Surgical Protocol by E. Lyle Cain, M.D. and Jeffrey R. Dugas, M.D. of the American Sports Medicine Institute

Transcription

1 Surgical Protocol by E. Lyle Cain, M.D. and Jeffrey R. Dugas, M.D. of the American Sports Medicine Institute

2 Indications Shoulder Indications Bankart repair SLAP lesion repair Acromioclavicular (AC) separation Rotator cuff repair Capsule repair or capsulolabral reconstruction Biceps tenodesis Deltoid repair Wrist Indications Scapholunate ligament reconstruction Elbow Indications Tennis elbow repair Ulnar or radial collateral ligament reconstruction Biceps tendon reattachment Medial and lateral repairs Knee Indications (Extra-capsular repair) Medial collateral ligament repair Lateral collateral ligament repair Posterior oblique ligament repair Joint capsule closure Iliotibial band tenodesis reconstruction Patellar ligament/ tendon repair Vastus medialis obliquus (VMO) muscle advancement The first deployable Features Allows anchors to be easily placed on the lower positions (4:00 8:00 o clock) for Bankart tears around the glenoid without compromising the subscapularis tendon of the rotator cuff Anchor can be inserted at the correct anatomical location to the bone when tying down soft tissue Curved instruments ideal for arthroscopic labral repairs in the shoulder and hip to be inserted 2.9mm resorbable MicroMax Anchor with MaxBraid Suture on a flexible shaft This brochure is presented to demonstrate the surgical technique utilized by E. Lyle Cain, M.D. and Jeffrey R. Dugas, M.D. Biomet Sports Medicine, as the manufacturer of this device, does not practice medicine and does not recommend this or any other surgical technique for use on a specific patient. The surgeon who performs any procedure is responsible for determining and utilizing the appropriate techniques for such procedure for each individual patient. Biomet Sports Medicine is not responsible for selection of the appropriate surgical technique to be utilized for an individual patient. Flexible obturator, drill and anchor work in conjunction with curved guide.

3 anchor through a curved guide.

4 Surgical Technique MicroMax FLEX Suture Anchor Figure 1 Figure 2 Portal Placement Access labral pathology to carry out arthroscopic shoulder stabilization utilizing a flexible 5mm AquaLoc Cannula. Placement of the cannula should be just superior to the subscapularis tendon using an anterior/inferior portal (Figure 1). Prepare Surface To promote fibroblastic healing to bone, a bleeding bone surface is prepared with the Biomet Sports Medicine rasp/elevator system (Figure 2). A 15 or 30 Biomet Sports Medicine tissue elevators may help free significant tissue scarring off the scapular neck. A shaver may need to be introduced to remove any fibrous adhesions.

5 Figure 4 Figure 3 Figure 5 Place Curved Guide The curved design of the MicroMax guide allows easy access to the lower 5 o clock position for anatomical attachment of the labral tissue. The curved guide is passed through the flexible anterior/ inferior 5 or 7mm AquaLoc Cannula at the lower position of the glenoid. Position MicroMax curved guide to desired location on glenoid bone (Figure 3). Drill Pilot Hole with the Flexible Drill Insert the MicroMax FLEX drill bit into power drill to proximal laser-etch line to ensure appropriate depth as the collar of the drill contacts that back of the guide (Figure 4). Insert the MicroMax drill into the drill guide (Figure 5) Advance drill until contact is made with curved guide (Figure 6). Figure 6

6 Surgical Technique MicroMax FLEX Suture Anchor Figure 8 Figure 8a Insert Anchor Remove the drill. Note: Caution must be taken to maintain precise guide position over the pilot hole during removal. While maintaining the curved guide position firmly against the bone, insert the 2.9mm MicroMax FLEX Suture Anchor through guide and into the pilot hole. Firmly push the handle to fully seat the 2.9mm MicroMax FLEX implant (Figure 7). Align the laser etch marks to ensure anchor is inserted to appropriate depth (Figures 8a and 8b). Figure 8b

7 Figure 9 Figure 11 Figure 12 Figure 10 Deploy Anchor Once anchor has been fully seated into glenoid bone, push the green safety button into the handle (Figure 9). While maintaining pressure, deploy implant using forefingers to firmly pull back the blue slide (Figure 10) The trigger pulls the inner pin into the body and engages the flanges. The anchor handle can then be removed from the guide. Remove curved drill guide from the joint (Figure 11). Pull on the #2 MaxBraid Suture attached to anchor to ensure anchor is seated in bone (Figure 12).

8 Surgical Technique MicroMax FLEX Suture Anchor Figure 15a Figure 13 Figure 14 Figure 15b Retrieve Suture The Vampire Suture Grasper is used to transfer a single suture limb to anterior/superior portal. The tip of the instrument can be used to separate the suture strands to retrieve desired limb of suture. The SpeedPass Suture Lariat 25 is inserted into the anterior/inferior cannula and passed through labral tissue inferior to anchor position. Once the tip of the SpeedPass Lariat penetrates the tissue, the Nitinol wire can be manually advanced into the joint (Figure 13). Through the anterior/superior portal the Vampire Suture Grasper is used to retrieve the Nitinol wire loop (Figure 14), and the SpeedPass Lariat inserter is removed. Outside the anterior/superior portal, five centimeters of suture of the suture limb is passed through the Nitinol wire loop, and the wire extending out anterior/inferior cannulas is pulled out the cannula (Figures 15a and 15b) which shuttles the suture through the labral tissue and out the inferior cannula (Figure 16).

9 Figure 16 Figure 18 Figure 17 Desired arthroscopic knots are then tied with an open or closed knot pusher (Figure 17). The Slotted MaxCutter can be used to cut MaxBraid Suture. SLAP Repair SLAP repair may be performed in a similar manner. The MicroMax FLEX Suture Anchor can be inserted percutaneously with a trocar to eliminate cannula placement through the rotator cuff. Sutures are transferred to the anterior/superior cannula (Figure 18).

10 Features Push-in insertion with mechanical deployment Easy deployment system Suture slides easily through anchor Loaded with MaxBraid Suture Small implant size allows for multiple implant placement 2.9 and 3.9mm sizes Fish mouth guide allows accurate anchor placement

11 Surgical Technique MicroMax Suture Anchor Figure 2 Figure 1 Portal Placement Access labral pathology to carry out arthroscopic shoulder stabilization utilizing a flexible 5mm AquaLoc Cannula. Placement of the cannula should be just superior to the subscapularis tendon using an anterior/inferior portal (Figure 1). Prepare Surface To promote fibroblastic healing to bone, a bleeding bone surface is prepared with the Biomet Sports Medicine rasp/elevator system (Figure 2). A 15 or 30 Biomet Sports Medicine tissue elevators may help free significant tissue scarring off the scapular neck. A shaver may need to be introduced to remove any fibrous adhesions.

12 Surgical Technique MicroMax Suture Anchor Figure 3 Figure 5a Figure 4 Insert MicroMax Drill Guide Load MicroMax drill bit into power drill to proximal laser-etch line (Figure 3). Position MicroMax fish mouth guide to desired location on glenoid bone. A sharp trocar or blunt obturator can be used to insert the guide into the gleno-humeral joint. Insert the MicroMax drill into the drill guide (Figure 4). Advance drill until contact is made with guide (Figure 5a and 5b). Figure 5b

13 Figure 7a Figure 6 Figure 7b Insert MicroMax Suture Anchor Remove the drill. Extreme caution must be taken to maintain precise guide position over the pilot hole during removal. While maintaining drill guide position, insert the MicroMax Anchor through the drill guide and into the pilot hole (Figure 6). Firmly push the handle to fully seat the implant. Align the laser etch marks to ensure anchor is inserted to appropriate depth (Figure 7a and 7b).

14 Surgical Technique MicroMax Suture Anchor Figure 8 Figure 9 Deploy Anchor Push the green safety button into the handle (Figure 8). While maintaining pressure, deploy the implant by using forefingers to firmly pull back the slide (similar to using a syringe) (Figure 9).

15 Figure 11 Figure 10 The trigger pulls the inner pin into the body and engages the flanges (Figure 10). The anchor handle can then be removed from the guide (Figure 11). Remove the drill guide from the joint.

16 Package Inserts Biomet Sports Medicine, Inc P.O. Box 587 Date: 01/07 56 East Bell Drive Warsaw, Indiana USA Biomet Sports Medicine Resorbable Soft Tissue Anchoring Devices ATTENTION OPERATING SURGEON DESCRIPTION The Biomet Sports Medicine Soft Tissue Anchoring Devices are resorbable repair devices used to attach soft tissue to bone. The devices are available with or without a suture. The devices are implanted into a predrilled bone hole and are made of a resorbable copolymer, a polyester derivative of lactic acid and glycolic acid. Polylactic/polyglycolic acid copolymer degrades and resorbs in vivo by hydrolysis to lactic and glycolic acids, which are then metabolized by the body. MATERIALS Poly-L-Lactic Acid/Polyglycolic Acid Ultra-High Molecular Weight Polyethylene (UHMWPE) Polyester Polypropylene INDICATIONS 1. LactoScrew L-15 Screw Anchor (85% PLLA/15% PGA) and the ALLthread LactoSorb Suture Anchor: Shoulder Bankart repair SLAP lesion repair Acromio-clavicular separation Rotator cuff repair Capsule repair or capsulolabral reconstruction Biceps tenodesis Deltoid repair Wrist/Hand Scapholunate ligament reconstruction Ulnar/radial collateral ligament reconstruction Ankle/Foot Lateral stabilization Medial stabilization Achilles tendon repair/reconstruction Hallux valgus reconstruction Mid- and forefoot reconstruction Elbow Tennis elbow repair Ulnar or radial collateral ligament reconstruction Biceps tendon reconstruction Knee Medial collateral ligament repair Lateral collateral ligament repair Posterior oblique ligament repair Joint capsule closure Iiotibial band tenodesis Patellar ligament/tendon repair 2. LactoSorb L-15 Screw and Washer (85% PLLA/15% PGA), MicroMax Suture Anchor, and LactoSorb L-15 Hitch Suture Anchor: Shoulder Bankart Repair SLAP Lesion Repair Acromio-clavicalur Separation Repair Rotator Cuff Repair Capsule Repair and Capsulolabral Reconstruction Biceps Tenodesis Deltoid Repair Wrist Scapholunate ligament reconstruction Elbow Tennis Elbow Repair Biceps Tendon Reattachment Medial and Lateral Repairs Ulnar or Radial Collateral Ligament Reconstruction Knee Extra-Capsular Repair Medial Collateral Ligament Repair Lateral Collateral Ligament Repair Posterior Oblique Ligament Repair Joint Capsule Closure Iliotibial Band Tenodesis Reconstruction Patellar Ligament/Tendon Repair Vastus Medialis Obliquus (VMO) Muscle Advancement LactoSorb L-15 Screw and Washer and MicroMax Suture Anchor are preloaded with suture for use at the discretion of the physician. CONTRAINDICATIONS 1. Active infection. 2. Patients with mental or neurologic conditions who are unwilling or incapable of following postoperative care instructions. 3. Patient conditions including: blood supply limitations, insufficient quantity or quality of bone, or latent infections. 4. Pathologic soft tissue conditions, which would prevent secure fixation. WARNINGS Biomet Sports Medicine internal fixation devices provide the surgeon with a means to aid in the management of soft tissue to bone reattachment procedures. While these devices are generally successful in attaining these goals, they cannot be expected to replace normal healthy soft tissue, or withstand the stress placed upon the device by full or partial weight bearing or load bearing, particularly in the presence of incomplete healing. Therefore, it is important that immobilization (use of external support, sling, etc.) of the treatment site be maintained until healing has occurred. Surgical implants are subject to repeated stresses in use, which can result in fracture or damage to the implant. Factors such as the patient s activity level and adherence to weight bearing or load bearing instructions have an effect on the service life of the implant. The surgeon must be thoroughly knowledgeable not only in the medical and surgical aspects of the implant, but also must be aware of the mechanical and polymeric aspects of the surgical implants. 1. Correct selection of the implant is extremely important. The potential for success in soft tissue to bone fixation is increased by the selection of the proper type of implant. While proper selection can help minimize risks, the device is not designed to withstand the unsupported stress of full weight bearing, load bearing or excessive activity. 2. The implants can loosen or be damaged when subjected to increased loading associated with inadequate healing. If healing is delayed, or does not occur, the implant or the procedure may fail. Loads produced by weight bearing and activity levels may dictate the longevity of the implant. 3. Inadequate fixation at the time of surgery can increase the risk of loosening and migration of the device or tissue supported by the device. Sufficient bone quantity and quality are important for adequate fixation and success of the procedure. Bone quality must be assessed at the time of surgery. Adequate fixation in diseased bone may be more difficult. Patients with poor quality bone, such as osteoporotic bone, are at greater risk of device loosening and procedure failure. 4. Care is to be taken to assure adequate soft tissue fixation at the time of surgery. Failure to achieve adequate fixation or improper positioning or placement of the device can contribute to a subsequent undesirable result. 5. The use of appropriate immobilization and postoperative management is indicated as part of the treatment until healing has occurred. 6. Correct handling of implants is extremely important. Do not modify implants. Do not notch or bend implants. Notches or scratches put in the implant during the course of surgery may contribute to breakage. Intraoperative fracture of devices can occur if excessive force (torque) is applied while seating. 7. Do not use excessive force when inserting suture anchors. Excessive force (e.g. long hard hammer blows) may cause fracture or bending of the device. Prior to insertion of the implant, predrill, awl, or tap. 8. DO NOT USE if there is loss of sterility of the device. 9. Discard and DO NOT USE opened or damaged devices, and use only devices that are packaged in unopened or undamaged containers. 10. Ensure contact of tissue to bone when implanting. DO NOT OVERTIGHTEN the screw. Structural damage to the tissue and implant may occur if the screw is overtightened. 11. Adequately instruct the patient. Postoperative care is important. The patient s ability and willingness to follow instructions is one of the most important aspects of successful soft tissue management. Patients affected with senility, mental illness, alcoholism, and drug abuse may be at a higher risk of device or procedure failure. These patients may ignore instructions and activity restrictions. The patient is to be instructed in the use of external supports that are intended to immobilize the repair site and limit weight bearing or load bearing. The patient is to be made fully aware and warned that the device does not replace normal healthy tissue, and that the device can break, bend or be damaged as a result of stress, activity, load bearing, or weight bearing. The patient is to be made aware and warned of general surgical risks, possible adverse effects, and to follow the instructions of the treating physician. The patient is to be advised of the need for regular postoperative follow-up examination as long as the device remains implanted. 12. MicroMax Suture Anchor Loss of bone fixation may occur if flanged wings are not properly deployed. PRECAUTIONS Instruments are available to aid in the accurate implantation of internal fixation devices. Intraoperative fracture or breaking of instruments has been reported. Surgical instruments are subject to wear with normal usage. Instruments that have experienced extensive use or excessive force are susceptible to fracture. Surgical instruments should only be used for their intended purpose. Biomet Sports Medicine recommends that all instruments be regularly inspected for wear and disfigurement. If device contains MaxBraid suture, refer to manufacturer package insert for further information. POSSIBLE ADVERSE EFFECTS 1. Infection can lead to failure of the procedure. 2. Neurovascular injuries can occur due to surgical trauma. 3. Bending, fracture, loosening, rubbing, and migration of the implant may occur as a result of excessive activity, trauma, or load bearing. 4. Implantation of foreign materials can result in an inflammatory response or allergic reaction. 5. Inadequate healing. 6. Pain, discomfort, or abnormal sensation due to the presence of the device. 7. Necrosis of the bone or tissue. STERILITY Biomet Sports Medicine resorbable implants are sterilized by exposure to Ethylene Oxide (ETO) Gas. Do not resterilize. Do not use past expiration date. STORE AT OR BELOW ROOM TEMPERATURE. DO NOT EXPOSE PRODUCT TO TEMPERATURES GREATER THAN 120 F OR 49 C. Caution: Federal Law (USA) restricts this device to sale, distribution, or use by or on the order of a physician. Comments regarding this device can be directed to Attn: Regulatory Dept, Biomet, P.O. Box 587, Warsaw, IN USA, FAX: Authorized Representative: Biomet U.K., Ltd. Waterton Industrial Estates Bridgend, South Wales CF31 3XA U.K. СЄ 0086 The information contained in this package insert was current on the date this brochure was printed. However, the package insert may have been revised after that date. To obtain a current package insert, please contact Biomet Sports Medicine at the contact information provided herein.

17 Distributed by: Biomet Sports Medicine, Inc East Bell Drive Date: 02/08 P.O. Box 587 Warsaw, Indiana USA MaxBraid POLYETHYLENE SUTURE Non-absorbable Surgical Suture U.S.P. except for oversized diameter. Sterile: Contents sterile unless package has been opened or damaged. Single Use Only, Do Not Resterilize. DESCRIPTION MaxBraid Polyethylene Surgical Suture is a nonabsorbable, sterile surgical suture composed of ultra high molecular weight polyethylene. MaxBraid Polyethylene Suture is provided undyed (white), as a co-braid of undyed polyethylene and blue monofilament polypropylene or as a co-braid of undyed polyethylene and black monofilament nylon. MaxBraid sutures are U.S.P. except for diameter in the following sizes: MaxBraid sutures exceed USP specifcations for diameter. Suture Size USP Ave. Diameter Specification (mm) <861> Maximum Oversize Average Diameter (mm) Maximum Oversize Average Diameter from USP (mm) INDICATIONS MaxBraid Polyethylene Nonabsorbable Surgical Sutures are indicated for use in approximation and/or ligation of soft tissues, including use of allograft tissue for orthopedic surgeries. ACTIONS MaxBraid Polyethylene Surgical Suture elicits a minimal acute inflammatory reaction in tissues, which is followed by gradual encapsulation of the suture by fibrous connective tissue. WARNINGS Do not resterilize. Do not use if package is opened or damaged. Discard open, unused sutures. Users should be familiar with surgical procedures and techniques involving nonabsorbable sutures before employing Polyethylene Surgical Suture for wound closure, as the risk of wound dehiscence may vary with the site of application and the suture material used. As with any foreign body, prolonged contact of this or any other suture with salt solutions, such as those found in urinary or biliary tracts, may result in calculus formation. Acceptable surgical practice must be followed with respect to drainage and closure of infected or contaminated wounds. PRECAUTIONS In handling this or any other suture material, care should be taken to avoid damage from handling. Avoid crushing or crimping damage due to application of surgical instruments such as forceps or needle holders. Adequate knot security requires the accepted surgical technique of flat, square ties, with additional throws as warranted by surgical circumstance and the experience of the surgeon. Users should exercise caution when handling surgical needles to avoid inadvertent needle sticks. Discard used needles in sharps containers. This device should be handled and disposed of in accordance with all applicable regulations including, without limitation, those pertaining to human health and safety and the environment. ADVERSE REACTIONS Adverse effects associated with the use of this device include: wound dehiscence, calculi formation in urinary and biliary tracts when prolonged contact with salt solutions such as urine and bile occurs, infected wounds, minimal acute inflammatory tissue reaction, and transitory local irritation. HOW SUPPLIED MaxBraid Polyethylene Surgical Suture is available in USP sizes 5-0 through 5 (metric sizes 1 through 7). MaxBraid Polyethylene Suture is provided sterile. MaxBraid Polyethylene Suture is provided undyed (white), as a co-braid of undyed polyethylene and blue monofilament polypropylene, or as a co-braid of undyed polyethylene and black monofilament nylon. The suture is provided in a variety of lengths, with and without needles, with or without pledgets, and may be supplied in a variety of cut lengths or on ligating reels. Finished suture may be packaged in cartons as single packs, multipacks, or procedure packs. STERILITY MaxBraid Polyethylene Nonabsorbable Surgical Sutures are sterilized by exposure to Ethylene Oxide (ETO) Gas. Do not resterilize. Do not use past expiration date. MaxBraid is a trademark of Biomet Sports Medicine, Inc. Caution: Federal law (USA) restricts this device to sale, distribution or use by or on the order of a physician. Comments regarding this device can be directed to Attn: Regulatory Dept., Biomet Inc., P.O. Box 587, Warsaw, IN USA, Fax: Biomet and all other trademarks herein are the property of Biomet, Inc. or its subsidiaries. Manufacturer: Teleflex Medical 600 Airport Road Fall River, MA USA Telephone Suture CE marked by Teleflex (USA only) The information contained in this package insert was current on the date this brochure was printed. However, the package insert may have been revised after that date. To obtain a current package insert, please contact Biomet Sports Medicine at the contact information provided herein.

18 Biomet Sports Medicine E. Airport Dr. Date: 09/08 Ontario, CA WARNINGS AND PRECAUTIONS FOR USE OF FLEXIBLE MICROMAX DISPOSABLE CURVED GUIDE SYSTEM DESCRIPTION Flexible MicroMax Curved Guide Systems are to be used for preparation of bone to allow insertion of MicroMax Suture anchors in procedures for which the anchor is indicated. The system contains a flexible drill that passes through a curved guide. MATERIALS: Stainless Steel ABS Plastic Instruction for Use, Care, Handling: General Use: Use the drills only for their intended purpose, to prepare bone to allow insertion of MicroMax Suture anchors in procedures for which the anchor is indicated. Refer to product literature for the specific size and order number for each implant system. 1. Load the MicroMax drill bit into the power drill so the edge of the tri-shank drive portion is flush with the tip of the drill chuck. Tighten the drill chuck. 2. Introduce the guide into the joint with the aid of the provided obturator. Remove the obturator once inside the joint. 3. Position the guide tip securely on the bony anatomy at the desired suture anchor location. Orient the guide handle to achieve the desired hole trajectory. 4. Carefully insert the MicroMax drill bit into the drill guide and slowly advance the drill until contact with the bony anatomy. 5. Begin drilling and slowly advance the drill until the drill chuck contacts the back of the guide handle. 6. Continue to drill slowly clockwise as the drill is gently removed from the guide. Extreme caution must be taken to maintain precise guide position over the pilot hole during drill removal. 7. While maintaining guide position and trajectory, the anchor may be inserted through the guide into the pilot hole and fully seated according to the MicroMax Suture anchor instructions for use. The maximum recommended drill speed is 900 RPM in order to avoid failures such as breakage of the drill. WARNINGS: Intraoperative separation (fracture) of the cutting head from the flexible shaft can occur. Fractured cutting heads may lodge in bone causing added surgery time and surgical complications. PRECAUTIONS: 1. Flexible drills are to be used with the curved guide which will be packaged with the drill in the Flexible MicroMax Curved Guide System. Take caution in handling. The use of the curved guide provides support for the flexible drill, shielding the drill from excessive bending. Failure to use the curved guide may cause fracture of the device and surgical complications associated with removal of a fractured cutting head. 2. The Curved Guide should be held firmly in place against bone for the duration of the drilling cycle. Any translation of the guide or change in the angle of the guide after the drill tip has entered the bone can result in fracture of the drill. 3. Instruments that have experienced extensive use or excessive force are susceptible to fracture. Do not apply excessive forces to the flexible portion of the drill prior to insertion into the guide or use excessive force during drilling. 4. Extensive use of flexible drills will result in normal dulling of the cutting heads. Biomet recommends that all flexible drills be examined for damage and sharpness prior to the drilling of each hole during the case. Drills that are dull or performing inadequately during the case should be disposed of. 5. In cases requiring higher quantities of anchors (greater than 3) or above average bone hardness, use multiple drills within the case and limit the number of holes created with each drill. 6. The Flexible MicroMax Curved Guide System is packaged sterile. Do not attempt to resterilize any component of the system. Do not use the system in more than one case. Resterilization processes will compromise the mechanical strength of the instruments. While an instrument may appear undamaged, previous stress may have created imperfections that would reduce the service life of the instrument. 7. Do not use instruments that have been, even momentarily, placed in a different patient. 8. Do not use if there is a loss of sterility of the instrument. 9. Discard and DO NOT USE opened or damaged devices, and use only devices that are packaged in unopened or undamaged containers. 10. Correct handling of instruments is extremely important. Do not modify instruments. Do not notch or bend instruments. Examine the flutes of the drill head periodically for damage or wear. Notches, scratches or other damage and/or wear in the instrument occurring during surgery may contribute to breakage. 11. Do not reshape or bend the drill shaft in any way. If the shaft should become bent from its original shape, do not use, as this will affect the performance of the drill. Bent drill shafts should be disposed of. STERILITY The Flexible MicroMax Curved Guide System are supplied sterile, and are sterilized by a minimum dose of 25 kgy of gamma radiation. Do not resterilize. Do not use past expiration date. Caution: Federal Law (USA) restricts this device to sale, distribution, or use by or on the order of a physician. Comments regarding this device can be directed to the Customer Service Dept. Ontario, CA, telephone # Biomet and all other trademarks herein are the property of Biomet, Inc. or its subsidiaries. Authorized Representative: Biomet, U.K., Ltd. Waterton Industrial Estate Bridgend, South Wales CF31 3XA, U.K. СЄ 0086

19 Ordering Information MicroMax Suture Anchors MicroMax Disposable Kit (Straight) MicroMax Drill Bits mm Long mm Long MicroMax Suture Anchors 2.9mm 3.9mm MicroMax Drill Guides R 2.9mm Offset Guide Long mm Offset Guide Long MicroMax Obturators mm Blunt Long mm Trocar Long mm Blunt Long mm Trocar Long MicroMax FLEX Suture Anchors MicroMax FLEX Suture Anchors mm MicroMax FLEX Disposable Kit (Curved)

20 All trademarks herein are the property of Biomet, Inc. or its subsidiaries unless otherwise indicated. This material is intended for the sole use and benefit of the Biomet sales force and physicians. It is not to be redistributed, duplicated or disclosed without the express written consent of Biomet. For product information, including indications, contraindications, warnings, precautions and potential adverse effects, see the package insert and Biomet s website. One Surgeon. One Patient. P.O. Box 587, Warsaw, IN ext Sports Medicine Form No. BSM REV