranial cortex by placing the holejust behind it. By doing this, thepath of least resistance for anycracks is more likely to be alongthe length of the bone thanstraight out through the cortex.Press the Drill Guide against the medialaspect of the tibia with protruding peg forcedup against the cranial side of the tibia. Hold itin that position. Correct use of the Drill Guidewill place the Maquet hole just caudal to thecranial cortex of the tibia. The direction ofdrilling should be approximately parallel to theaxis of stifle rotation to avoid medial or lateraldisplacement of the tibial tuberosity duringadvancement.A peg is placed into one of the holes in thehorizontal arm of the Drill Guide, selecting thenumber of millimeters measured during preoperativeplanning (thickness of cranial cortexof bone at Maquet hole level). Use of the drillguide ensures correct positioning of theMaquet hole.48

www.vetinst.comJOINT SURGERY 1The Drill Guide is now in the optimal positionand a 2 or 3 mm hole, depending on the sizeof the dog, can be drilled.NOTE: the Maquet hole in the TTA Rapid DrillGuide is designed for a 3mm Drill Bit. If usinga 2mm Drill Bit, a standard 2mm Drill Guideshould be inserted in the hole of the TTARapid Drill Guide, to maintain optimalpositioning.The depth of the osteotomy is measured witha Drill Depth Gauge at the proximal extent ofthe osteotomy. This measurement is roundedup to select the correct cage length.Using the Saw GuideSawing the crista tibiaeThe Drill Guide and the positioning wire cannow be removed.A 2.5mm Pin is placed through the jointcapsule at the intersection of the femoralcondyle and the tibial plateau. On the lateralside, the pin should start at the level of“Gerdy’s Tubercle”. This Pin is used as theproximal fixation of the Saw Guide.Fixating the CageThe cage ears should be contoured slightly upon the tibia side, slightly down on the cranial(crista tibiae) side. Elevate the periosteum inthe cage area, and insert the Cage into theosteotomy. Use bone forceps to ensure thecage ears are in good bone contact. Once theCage is in place,the height of the Cage can bechecked by palpating the proximal tibia with aSmall Mosquito Forcep — there should be3mm of bone above the top of the cage. LargeBone Forceps may be used to increase Cageto bone contact if desired.The appropriate size Anchoring Device (3 or2mm depending on the Maquet hole drilled)for the saw guide is placed into the Maquethole. Make sure the slot in the device is facingproximally .The hole of the Saw Guide is slid over the2.5mm Pin and the body is placed on top ofthe Anchoring Device and can be clamped inplace if desired.Use the Saw Guide to create the osteotomy.Optionally, a blade can be used to open thefascia/ periostium prior to the osteotomy. Ifnecessary the osteotomy may be completedwith a hand saw with the Saw Guide removed.2.4mm Screws are used in the cage. Startwith the most cranial proximal screw, then themost distal caudal. Screw orientation ismedio-proximal to latero-distal in the tibialcrest mimicking the angle of the forks in theoriginal TTA. The tibial screws are placedcranio-medio-proximal to caudo-latero-distal.Remove all forceps and re-tighten all screws.NanoPaste paste may be inserted inside andbelow the cage at this stage, which willaccelerate healing of the osteotomy.Closure is routine.Opening the OsteotomyTTA RAPID TRAINING MATERIALSBRTTARAP Step by Step Guide to TTA Rapid £FOCThis is the most critical part of the procedure, and should be performedslowly and carefully allowing the bone time to adjust. This will makehinge failure unlikely.Start with the smallest Spreader inserted as shown in the most proximalsection of the osteotomy The handle is rotated downwards to minimiseforces on the fragment, gently. A second Spreader can be used tomaintain displacement but should NEVER be used to advancedisplacement as a hinge fracture will result. Work up through theSpacers until the correct advancement is achieved.TTA Rapid Training Courses will be held in the UKand Europe during the coming year.Please e-mail info@vetinst.comto indicate an interest in attending.A Step by Step Guide is available at www.vetinst.com orcall 0845 130 9596 e-mail info@vetinst.comfor a printed copy.49

1 JOINT SURGERYTTA RAPID CONVERSION KITThis Kit will appeal to the surgeon who is experienced withTTA or similar techniques, and would like to add the basics forTTA Rapid to an existing setup. It does not include a storage case.Kit contains:TTA Rapid Saw Guide CompleteTTA Rapid Drill Guide CompleteTTA Rapid Lever-Spreader Double-ended 4 and 6mmTTA Rapid Lever-Spreader Double-ended 9 and 12mmOne of each size of Cage from 4.5/12 to 12/28 (total 18)3mm Cages are also available but not included in this Starter Kit.The kit price is discounted by over 10% compared to the componentprice.TTA RAPID STARTER KITTTARSTART TTA Rapid Conversion Kit £2,750.00TTARMIN TTA Rapid Conversion Kit - Instruments Only £395.00TTA RAPID PREMIUM INSTRUMENT ANDIMPLANT KITTTA RAPID INSTRUMENTATIONTTA RAPID DRILL GUIDEThe Drill Guide is an L shaped device developed to facilitate the correctpositioning of the Maquet hole during the TTA Rapid procedure. Thevertical arm of the guide carries numbers which correspond to the size ofthe cage, while the horizontal arm carries a scale in mm.This is supplied with a guide pin, and is used in conjunction with a1.25MM ‘K’ or ‘A’ Wire.TTA RAPID DRILL GUIDETTAR132403000 TTA Rapid Drill Guide £65.00TTA RAPID SAW GUIDEThe Saw Guide has been developed to ensure a sufficiently large cranialfragment is created for screw placement. The Saw Guide consists of 2pieces. The Saw Guide itself has a 2mm hole at the top and is slotted,while the second part is an anchoring device which is placed in theMaquet hole. This peg is slotted to allow the cut to reach the Maquethole, and is supplied with a 3mm anchor for most cases and 2mm foruse in smaller patients.TTA RAPID SAW GUIDETTAR132405000 TTA Rapid Saw Guide £295.00TTA RAPID LEVER SPREADERThe Complete Instrument and Implant Kit is supplied in 2 AutoclavableTrays, allowing easy use, convenient storage and easier replenishmentof consumables.The Kit contains a full set of the required instrumentation in one tray,plus two of each Cage (all sizes, 42 Cages in total)) and 5 each of2.4mm Titanium Screws from 6 to 40mm (90 in total) in a second implanttray.Instrument Kit Tray contains:TTA Rapid Saw Guide CompleteTTA Rapid Drill Guide CompleteTTA Rapid Lever-Spreader Double-ended 6 and 8mmTTA Rapid Lever-Spreader Double-ended 9 and 12mmTTA Rapid Bending IronTwist Drills 1.8, 2 and 3mmTTA Depth GaugeAO Screwdriver HandleTTA Rapid Screwdriver Shaft for 2.4 Hex Screw and Holding SleeveKirschner Wire, 1 & 2.5mm, one of eachDrill Guide 2.0/2.7TTA Rapid Holding Forceps AngledThese are used to open the osteotomy incrementally to the requiredwidth. Available in 2 Doubled-ended sizes.TTA RAPID LEVER SPREADERTTAR132400013TTAR132401013TTA RAPID BENDING IRONTTA Rapid Lever Spreader Double-ended4mm & 6mm Broad £40.00TTA Rapid Lever Spreader Double-ended9mm & 12mm Broad £40.00(Patent Pending).TTA RAPID PREMIUM INSTRUMENT AND IMPLANT KITTTARPREMALL TTA Rapid Premium Instrument and Implant Kit £7,500.00TTARPREMIMP TTA Rapid Premium Implant Kit £6,450.00TTARPREMINST TTA Rapid Premium Instrument Kit £1,550.00This is used for contouring the cage ears for accurate placement.TTA RAPID BENDING IRONTTAR132402000 TTA Rapid Bending Iron £40.0050

www.vetinst.comJOINT SURGERY 1TTA RAPID INSTRUMENTSTTA RAPID CAGESTTA RAPID INSTRUMENTSTTAR132403000 TTA Rapid Drill Guide £65.00TTAR132405000 TTA Rapid Saw Guide £295.00TTAR132402000 TTA Rapid Bending Iron Double-ended £40.00TTAR10386300 TTA Rapid Screwdriver Handle AO Coupling £60.00TTAR20342420TTA Rapid Screwdriver Shaft for 2.4 HexAO Fitting 100mm £70.00TTAR20346424 TTA Rapid Holding Sleeve for 2.4 Hex Screws £40.00TTAR132400013TTAR132401013TTA Rapid Lever Spreader Double-ended4mm & 6mm Broad £40.00TTA Rapid Lever Spreader Double-ended9mm & 12mm Broad £40.00TTAR164005016 TTA Rapid Plate Holding Forceps Angled 160mm £40.00TTAR164242735 TTA Rapid Depth Gauge 40mm 150mm £105.00TTAR164007027 TTA Rapid 2.0/2.7 Sleeve/ Guide for 1.8mm Drill £75.00TTAR2103624TTA Rapid 2.4mm Screw Rackfor 6-40mm Screws Supplied empty £85.00TTAR132500000 TTA Rapid Implants Box Supplied empty £345.00TTAR132500010 TTA Rapid Instruments Box Supplied empty £345.00TTA Rapid Sagittal SawVeterinary Instrumentation currently offers four surgical saw optionssuitable for TTA Rapid. The four options are the multi saw (page 136),the VI Black series (page 142), the MiniDriver (page 138) and theMaxiDriver (page 140). A selection of blades is available for TTA Rapid.Please note a blade thickness of 1mm or less is required for the TTARapid Saw Guide.NanoPaste Bone SubstitutesNanoPaste and TTARUse to save time harvesting autograft or when the quality of theautograft is poor. NanoPaste will extend autograft.NanoPaste may be injected directly into the defect where it conforms tothe defect shape. NanoPate may also be injected into the cage.Nano HA paste conforms to ENISO 13779-1:200 and ASTM F1185-88for medical grade HA.NanoPaste is also available in a granule formulation see page 221‘ReproBone’ which may be used alone or as an extender of naturalcancellous bone graft.NANOPASTEPAS2.5 NanoPaste Syringe 2.5ml £70.00PAS5 NanoPaste Syringe 5ml £105.00TTA RAPID CAGES TITANIUMTTAR310 TTA Rapid Cage 3/10 Titanium £150.00TTAR313 TTA Rapid Cage 3/13 Titanium £150.00TTAR316 TTA Rapid Cage 3/16 Titanium £150.00TTAR4512 TTA Rapid Cage 4.5/12 Titanium £150.00TTAR4515 TTA Rapid Cage 4.5/15 Titanium £150.00TTAR4518 TTA Rapid Cage 4.5/18 Titanium £150.00TTAR616 TTA Rapid Cage 6/16 Titanium £150.00TTAR619 TTA Rapid Cage 6/19 Titanium £150.00TTAR622 TTA Rapid Cage 6/22 Titanium £150.00TTAR7516 TTA Rapid Cage 7.5/16 Titanium £150.00TTAR7519 TTA Rapid Cage 7.5/19 Titanium £150.00TTAR7522 TTA Rapid Cage 7.5/22 Titanium £150.00TTAR919 TTA Rapid Cage 9/19 Titanium £150.00TTAR922 TTA Rapid Cage 9/22 Titanium £150.00TTAR925 TTA Rapid Cage 9/25 Titanium £150.00TTAR10519 TTA Rapid Cage 10.5/19 Titanium £150.00TTAR10522 TTA Rapid Cage 10.5/22 Titanium £150.00TTAR10525 TTA Rapid Cage 10.5/25 Titanium £150.00TTAR1222 TTA Rapid Cage 12/22 Titanium £150.00TTAR1225 TTA Rapid Cage 12/25 Titanium £150.00TTAR1228 TTA Rapid Cage 12/28 Titanium £150.00TTA RAPID TITANIUM SCREWS - HEX HEADTTA RAPID SCREWS 2.4MM TITANIUMTTARSC2406 TTA Rapid 2.4mm Screw Titanium 6mm £7.00TTARSC2408 TTA Rapid 2.4mm Screw Titanium 8mm £7.00TTARSC2410 TTA Rapid 2.4mm Screw Titanium 10mm £7.00TTARSC2412 TTA Rapid 2.4mm Screw Titanium 12mm £7.00TTARSC2414 TTA Rapid 2.4mm Screw Titanium 14mm £7.00TTARSC2416 TTA Rapid 2.4mm Screw Titanium 16mm £7.00TTARSC2418 TTA Rapid 2.4mm Screw Titanium 18mm £7.00TTARSC2420 TTA Rapid 2.4mm Screw Titanium 20mm £7.00TTARSC2422 TTA Rapid 2.4mm Screw Titanium 22mm £7.00TTARSC2424 TTA Rapid 2.4mm Screw Titanium 24mm £7.00TTARSC2426 TTA Rapid 2.4mm Screw Titanium 26mm £7.00TTARSC2428 TTA Rapid 2.4mm Screw Titanium 28mm £7.00TTARSC2430 TTA Rapid 2.4mm Screw Titanium 30mm £7.00TTARSC2432 TTA Rapid 2.4mm Screw Titanium 32mm £7.00TTARSC2434 TTA Rapid 2.4mm Screw Titanium 34mm £7.00TTARSC2436 TTA Rapid 2.4mm Screw Titanium 36mm £7.00TTARSC2438 TTA Rapid 2.4mm Screw Titanium 38mm £7.00TTARSC2440 TTA Rapid 2.4mm Screw Titanium 40mm £7.00TTA RAPID ACCESSORIESTTA RAPID ACCESSORIESTTAR144101010 TTA Rapid K Wire Single Trochar Tip 1.0mm x 100mm £3.50TTAR144102510 TTA Rapid K Wire Single Trochar Tip 2.5mm x 100mm £3.75TTAR148008018 TTA Rapid 1.8mm Drill Bit Round Shaft £19.50TTAR148008020 TTA Rapid 2.0mm Drill Bit Round Shaft £20.00TTAR148008030 TTA Rapid 3.0mm Drill Bit Round Shaft £20.50TTAR148008118 Twist Drill 1.8mm AO 140/30mm AO Shaft £25.00TTAR148008120 Twist Drill 2.0mm AO AO Shaft £25.00TTAR148012030 Twist Drill 3.0mm AO 110/85 AO Shaft £25.0051

1 JOINT SURGERYNanoPaste Bone SubstitutesThe addition of osteoconductive bioceramic hydroxyapatite to anorthopaedic site can significantly decrease healing times. NanoPaste isavailable as two presentations.NanoPaste. The sterile presentation is an aqueous paste supplied in asyringe (2.5ml or 5.0ml). The paste may be injected directly into a defectwhere it conforms to fill the space. The paste is readily colonised bybone cells and acts as a scaffold encouraging penetration of host bone.The putty-like consistency means that the paste may be pressed ontobone where it sticks until resorbed. NanoPaste is very similar to Ostimwhich has an established clinical record.Applications include: joint arthrodesis, TTA, non-unions, delayed unionsand filling spine cages.Veterinary Tissue BankVeterinary Tissue Bank is Europe’sfirst tissue bank dedicated tohelping companion animals.Products are available in variouspresentations, and have manyapplications from use during procedures such as TTA and jointarthrodesis to dealing with the difficult non-union case.DBMDemineralised Bone Matrix (DBM) iscortical bone which has been cut,milled into fine particles and washed toremove soft tissues, cells and marrowelements. Further processing removesminerals to leave collagen matrix andendogenous bone growth factors suchas bone morphogenic proteins.DMB is used where osteoinduction isrequired but the graft does not requireany structural properties, for examplein small joint arthrodesis.DBM isrehydratedwith salineprior to use.Packed around acomminuted tibial fracturein a 2 year old GDS.Available in either Canine or Feline Powder, or now as DBM Putty(Canine only).DBM PuttyA new product, this is supplied as a two part product for reconstitution.DBM particulates are mixed with nanocrystaline hydroxyapatite aqueoussuspension prior to use, in the syringes provided. The addition ofhydroxyapatite provides a high surface area for osteoconduction, andallows the putty-like texture to form. The product sticks well to the bonesurface and conforms to the defect, improving contact to bone. It can beinjected into the surgical site direct from the syringe, e.g. in TTA, and willalso pass through a 14g needle for non-invasive surgery such as MIPOprocedures.NanoPaste and TTAUse to save time harvesting autograft or when the quality of theautograft is poor. NanoPaste will extend autograft.NanoPaste may be injected directly into the defect where it conforms tothe defect shape.Nano HA paste conforms to ENISO 13779-1:200 and ASTM F1185-88for medical grade HA.NanoPaste is also available in a granule formulation see page 221‘ReproBone’ which may be used alone or as an extender of naturalcancellous bone graft.NANOPASTEPAS2.5 NanoPaste Syringe 2.5ml £70.00PAS5 NanoPaste Syringe 5ml £105.0052

www.vetinst.comJOINT SURGERY 1Cancellous ChipsCancellous Chips offer structure to a graft as well as providing a scaffoldfor osteoconduction.This is available in canine and feline variants. Canine is available in 3chip sizes for closer matching to defect size, and 3 pack sizes. Theproduct consists of morcelised cancellous bone, processed to removesoft tissue, cells and marrow elements, freeze-dried and irradiated afterpacking for sterility.Useful in TTA, filling corrective osteotomies, fracture repair, spinalfusions among other procedures. It is also useful for extending anautograft where harvesting has not produced sufficient material.Graft SelectionOsteoinductionOsteoconductionOsteoconduction and osteoinductionDBMCancellous ChipsDMB PuttyVETERINARY TISSUE BANK PRODUCTSDBMPUTC1101 DBM Putty 1cc £110.00C0901 DBM Canine 0.1-0.5mm Granules 1cc £85.00C0903 DBM Canine 0.1-0.5mm Granules 3cc £185.00C0905 DBM Canine 0.1-0.5mm Granules 5cc £275.00C1001 DBM Canine 0.5-1.0mm Granules 1cc £85.00C1003 DBM Canine 0.5-1.0mm Granules 3cc £185.00C1005 DBM Canine 0.5-1.0mm Granules 5cc £275.00FL205 DBM Feline 1mm Granules 0.5cc £85.00C0101 Cancellous Chips Canine 2-4mm Chip Size Coarse 1cc £57.50C0103 Cancellous Chips Canine 2-4mm Chip Size Coarse 3cc £135.00C0105 Cancellous Chips Canine 2-4mm Chip Size Coarse 5cc £225.00C0201 Cancellous Chips Canine 1-2mm Chip Size Medium 1cc £57.50C0203 Cancellous Chips Canine 2-4mm Chip Size Medium 3cc £135.00C0205 Cancellous Chips Canine 2-4mm Chip Size Medium 5cc £225.00C0301 Cancellous Chips Canine

1 JOINT SURGERYExamination and Surgery ofthe MeniscusIntroductionMenisci contribute greatly to the normal function of the stifle joint. Thestifle joint is not a simple hinge as knee replacements in both man anddogs which were based on the hinge premise have discovered. Themenisci are the interface between the two articular surfaces. Theytransmit load, absorb energy and lubricate the joint. Importantly theycontribute to joint stability to both shear and rotational forces.When the cranial cruciate ligament fails the menisci become vulnerableto damage as the femur is free to move relative to the tibia creatingexcessive crushing and shearing forces. The lateral meniscus isrelatively securely attached to the femur so moves with it avoiding injury.The medial meniscus is, however, firmly attached to the tibia and subjectto repetitive trauma. Injuries to the lateral meniscus are uncommonwhereas medial injuries are common. The incidence and severity ofmeniscal injuries are related to the weight of the dog and the duration ofthe injury.The meniscus is avascular except around the periphery and generallydoes not heal. Despite active research in man to find repair andreplacement techniques these are not readily applicable to the caninepatient.DiagnosisMeniscal damage may be suspected in a stifle which seems significantlymore painful than might be expected with cruciate rupture alone. Somepatients may exhibit an audible and palpable click on walking. Thisoccurs as the femur rolls over a detached meniscus which has foldedover. MRI in larger patients may suggest a meniscal injury.A definitive diagnosis is provided by examination of the meniscus eitherby direct visualisation via arthotomy or by arthroscopy.The caudal horn is not easy to expose regardless of technique.Veterinary Instrumentation offers a substantial range of instrumentsdesigned to make exposure easier. Caudal detachments, longitudinaland bucket handle tears may be difficult to identify without detailedprobing of the surface of the meniscus. The detached areas often fallback into position when not loaded.Surgical Management of Meniscal InjuriesThe poor healing characteristics of the meniscus leaves removal of thedamaged area as the only real surgical option. The damaged areas aremade slippery by synovial fluid and are difficult to grasp and cut withoutdedicated instruments. Typically, damaged areas are grasped andretracted as far as they can be and detached from their remainingattachments using knives of various designs. Arthroscopic punches maybe used to ‘tidy up’ less distinct areas of damage in both open andarthroscopic approaches. (see chapter 2)Meniscal ReleaseThis procedure remains contentious. Recognising the important functionof the meniscus anti-release surgeons seek to preserve as much intactmeniscus as possible. However, all the tibial plateau levelling techniquesleave the stifle unstable in certain circumstances leaving the meniscusvulnerable to injury from the resulting crushing and shearing forces.Pro-release surgeons argue that releasing the meniscus removes it fromharm from the femur and that no meniscus is better than a damagedone. It is certainly the case that meniscal release reduces the incidenceof late meniscal injury which might be linked to the initial injury. Longerterm outcomes in terms of the development of degenerative jointdisease (DJD) are less predictable.Ultimately the evidence is unclear so surgeons must make their owndecision.Classification of Meniscal InjuriesMeniscal release is performed by transecting the medial horn by a radialcut just caudal to the medial colateral ligament at ‘x’.(illustrated). Thecaudal horn of the medial meniscus will rotate caudally into the caudalcompartment of the joint capsule. If the meniscus does not movesignificantly it has not been released. Alternatively the meniscus may bereleased by transection of the meniscotibial ligament ‘y’.The crushing and shearing forces resulting from a cruciate deficient stiflecreate a number of relatively specific meniscal injuries. These wereclassified by Bennett and May in 1991 into seven types.1. Caudal detachment with folded caudal horm2. Longitudinal tear3. Multiple longitudinal tears4. Fibrillation/tearing of the surface5. Axial fringe tear6. Bucket handle tear (similar to type 2 or 3 but inner concave portion, orportion between two longitudinal tears, of meniscus becomes lax anddisplaced from the tibial surface give the appearance of a bucket handle)7. Transverse tear54VideoGeoff Robins has created a video illustrating a number of meniscalsurgery procedures. It is available free of charge on the VI cruciate DVDor as a download from www.vetinst.comPhoto: Geoff Robins

www.vetinst.comJOINT SURGERY 1Arthroscopic Stifle Lever VSTLStifle LeverAtraumatic TipThumb RingContoured tofit trochleaPhoto: Noel FitzpatrickExposure of the medial meniscus for examination and treatment is nevereasy. Many instruments have been developed for the purpose. Theoriginal technique required a Hohman to advance the tibia. StandardHohmans are not designed for the purpose and can cause trauma toboth tibia and trochlea. The original stifle lever addresses these issuesbut is a little bulky for arthroscopic use. The arthroscopic version is finer,longer and has a substantial teflon handle allowing better manipulationof the joint. A notch on the handle alerts the surgeon as to the position ofthe tip.Developed for stifle surgery by Ian Holdsworth.Also very effective in open arthrotomies.Please note the Arthroscopic Stifle Lever now has a white teflon handle.ARTHROSCOPIC STIFLE LEVER VSTLAR-17-02 Arthroscopic Stifle Lever VSTL 280mm £135.00Examination and management of meniscal injuries is made extremelydifficult by the limited access to the medial meniscus during routineapproaches. Exposure of the medial meniscus is typically achieved byeither use of a stifle distractor or by a Hohman retractor. Hohmanretractors are not designed for levering against articular cartilage in thatthe blade does not ‘fit’ the trochlea. The stifle lever is designed tosubstitute for the Hohman.The caudal surface of the stifle lever is contoured to fit the trochlea of largedogs. The load is dissipated over a large area minimising trauma. The ringstyle handle is convenient for retraction by the surgeon using the thumb.The tip atraumatically hooks behind the caudal aspect of the tibial plateau.STIFLE LEVER001115 Stifle Lever >20kg 225mm £57.50001115S Stifle Lever Small

1 JOINT SURGERYMeniscectomy InstrumentsBeaver Type Scalpel HandleLigament Clamp JawsDamage to the medial meniscus following CCL rupture increases with:1. time after injury.2. size of the dog.Removal of severely damaged cartilage is assisted by instruments designedfor the purpose. The jaws of the Ligament Clamp have multiple small teethfor maximum grip in the presence of synovial fluid.MENISCECTOMY INSTRUMENTS001100 Meniscectomy Instrument Set £105.00001107 Meniscectomy Knife 165mm £65.00001110 Ligament/ Cartilage Clamp 140mm £60.00Toothed HalsteadsHolds Beaver and Swann Morton fine blades. Ideal for delicate control andmaximum visualisation.BEAVER TYPE SCALPEL HANDLE06054 Beaver Type Scalpel Handle. (VI) 130mm £13.5006051 Beaver Type Scalpel Handle. 130mm £18.5006052 Beaver Type Scalpel Handle. 100mm £18.5006053 Beaver Type Scalpel Handle. 80mm £18.50Swann Morton Beaver Type BladesNo. 64No. 65103185TOOTHED HALSTEADS103185 Halstead Mosquito Forceps 1/2 Teeth Cof 125mm £25.50103180 Halstead Mosquito Forceps 1/2 Teeth Str 125mm £25.50Fat Pad RetractorVisualisation of the medial meniscus is maximised by retraction of the fatpad. Previously this has been achieved by use of a Senn ("cats paw")retractor. The Fat Pad Retractor has the same clawed foot but has a muchmore practical means of holding the instrument.FAT PAD RETRACTOR001114 Fat Pad Retractor 180mm £24.50833305 Senn Cats Paw Retractor 165mm £24.50The 64 blade (best for meniscal release) cuts around the tip as well as theventral surface. The 65 blade (best for trimming flaps) is essentially ascaled down No. 11 blade. The 65a blade is even smaller. Very useful inrestricted areas minimising risk to articular cartilage.SWANN MORTON FINE BEAVER TYPE BLADES05904 No 64 blades (25). Beaver Type £25.5005905 No 65 blades (25). Beaver Type £25.5005906 No 65(a) blades (25). Beaver Type £25.50Meniscus ProbesHook Knife and Push KnifeThese three hand held knives can deal with most meniscal tears. Theirlow profile makes them suitable for both open and arthroscopicsurgeries.Visualisation of the caudal horns of the meniscus can be a challenge.Often the process of exposing the caudal horn can result in distortions. Anormal meniscus can look damaged and occasionally a bucket handle tearcan sit back and look normal. It is helpful to gently probe the meniscus toestablish its true condition. Dimensions refer to length of tip. Use 1mm indogs 30kg use 2mm.MENISCUS KNIVESAR-17-19XS Hook Knife 150mm £85.00AR-17-19X Hook Knife 225mm £85.00AR-17-11X Push Knife 225mm £85.00MENISCUS PROBE001408 Meniscus Probe 1mm tip 190mm £32.50001409 Meniscus Probe 2mm tip 220mm £32.50AR-17-10Meniscus Probe 2.2mm black shaft forarthroscopy 220mm £65.0056

www.vetinst.comJOINT SURGERY 1Meniscus Surgery SetCase Geoff RobinsThe tear is grasped mid sectionand sectioned from its axialattachments.The abaxial attachments are alsosectioned.The damaged segment ofmeniscus is removed from the joint.The Meniscus Surgery Set includes all the essential instruments for theexamination and management of meniscal injuries in a stainless steelautoclave case. Purchased as a set there are significant savings.Large Stifle DistractorHohman Retractor 12mmMeniscus Probe 1mmMicroToothed HalsteadsBeaver Type Scalpel Handle25 x No 65 Blade (mini no 11)Stainless CaseSilicone Protective InsertSmall Balloon Cloth DrapeManagement of meniscal injuries has three phases all of which willrequire special instrumentation.• Exposure of the meniscus, particularly the caudal horn of the medialmeniscus. This will require that the tibia is advanced and distractedrelative to the femur.• Examination of the meniscus for lesions. A visual examination is notenough. The surface of the meniscus should be probed for defectsand tears. The circumferential attachments should be checked forsecurity.• Lesions discovered must be managed by debridement or meniscalrelease.ToothedHalsteadsMENISCUS SURGERY SET001116 Meniscus Surgery Set £325.00Meniscus Surgery Set - EnhancedThis set includes all theinstruments in the MeniscusSurgery Set shown above butwith additional instruments toextend the range of optionsand patients.AR-17-11X Push Knife (page 56)AR-17-19X Pull Knife (page 56)The Push Knife and Pull Knife are the standardinstruments in man for the removal of meniscal tears001113 Small Stifle Joint Distractor (page 58) for smallerpatientsMENISCUS SURGERY SET - ENHANCED001117 Meniscus Surgery Set - Enhanced £525.00Loupes and LightsMeniscusProbeSmallGelpiLarge StifleDistractorImage Geoff RobinsMeniscal lesions are small anddifficult to see in idealconditions. Where lighting ispoor, diagnosis and treatmentis very difficult.Use of focal lighting andloupes will significantlyimprove success rates. Seepages 260-263 for loupes andpages 346-347 for lighting.57

1 JOINT SURGERYStifle DistractorsSmall Stifle Joint Distractor001112Damage to the medial meniscus is commonly associated with rupture of theCranial Cruciate Ligament (C.C.L.). It is most frequently found in largerdogs with a longstanding injury. Failure to deal with meniscal damage is aserious omission in C.C.L. repair. Exposure of the medial meniscus forexamination and repair is extremely difficult. For further information see ourweb site or request our free DVD ‘Surgical Management of Canine CranialCruciate Disease’.WHICH DISTRACTOR?>5kg 001113VSX Miniature5kg 001113VS Very Small5-15kg 001113 Small15-50kg 001112 Standard50kg 001112/L Large001112 the original stifle distractor remains the most usefulStifle Distractor0011136mmThe Small Distractor is also useful as small local muscle and tissueretractors in and around canine joints e.g. elbow exploration. Total length130mm.SMALL JOINT DISTRACTOR/ RETRACTOR 6mm wide tips001113 Small Joint Distractor/ Retractor 6mm wide tips £145.00Very Small Stifle Joint DistractorThe Very Small Distractor is extremely useful asa small joint retractor during the meniscal releaseprocedure. It is used to open a small window,caudal to the medial collateral. Total length 140mm001113VS3mmStifle Distractor Tips001112The Stifle Distractor is designed to separate the femoral component of thestifle from the tibia. Ideally the two joint surfaces should move away fromeach other in a parallel fashion so that the meniscus is exposed in itsnatural state and minimally distorted by the examination. One tip is placedin the intercondylar notch and the other on the cranial intercondylar area.Neither tip should involve articular cartilage. Test distractions (by squeezingthe handles) will allow the surgeon to find the exact point at which a fulldistraction will expose the medial (usually) meniscus. The spinlock is thenengaged to powerfully open up the stifle joint. The distractor isself-retaining leaving the surgeon with two free hands to examine themeniscus and deal with any pathology.When closed the tips overlap making the points atraumatic as they enter thejoint. Additionally the overlapping feature reduces the profile of the tips asthey enter the joint.Money-back guarantee! If this instrument is not an improvement on whateveryou are currently using, we will give you a full refund.STIFLE DISTRACTOR001112/L Large Stifle Distractor min spread 10mmmax 40mm 210mm £185.00001112 Stifle Distractor min spread 8mmmax 30mm 190mm. £185.00VERY SMALL JOINT DISTRACTOR/ RETRACTOR 3mm wide tips001113VS V Small Joint Distractor/ Retractor 3mm wide tips £145.00Miniature Stifle DistractorAlthough the tips on our Very Small Stifle Distractor are very small therest of the instrument remains too bulky for very small and miniaturedogs. The Miniature Stifle Retractor has been scaled down all roundmaking it ideal for smaller breeds. Small breeds get meniscal injuriestoo. As is the case with all our stifle distractors the retaining tips areoverlapping creating a low profile, atraumatic entry into the joint.MINIATURE STIFLE DISTRACTOR001113VSX Miniature Stifle Distractor 100mm £145.0058

www.vetinst.comJOINT SURGERY 1Spinlock Stifle DistractorThe working tips of our Spinlock Stifle Distractors are just the same as theratchet version. The spin lock offers a more secure distraction as it isimpossible forthe distractor toslip. In additionthe spinlockvariant allowsthe surgeon to‘crank’ open thejoint in the mannerof the larger versionsof this instrument.Many of our Gelpi selfretaining retractors arealso available with aspinlock. See page 100.Extra Articular JointDistractionExternal Stifle DistractorSPINLOCK STIFLE DISTRACTORS001113SL Spinlock Small Stifle Distractor 140mm 6mm tips £145.00001113VSSL Spinlock Very Small Stifle Distractor 140mm 3mm tips £145.00JOINT SURGERYPRACTICAL DVDThe University of Sydney’s Centre for Veterinary Education producesa range of excellent teaching DVDs. Veterinary Instrumentation ispleased to have been appointed a distributor.Surgical Approaches tothe Bones and Joints of the DogDr. Wing Tip WongThis DVD includes all the common approaches to the shoulder,elbow, hip, stifle and hock joints as well as the humerus and ilialshaft. Bone models are included to highlight the approach. The DVDis suitable for general practitioners contemplating any surgicalprocedure involving canine joints.SURGICAL APPROACHES DVD DR WING TIP WONGProcedures include:Caudal approach to shoulderDistal humerus via olecranonLateral approach to humerusLateral approach to elbowMedial approach to elbowDorsal approach to hipLateral approach to stifleMedial approach to hockApproach to ilial shaftDuration: 40 minutesDVDSAW Surgical Approaches DVD Dr Wing Tip Wong £67.50Osteoarthritic stifles can be very ‘tight’ making examination andtreatment of meniscal lesions difficult. Distraction of the articularsurfaces using intra-articular instruments clutters the operative field.Originally developed for arthroscopic use the extra articular distractorworks very well in open surgery.Pins are placed above and below the stifle approximately along the lineof the medial collateral ligament. The standard distractor uses 2.5mmpins. For those TPLO surgeons who wish to use the proximal tibial pinas their proximal jig pin a version is available which takes 3.2mm (1/8”)pins.Turning the thumb screw distracts the joint from the medial side exposingthe medial meniscus. For better view of the caudal horn the pins may betwisted relative to one another which brings the tibial plateau forward.EXTRA ARTICULAR STIFLE DISTRACTORAR-17-01 Extra Articular Stifle Distractor 2.5mm pins 80mm £185.00AR-17-01/TPLO Extra Articular Stifle Distractor 3.2mm pins 80mm £185.0059

1 JOINT SURGERYPatella Sub-LuxationPatella Sub-Luxation is a common condition of the canine stifle joint whichrequires intervention by the veterinary surgeon. Although most common insmall and miniature breeds the condition seems to be becomingincreasingly seen in medium, large and giant breeds of dog. In larger dogs,particularly those with angular deformities of either or both femur and tibia,management can be very challenging.Patella luxation can be classified into four levels of severity. The leastsevere is grade 1 where the patella stays in the trochlea most of the time.In grade 4 the patella is permanently luxated.In many cases the trochlea is very shallow but rarely is a shallow trochleathe only problem and by the same token only deepening the trochlea rarelydeals with the problem. Similarly a simple imbrocation is rarely effective.Usually the underlying problem is a malalignment of the quadricepsmechanism. Re-alignment of this axis is by far the most important aspectof patella management.The most common technique for re-alignment of the quadricepsmechanism is tibial crest transfer which can be very effective particularly insmall and miniature dogs. Extreme cases may require osteotomy of thefemur or the tibia or both.Trochleaplasty where desirable may be achieved by a number oftechniques including sulcoplasty, wedge sulcoplasty and block sulcoplasty.More sophisticated techniques of trochlea ridge transplant and eventrochlea implants are also available. Ideally techniques should attempt topreserve as much articular cartilage as possible. In miniature dogs wherethis is difficult a simple deepening of the trochlea with a rasp which is backfilled by fibro cartilage is acceptable.A step by step guide for the management of patella sub-luxation will beavailable June 2013.BRPATCorrective Osteotomy Sawguide SystemCorrective osteotomy is a recognised procedure in the management ofpatella luxation particularly in medium and large dogs.Positioning the osteotomy at the CORA (centre of rotation) can be achallenge.Creating an accurate osteotomy at the site is a further challenge.The new osteotomy and sawguide system allows the surgeon to createaccurate osteotomies positioned at the correct site.Grading of patella sub-luxation after Singleton 1969FemurGrade 1 Grade 2TibiaGrade 3 Grade 4NORMALPatellaTibialTubercleOsteotomy of the distal femur is now an accepted technique for correctionof patella luxation in medium and large dogs with a limb alignmentdeformity. The distal femur is a difficult area to appropriately contour andplace sufficient screws. Using finite element analysis Mark Glyde designeda preformed plate specifically for this area. Screw hole placement allowsfor a closing wedge osteotomy. See page 198 for further informationregarding the Supracondylar Osteotomy Plates (SCOP).The Osteometer/ Sawguide is sucessfully employed in the TTOtechnique of cruciate management to create accurate small wedgeosteotomies. In the TTO technique the sawguide is located into guideholes drilled into the bone. This is not an option in more cylindricalbones. The spinlock saw guide clamp incorporates an appropriate guidehole and can be clamped to virtually any bone. Once the osteotomyangle is determined the sawguide is secured into position using a 1.6mmK wire. The sawguide may then be moved very accurately from proximalto distal cuts to create the precalculated osteotomy.CORRECTIVE OSTEOTOMY SAWGUIDE SYSTEMTTO011 Osteometer/ Sawguide £275.00TTO013 Saw Guide Attachment Forceps 9 1 /2”/245mm £125.0060

www.vetinst.comJOINT SURGERY 1X-Acto SawRectangular Sulcoplasty InstrumentsAlthough not stainless, this fine toothed hard backed saw is ideal for wedgetrochleaplasty. Provided the blade is kept absolutely dry, apart from theactual procedure, you will get several procedures from it before it needsreplacing. Handle is aluminium. Consider also the Hard BackedOrthopaedic Saw (001004).X-ACTO SAWXACTOB/H X-acto Saw Complete 270mm £26.00XACTOHANDLE X-acto Saw Handle only 140mm £20.00XACTOBLADE X-acto Saw Blade 0.3mm cut 140mm £13.50XACTOSTERILE X-acto Saw Blade Sterile 0.3mm cut 140mm £19.50Hard Backed Orthopaedic Saw140mm long 23mm deep0.4mm cut.In the style of the X-ACTO sawblade but is stiffer and has slightlybigger teeth, more suitable forbone. It is made from stainlesssteel and can be autoclaved. Thestiff back helps to guide the sawbetter than with hacksaw typeblades which often deviate.Use for wedge sulcoplasty andosteotomies up to 23mm deep.A rectangular sulcoplasty retains the maximum articular cartilage. Creationof the sulcoplasty can be a challenge in that most osteotomes are too thickand the block tends to break up. Our super slim 8mm osteotome minimisesbreakup. The rectangular rasp is designed to tidy up the corners of thesulcoplasty to maximise ‘fit’.RECTANGULAR SULCOPLASTY INSTRUMENTS001017 Super Slim Osteotome 8mm 180mm £47.50001018 Rectangular Bone Rasp 210mm £35.00Osteophyte RaspOSTEOPHYTE RASPMost stifles requiring cruciaterepair will exhibit someosteophytes. In some cases theymay be bulky necessitatingremoval. The Osteophyte Rasp isa small yet very effective rasp tokeep in the cruciate set.001019 Osteophyte Rasp £45.00Modular Osteotome with Ultra-thin InterchangeableBlades and Diamond RaspHARD BACKED ORTHOPAEDIC SAW (stainless)001004 Orthopaedic Hard Back Saw0.4mm cut. Stainless steel 145mm £39.50Trochlea RaspDesigned for deepening thetrochlea groove, the trochlearasp has a range of diametersto suit breeds from chihuahuasto bull terriers. For largerbreeds perform a wedge orblock trochleaplasty using ahard backed saw. Anaccurately contoured trochlea is essential for a successful trochleaplasty.Articular cartilage is removed to be replaced by fibrocartilage. Total length190mm.TROCHLEA RASP001020 Trochlea Rasp 11mm max 5mm min diameter £52.50001022 Trochlea Rasp Small 8mm max 3mm min diameter £52.50The osteotome is supplied as a comfortable handle into which fits alarge range of blades. The blades are very thin (1.1mm) making themsuitable for a variety of procedures including block sulcoplasty. Theblock including the articular cartilage may be harvested with minimalbreakage of the block. Supplied as a handle plus the following blades4mm, 6mm, 8mm, 10mm, 12mm, 15mm and 20mm. A new diamondcoated6mm rasp has been added to the range to tidy up the corners ofthe sulcoplasty. Total length of Osteotome and blade is 230mm.MODULAR OSTEOTOME001380 Modular Osteotome Complete with 7 blades £195.00001382 Modular Osteotome Replacement Blade 4mm £24.00001383 Modular Osteotome Replacement Blade 6mm £24.00001384 Modular Osteotome Replacement Blade 8mm £24.00001385 Modular Osteotome Replacement Blade 10mm £24.00001386 Modular Osteotome Replacement Blade 12mm £24.00001387 Modular Osteotome Replacement Blade 15mm £24.00001388 Modular Osteotome Replacement Blade 20mm £24.00001389 Modular Diamond Rasp 6mm £47.5061

1 JOINT SURGERYTRIPLE & DOUBLE PELVICOSTEOTOMYTriple Pelvic Osteotomy (TPO) and Double Pelvic Osteotomy (DPO) areboth techniques which rotate the acetabular segment of the pelvis tocreate greater coverage of the head of the femur resulting in more stability.The long term consequence in cases of severe HD is reduced DJD and areduced need for Total Hip Replacement (THR).The technique has been used for many years but recently has fallen out offashion. The introduction of locking plate technology appears to have giventhe technique a renewed lease of life.TPO involves transection of Ilium, Pubis and Ischium to free the acetabularsegment. The free segment may then be rotated and fixed into positionusing an angled plate across the Ilial osteotomy. A more stable postoperative construct may be achieved by creating two cuts only in the Iliumand the Pubis. This is the DPO technique which although more stable doesrequire that the ischium has to be folded to allow the desired rotation. It issometimes the case that the stiffness of the ischium prevents the fullrotation indicated on the plate being achieved. A compromise technique,the so called ‘DPO and a half’ procedure, involves complete osteotomiesof the ilium and pubis but only the dorsal cortex of the ischium whichtherefore folds more easily allowing the acetabular segment to fully rotatebut leaving a stable post operative construct.A number of plates are available, both locking and non-locking for the TPOand DPO procedures.Slocum Style TPO/ DPO PlatesSlocum style TPO plate on aSheltie.Case: Nick VanVoorenOriginal Slocum style platewith round and DCP holesplus a hole for cerclagewire.Most authors now suggest that 25 degrees is the most useful rotation. Inaddition 20 and 30 degree plates are available. Pre-angled plates are allhanded, left or right. Flat plates may be twisted prior to the procedure.VI Twistable TPO/ DPO PlatesBarclay Slocum first described the TPO technique in 1986. His original plateis still widely used. There are 3 x 3.5mm holes on either side of the ilialosteotomy with an additional small hole on the distal side for a cerclage wire.A locking screw version for standard twin start locking screws is available foradditional angular rigidity. Includes one DCP hole for compression.The plates are supplied flat to be twisted prior to surgery or pre-bent byourselves prior to despatch. Please advise angle and side. Thirty degreesrotation is the most widely applied. The plates accept 3.5mm cortical, 3.5mmcancellous, 4mm cancellous and 9/64" Sherman self tapping screws.TRIPLE PELVIC OSTEOTOMY PLATE090167 Large TPO Plate £50.00090179 Small TPO Plate £45.00090167L30 Large TPO Plate Prebent 30°. Left £55.00090167R30 Large TPO Plate Prebent 30°. Right £55.00090179L30 Small TPO Plate Prebent 30°. Left £50.00090179R30 Small TPO Plate Prebent 30°. Right £50.00HDTPODVD TPO Technique DVD Hamish Denny £45.00Rasenberg TPO/ DPO PlatesThis plate is more flexible than the VI or theSlocum plate. Less pelvic narrowing than theVI plate. Less screw pull out than Slocumplate. For a free powerpoint presentation onthe technique please phone or e-mail us atinfo@vetinst.com Cut-outs on the plate allowthe placement of additional screws should theybe necessary.Available in 25 degrees only.RASENBERG TPO PLATE090195 Rasenberg 3.5mm TPO Plate 25°. Right £70.00090196 Rasenberg 3.5mm TPO Plate 25°. Left £70.00CDRAS Powerpoint Presentation on CD £FOCLockingLOCKING SLOCUM STYLE TPO & DPO PLATES 3.5MM09910320L Slocum Style TPO/ DPO Plate 20 Left £75.0009910420R Slocum Style TPO/ DPO Plate 20 Right £75.0009910525L Slocum Style TPO/ DPO Plate 25 Left £80.0009910625R Slocum Style TPO/ DPO Plate 25 Right £80.0009910730L Slocum Style TPO/ DPO Plate 30 Left £85.0009910830R Slocum Style TPO/ DPO Plate 30 Right £85.0009920320L Slocum Style TPO/ DPO Plate 20 Left Locking £80.0009920420R Slocum Style TPO/ DPO Plate 20 Right Locking £80.0009920525L Slocum Style TPO/ DPO Plate 25 Left Locking £85.0009920625R Slocum Style TPO/ DPO Plate 25 Right Locking £85.0009920730L Slocum Style TPO/ DPO Plate 30 Left Locking £90.0009920830R Slocum Style TPO/ DPO Plate 30 Right Locking £90.00LSDG35XL 3.5 Locking Screw Drill Guide Extra Long £52.5062

www.vetinst.comJOINT SURGERY 1VI Locking TPO/ DPO PlatesOver the past three years we havebeen developing a locking version ofTPO/ DPO plates. The plate has aslightly larger ‘footprint’ than the originalSlocum plate. The locking screwsplaced at diverging angles give bettersecurity than regular cortical screws.One hole next to the osteotomy site onthe sacral side is a regular DCP hole so that a regular screw can pull theplate down to the sacral section of the ilium and then create compression atthe osteotomy. Available in both 3.5 and 2.7mm formats. Will also acceptregular cortical screws.VI LOCKING TPO & DPO PLATES09930320L 3.5 TPO/ DPO Locking Plate 20 Left £90.0009930420R 3.5 TPO/ DPO Locking Plate 20 Right £90.0009930525L 3.5 TPO/ DPO Locking Plate 25 Left £95.0009930625R 3.5 TPO/ DPO Locking Plate 25 Right £95.0009930730L 3.5 TPO/ DPO Locking Plate 30 Left £100.0009930830R 3.5 TPO/ DPO Locking Plate 30 Right £100.0009940320L 2.7 TPO/ DPO Locking Plate 20 Left £90.0009940420R 2.7 TPO/ DPO Locking Plate 20 Right £90.0009940525L 2.7 TPO/ DPO Locking Plate 25 Left £95.0009940625R 2.7 TPO/ DPO Locking Plate 25 Right £95.0009940730L 2.7 TPO/ DPO Locking Plate 30 Left £100.0009940830R 2.7 TPO/ DPO Locking Plate 30 Right £100.00LSDG2724XL 2.7 Locking Screw Drill Guide Extra Long £52.50LSDG35XL 3.5 Locking Screw Drill Guide Extra Long £52.50Locking Screw TapsLocking ScrewsThe angular security of locking plate systems depends on a rigid interfacebetween screw and plate. This is achieved either by the use of interlockingthreads or by using the morse taper phenomenon as seen in the Fixinsystem.Threaded systems are the most common. The modulus of bone andstainless steel differs greatly and the ideal screw thread for one will not suitthe other. Stainless steel demands fine threads whereas bone needs arelatively coarse thread. If we use a fine thread in the plate and a coarsethread in the bone, when the head of screw engages the plate, the screwmoving faster through the bone than the plate would have the effect ofpulling the plate towards the bone. This is exactly what we do not want.Some systems compromise by using the same thread in both screw headand bone plate.At Veterinary Instrumentation and in the industry standard locking screwthe problem is solved by some ingenious engineering. The threads on thehead of our screws are fine as required but have a twin start. The threadstaper down the head as a double helix. The pitch (the distance betweenthe tips of the threads) of each individual fine thread is the same as thethreads on the bone screw but because of the double helix the number ofthreads per millimeter of locking thread is double that of the bone screwgiving the fine threads required for metal on metal. The screw movesthrough the bone at the same rate as it moves through the platemaintaining the relative positions of both bone fragment and plate.There is an additional benefit of the double helix. As the screw headapproaches the plate a single start thread may have to wait 360 degreerotation before the threads start to engage. In the 3.5 screw this mightmean that the plate is pushed around one millimeter before the head of thescrew engages. With a twin start thread the screw head will engage within180 degrees of contact.Where angular security is important and where contouring is difficultVeterinary Instrumentation is creating special plates with locking holetechnology.For the complete range and further information see page 188.Locking Screw SetsAvailable in both 3.5, 2.7mm (with 2.4mm head), 2.4mm and 2.0mm.Supplied in a stainless steel screwbox. Sets discounted by over 5% fromcomponent price.Since the introduction of locking screws into veterinary orthopaedics wehave had the feedback that the self tapping feature works well inrelatively soft bone (e.g. proximal tibia for TPLO) but it is less effective indense cortical bone where getting the screw started can be a challenge.Starting the screw at any angle other than 90 degrees to the plate willhave serious consequences when the locking threads meet the plate. Inaddition if the screw does not tap the trans cortex efficiently a disc ofbone may be punched from the bone surface as the screw exits.LOCKING SCREW TAPTSLS35 Tap for 3.5 Locking Screws £82.50TSLS27 Tap for 2.7 Locking Screws £82.50TSLS24 Tap for 2.4 Locking Screws £82.50TSLS20 Tap for 2.0 Locking Screws £82.50QRCS01F Quick Release Tap Handle £145.00TSLSET Handle and Locking Tap Set (one of each tap) £425.003.5mm set includes 3 x 12-20mm, 4 x 22-26mm, 5 x 28-40mm, 4 x 42-50mm, 3 x 52-58mm locking screws and 5 locking plugs2.7mm and 2.4mm set includes 3 x 6-8mm, 4 x 10-16mm, 5x 18-28mm,4 x 30-32mm, 3 x 34-40mm locking screws and 5 locking plugsLOCKING SCREW SETSLS35KIT 3.5 Locking Screw Set Hex Drive £1,495.00LS35STARKIT 3.5 Locking Screw Set Star Drive £1,495.00LS27STARKIT 2.7 Locking Screw Set Star Drive £995.00LS24STARKIT 2.4 Locking Screw Set Star Drive £995.00LS20STARKIT 2.0 Locking Screw Set Star Drive £995.0063

1 JOINT SURGERYAdjustable Bone SawGigli Wire Passer - Nick VanVoorenUseful for many bone procedures, this saw comes complete with five, finechrome plated blades. Blade length is adjustable from 40mm to 100mm.Procedures include trochleaplasty, tibial crest transplants, amputations,trochanteric osteotomy and excision arthroplasty. Also useful for splittingmulti-rooted teeth prior to extraction. Handle length130mm. Blade length155mm.ADJUSTABLE BONE SAW001000 Adjustable Bone Saw c/w 5 Fine Blades £57.50001001 Spare Fine Blades. Pack of 5 Chrome Plated £14.50001000SS Adjustable Bone Saw Blade (Single) Sterile £6.75Rhinotomy/ Plaster Saw BladeMinimally invasive passing of Gigli wire around the ischium for TPO/ DPOcan be challenging. This device, developed by Nick VanVooren simplifiesthis process. The wire is simply passed down the tube, where the bendforces it back on itself for easy retrieval. Total length 160mm.GIGLI WIRE PASSER001518 Gigli Wire Passer - 160mm £65.00This is a curved stainless blade with a radius of 15mm. Useful forrhinotomy, plaster cutting and osteotomies where access is limited,e.g. radius, ulna and ilium during a TPO. Total length 85mm.RHINOTOMY/ PLASTER SAW BLADE001003 Rhinotomy/ Plaster Saw Blade (single) £14.50Gigli Wire - 10m spoolsEyed wire will not pass through the tube of the wire passer, so wire withouteyes is required. Simply cut to length before autoclaving. We would adviseallowing another 10-15mm more than with eyed wires to allow attachmentto the handles.GIGLI WIRE - 10M SPOOLS001519 Gigli Wire - 10m spool £77.50VI Handles for Gigli WireCoarse Stainless BladeVery useful for larger patients. The tooth pitch is 15 teeth per inch. Thisblade does not clog easily. Also useful for trochleaplasty.COARSE STAINLESS BLADE001002 Coarse Stainless Blade (single) 140mm £14.50Saw Blades for Scalpel HandlesAttachment of non-eyed wires to these handles is achieved by means of athumb screw. The wire is gripped more firmly if it is wrapped once aroundthe handles before tightening the screw.VI HANDLES FOR GIGLI WIRE001514 VI Handles for Gigli Wire 110mm (Pair) £55.00Four different blades are included in the saw set. All saws fit the No3scalpel handle. The blades are very thin (0.25mm) making them suitablefor a variety of small bone cutting procedures. Scapel Blade Kit includes3 sets of blades and a free scapel handle (0803VI).SCALPEL FIT SAW BLADESSBLSET Scalpel Fit Saw Blades (4 different blade styles) £17.50SBLKIT Scapel Saw Blade Kit (3 of above plus handle) £49.50Gigli SawGIGLI SAWEssentially a bonecutting wire. Moreuseful in large dogs.Hard to persuade thesaw to cut where youwant it to. Can bethreaded throughholes to makeinaccessible cuts.e.g. ulna osteotomies.001515 Gigli Saw Handles (pair) 75mm £39.50001516 Gigli Saw 30cm £9.50001517 Gigli Saw 50cm £10.5064

www.vetinst.comJOINT SURGERY 1Excision Arthroplasty RaspHohman Retractors with short tip001041Designed specifically to remove any bone spurs following excisionarthroplasty. Failure to remove bone spurs is the most common cause ofproblems with this procedure. Teeth cut on the back stroke.EXCISION ARTHROPLASTY RASP001010 Excision Arthroplasty Rasp 170mm £54.50Combination Bone Rasp Set001042A deceptively useful instrument, this style of Hohman is useful in:1. retraction of facia lata during CCL repair2. elevation of femoral head and neck3. muscle retraction during many joint and fracture procedures.If you intend to buy just one Hohman, the one you need is 001041, 18mmwith a short tip. This is usually the one described in texts as ‘Hohman’.HOHMAN RETRACTORS with short tip001041 Hohman Retractor 18mm Short Narrow TipTotal length 240mm £52.50001042 Hohman Retractor 12mm Short Narrow TipTotal length 175mm £52.50Gutter HohmanThe three interchangeable rasp blades offer a range of cutting surfaces, flat,round and ‘putti’ style. The handle has an ergonomic design which is easyto grip even when wet.COMBINATION BONE RASP SET001015 Combination bone rasp with 3 interchangeable heads £160.00OCD CuretteThe Gutter Hohman is the brain-child of Haralabos Haralabidis, DVM fromAthens. When used to lever the two bones of an oblique fracture into adistracted position during reduction, the top segment is inclined to slide off astandard Hohman retractor. The gutter we have created prevents thisslippage until the bones fall into reduction.GUTTER HOHMAN RETRACTOR001035 Gutter Hohman Retractor 180mm £62.50Mini Hohman Broad Blade Short TipActual sizeOne of a range of mini Hohmans designed to manipulate bone fragmentsand overlying muscles. The blade is 25mm wide and the overall length is120mm.MINI HOHMAN BROAD BLADE SHORT TIP001040 Mini Hohman 25mm Broad Blade 120mm long £59.50Swan-Neck HohmanLoose flaps of cartilage at the OCD lesion must be removed. The doubleended OCD curette is designed to perform this task within the limited spaceavailable. Healthy fibrocartilage within the lesion should not be disturbed.OCD CURETTE001030 OCD Curette 215mm £49.50001032 OCD. Curette Small 180mm £49.50Suggested by Martin Owen. Works great at keeping the femur and yourhand out of the surgical field.SWAN-NECK HOHMAN001034 Medium Swan-Neck Hohman 11mm Blade,short tip, 220mm long £65.0065

1 JOINT SURGERYHohman Retractor with long broad tipHohman Retractor Broad with Short Narrow Tip001043001044001045001046Useful in and around the shoulder joint and other retraction situations whena blunt tip is desirable.HOHMAN RETRACTOR with long broad tip001043 Hohman Retractor 24mm Long Broad Tip 280mm £55.00001044 Hohman Retractor 18mm Long Broad Tip 175mm £55.00Hohman Retractor 20mm wide with short kinked tipThe 48mm Hohman is very useful in the large dog for elevation of thefemoral head and neck for excision or toggle. The 24mm is designed toretract muscles during plating and cerclage procedures.HOHMAN RETRACTOR BROAD with Short Narrow Tip001045 Hohman Retractor 48mm Short Narrow Tip 260mm £52.50001046 Hohman Retractor 24mm Short Narrow Tip 185mm £52.50Mini Hohman 6mm & 8mm Short TipThis Hohman is designed for femoral neck retraction for THR after thefemoral head has been removed, in order to visualise the acetabulum foracetabular reaming. The idea is that the bent tip of the Hohman is engagedcaudoventral to the acetabulum with the osteotomised surface of thefemoral neck behind it and then the Hohman is retracted to pull the femoralneck out of the way for the reamer. This is much easier than having to geta rake retractor or Meyerding on the trochanter to physically pull the femurout of the way which is knackering. The Hohman does all the work for youmakesthings MUCH easier for reaming! Total length 200mm.HOHMAN RETRACTOR 20MM WIDE WITH SHORT KINKED TIP001039 Hohman 20mm wide with Short Kinked Tip £65.00Hip HohmanManipulation of small bone fragments during repair requires carefulretraction of soft tissues to minimise devascularisation. The blade of theHohman retracts the soft tissue as the tip effectively elevates and exposesthe bone fragment.Exact anatomical repair of the bones will not result in satisfactory healingwithout adequate blood supply.Mini Hohmans allow delicate, precise retraction of the vital soft tissues,allowing placement of screws or wires.An assistant to hold these instruments is a distinct advantage.MINI HOHMAN 6mm and 8mm Short Tip001047 Mini Hohman Retractor 6mm Short Tip 165mm £52.50001048 Mini Hohman Retractor 8mm Short Tip 165mm £52.50Micro Hohman 4mm Short Narrow TipOriginally developed as a Hohmanspecifically for Total HipReplacement (THR) this style hasproved useful in elevating thehead of the femur for other hipprocedures including toggling andtotal head and neck excision(THNE). The multiple small teethat the tip sit securely on thefemoral neck outside the zone ofarticular cartilage.Three sizes are available. Approximate guidelines as follows:Large: 255mm long with 25mm wide tip for large dogs >30kgMedium: 175mm long with13mm wide tip for medium dogs 10-30kgSmall: 125mm long with 8mm tip for small dogs < 10kgHIP HOHMAN001038 Large Hip Hohman 255mm x 25mm x 36mm Blade £65.00001037 Medium Hip Hohman 175mm x 13mm x 18mm Blade £65.00001036 Small Hip Hohman 125mm x 8mm x 12mm Blade £65.000010300SET Hip Hohman Set of 3 (as above) £150.00For some patients and some procedures even our mini 6mm Hohman istoo big. The micro 4mm Hohman is scaled down further. Two versionsare available, the standard version and a version with a long narrowshaft to work within standard instrument portals.MICRO HOHMAN 4MM SHORT NARROW TIP001049 Micro Hohman Retractor 4mm Short Tip 160mm £52.50001049A Micro Hohman Retractor 4mm Short Tipwith narrow shaft for arthroscopy 160mm £59.5066

www.vetinst.comJOINT SURGERY 1Coughlan Soft Tissue MangeursDeveloped by AndrewCoughlan of NorthwestSurgeons, the mangeur isdesigned to rapidly removesoft tissues eg. fat pad whichcan obscure the operativefield. Also ideal for theremoval of the remnants ofthe ruptured cranial cruciateligament.COUGHLAN SOFT TISSUE MANGEURS001108SGoniometerCoughlan Soft Tissue Mangeur - Very Small2mm x 8mm Shaft 115mm £145.00001108 Coughlan Soft Tissue Mangeur - Small2.5mm x 10mm Shaft 160mm £145.00001109 Coughlan Soft Tissue Mangeur - LargeCondyle ClampClose-up detail5mm x 12mm Shaft 180mm £145.00Fracture of the lateral humeral condyle is a relatively common fracture inyoung dogs. Reduction and repair is simple using the condyle clamp anddamage to periarticular structures is reduced to a minimum. No need to lagscrew with this clamp. Pressure should be applied proximo-laterally notpurely laterally. See diagram. Reduction may be checked by radiographyprior to fixation with a single screw. Use only within 48 hours of the fractureand if the fractured condyle is still mobile.CONDYLE CLAMP001080 Condyle Clamp Stainless Steel £70.00The goniometer may be used for the calculation oftibial plateau angles, wedge resections, angles ofanteversion etc. Also used to measure pre andpost-op range of motion of joints together with theeffect of physiotherapy. Clients may use tomeasure progress. 360˚ measurement.GONIOMETERGONIO Goniometer 6”/ 150mm (illustrated) £16.00GONIO2 Goniometer 12”/ 300mm £24.00Stainless Steel GoniometersFor intra surgery useor where a morerobust instrument isrequired. The FemoralNeck Goniometer isuseful for assessingimplant size in hipreplacement.STAINLESS STEEL GONIOMETERSGONIO3 Stainless Steel Goniometer 340mm £62.50HE-GONIO Femoral Neck (Stainless Steel) Goniometer 120mm £62.50DisarticulatorRupture of the roundligament (Teres) can beextremely difficult. Thedisarticulator isdesigned to elevate thefemoral head ready forexcision. The notch atthe tip of the instrumentengages and rupturesthe round ligament. Thedisarticulator is alsoparticulary useful inmanipulation of thehumeral head in OCDlesions, investigation ofelbow lesions and as a general tissue retractor. If you cannot see the cut endof the round ligament you probably have not resected it.DISARTICULATOR001090 Small Disarticulator 145mm £49.50001091 Large Disarticulator 195mm £52.50Hatt SpoonAn alternativeto thedisarticulator inlarge dogs. Theedge of thespoon is sharp.As used byMartinOlmstead. Ourpattern has afibre handleand a finer shaftfor betterbalance.HATT SPOONActual size001092 Hatt Spoon 230mm (17mm x 30mm scoop) £62.50001093 Hatt Spoon 230mm (12mm x 18mm scoop) £62.50001094 Hatt Spoon 230mm (7mm x 12mm scoop) £62.5000109SET Hatt Spoon Set of 3 (as above) £125.0067

1 JOINT SURGERYHip Toggle ProcedureThe hip toggle procedure is a well established technique for themanagement of traumatic and unstable subluxation of the the coxofemoraljoint. Although somewhat invasive it does have the advantagethat by replacing the round ligament the hip has, postoperatively, a fullrange of movement.However, the suture is placed into a very hostile abrasive environmentand historically had a high failure rate. Newer materials have, to adegree, addressed this problem. LigaFiba ® isspun Ultra High Molecular WeightPolyethylene. This is the same high wearmaterial used for acetabular cups in Total HipReplacement. For any given weight (ordiameter) LigaFiba ® is 2.5 x stronger than thetraditional monofilament nylon. In addition thesofter more flexible nature of the materialallows a relatively larger implant to be passedalong bone tunnels. LigaFiba ® has in additionbetter wear characteristics than nylon.Veterinary Instrumentation is pleased to offeran updated range of hip toggles based on LigaFiba ® . The rangeincludes the new 2.0mm and 2.5mm toggle. Use of a dedicatedintroducer facilitates the introduction of the toggle through theacetabulum into the pelvis.Notes on the use the the Hip Toggle system1. Expose femoral head and floor of acetabulum via a cranio-lateralapproach. Perform a trochanteric osteotomy if necessary. The text ‘AnAtlas of Surgical Approaches to the Bones and Joints of the Dog andCat’ by Piermattei is an almost essental part of any veterinary surgeonslibrary. Code BK02 see page 321.LigaFiba ® Hip TogglesHip Toggle IntroducerThe Hip Toggle has an ‘eye’ to hold the suture and ismade from stainless steel 316LVM. Use the adjustabledrill guide to accurately place the hole in the femoralneck, (see chapter 7).All sterile packs contain a nylon Ormrod button for securefixation of the suture. Available with monofilament nylonor braided LigaFiba ® . LigaFiba ® is easier to work with,is stronger and ties better. However, it is a braidedmaterial with higher infection risks.2. Clear soft tissues (mostly shredded round ligament) from acetabulumand fovea of femoral head.3. Drill a hole through the acetabular fossa (effectively the origin of theround ligament). Drill size required3mm Toggle plus 250lb LigaFiba 4.5mm drill3mm Toggle plus 80lb Nylon 4.8mm drill2.5mm Toggle plus 250lb LigaFiba 4mm drill2mm Toggle plus 150lb LigaFiba 2.7mm drill4. Load the toggle into the insertion tool. The ‘long’ end goes into theinserter tip. The suture is retained onto the inserter shaft by sliding thesilicone ring over the toggle and inserter.5. Push projecting toggle into hole in acetabulum.6. Insert plunger and eject toggle into pelvic canal. Toggle should ‘flip’out preventing pull out. Check toggle security.7. Drill a bone tunnel (2.5-3.5mm) from fovea exiting from proximallateral femur.a. Use Adjustable Drill Guide for best results. (ADJDG2035)b. ‘Eyeball’ itc. Drill from fovea to femur (requires severe external rotationof femur)8. Pass free suture ends down the femoral neck tunnel from fovea tofemur. LigaFiba ® will require a suture puller or alternatively a folded loopof fine cerclage wire may be passed from lateral to medial to exit at thefovea. Pass the LigaFiba ® through the loop and pull back. Check thereare no soft tissues (usually joint capsule) interposed between head andacetabulum.9. Pass ends of the suture through holes in Ormrod button, pull tight andtie temporarily. Check that coxo-femoral joint has a full comma ofmovement. Tie securely over button. Over-tightening is a technical errorand will result in premature failure of the suture.NOTE: The implant always breaks within a few weeks of placementregardless of technique and material. The toggle provided temporarystability only. If it becomes necessary to remove the suture, locate theOrmrod button and remove both button and suture. It is not possible toretrieve the toggle which, lying extra-articularly, does not cause aproblem.68Braided polyethylene is 2.5 x stronger than monofilament nylon and hasthe additional benefit of a high resistance to abrasion. These propertiesare ideal for a hip toggle suture. Additionally the braided materialconforms better and will therefore pass through a smaller hole. The new2mm toggle and 150lb (68kg) will pass through a 2.7mm bone tunnel.HIP TOGGLESHIPTOGLF250 Hip Toggle 3.0mm + 250lb LigaFiba ® ,Ormrod Button (Sterile Pack) Dogs over 10kg £24.50HIPTOGLF250M Hip Toggle 2.5mm + 250lb LigaFiba ® ,Ormrod Button (Sterile Pack) Dogs over 10kg £24.50HIPTOGLF150 Hip Toggle 2.0mm + 150lb LigaFiba ® ,Ormrod Button (Sterile Pack) Dogs under 10kg £24.50HIPTOGHip Toggle 3.0mm + 80lb Nylon, Ormrod Button(Sterile Pack) £19.50HIPINTLF250 Hip Toggle Introducer + Hip Toggle with 250lbLigaFiba ® + Ormrod Button (sterile pack) £95.00HIPINTHip Toggle Introducer + Hip Toggle with 80lbNylon + Ormrod Button (sterile pack) £95.00HIPTOGKITLF Contains Introducer, Hip Toggle with 250lbDrill Guide, 3.5 & 4.5mm Drills (discounted) £285.00HIPTOGKITContains Introducer, Hip Toggle with 80lb Nylon,Drill Guide, 3.5 & 4.8mm Drills (discounted) £285.00ADJDG2035 Adjustable Drill Guide 2.0, 2.5, 3.5mm Drills £185.00TOG Hip Toggle only 3.0mm (non sterile) £10.50TOGM Hip Toggle only 2.5mm (non sterile) £10.50TOGS Hip Toggle only 2.0mm (non sterile) £10.50

www.vetinst.comJOINT SURGERY 1Hip Toggle break-off styleDrill a bone tunnel from the foveato the lateral femur. Use of a drillguide will help direct the the drill.Use 2.5mm drill.Placing a hip toggle has been a popular technique for managing hipluxations for many years. Despite being very intuitive in that it attempts toreplace what was broken, the technique was not without problems. Placingthe toggle was difficult in that the insertion point through the fovea of theacetabulum was both deep and dark,additionally the toggle itself, even thelargest versions were small anddifficult to hold and insert. Anothermajor issue was that the inside of thehip joint is a very hostile environmentfor the toggle retaining suture whichwas subject to both tension andabrasion. Early failures werecommon.Case Hamish DennyThe break-off hip toggle combined with the new suture material LigaFibaaddresses these problems. The toggle is supplied as a 150mm pin with abreak off point just above the toggle. Positioned into the inserter, the distalhalf of the toggle may be pushed into the hole in the acetabulum. Rockingthe pin against the inserter breaks off the toggle which is then pushedthrough the hole using the broken off pin as a ‘pusher’.LigaFiba ® is very strong (2.5 x as strong as monofilament nylon) withgood abrasion resistance. It is easy to handle and requires a smalleracetabular hole for any given diameter of nylon. Despite being braided wehave had very few reports of infection.HIP TOGGLES BREAK OFFHIPTOG25BOP 2.5mm Break Off Hip Toggle with 150lb LigaFiba ® £32.50HIPTOG30BOP 3.0mm Break Off Hip Toggle with 250lb LigaFiba ® £32.50HIPTOG25APP 2.5mm Break Off Hip Toggle Applicator £57.50HIPTOG30APP 3.0mm Break Off Hip Toggle Applicator £57.50Surgical Technique for Break Off ToggleMost chronic hip luxations are inthe cranio-dorsal position. Theinitial dissection is to expose thehead of the femur prior to creatingthe bone tunnel and to expose theacetabulum. It is important toclear the acetabulum of softtissue prior to the togglingprocedure. Preserve the jointcapsule as far as is possible.Key points to this procedure are:• Careful dissection and clearing of acetabulum• Accurate positioning of the femoral bone tunnel• Accurate positioning of the acetabular hole• Careful reduction and tensioning of the suture.• Over tensioning is as great a technical error as under tensioning.• Check for a full range of motion before final tying.Drill a hole through the acetabularfossa large enough to allow thetoggle and LigaFiba ® to pass.4.0mm drill for 3.0 toggle, 3.2mmdrill for 2.5mm toggle.Place the tip of the toggle throughthe hole in the acetabular fossa.Pressing the applicator intoposition will retain the LigaFiba ® .Pass a suture puller or folded finewire from lateral femur through thebone tunnel and pull theLigaFiba ® strands through.See video clip onwww.vetinst.comLoad the break off toggle into theapplicator from the distal end. Pullthe LigaFiba ® back along theshaft of the applicator to retain thetoggle.Rock the shaft of the toggle pin toand fro until the shaft breaks off.Using the shaft, push the togglethrough the hole in the acetabularfossa and ensure that it flips andengages.The strands are pulled tight buttied loosley over the button.Check for full range of motion andcomplete tie. Do not over tightenwhich will lead to early failure.69