ISO-TOGGLE SYSTEM FOR THE MANAGEMENT OF CRUCIATE RUPTURE

1. ISO-TOGGLE SYSTEM FOR THE MANAGEMENT OF CRUCIATE RUPTURE

2. LIGA-FIBA ISO-TOGGLE PROSTHESIS 250 lb Liga-Fiba Toggle Tie-down button Threading needle with nylon loop

3. Demonstration on Plastic Model Drilling the femoral isometric tunnel

4. Demonstration on Plastic Model Drilling the tibial isometric tunnel

5. Demonstration on Plastic Model The implant: 250 or 500lb LIGAFIBA; UHMWPE (ultra high molecular weight polyethylene) buttons Push- Pull graft passer or threading needle is used to pass the graft

6. Demonstration on Plastic Model A 250lb LIGAFIBA loop secured over an UHMWPE toggle on the medial aspect of the femur

7. Demonstration on Plastic Model A 250lb LIGAFIBA loop tied over an UHMWPE button on the medial aspect of the tibia. Note that the loop can either pass over or under the LDE.

8. Demonstration on Plastic Model x Note the orientation of the 250lb LIGAFIBA loop Compression of the LDE tendon (X) is a theoretical problem and placing the material under the tendon is an alternative

9. ISO-TOGGLE SYSTEM USING250 lb LIGA-FIBA Pointer on the lateral fabella Lateral parapatellar approach with reflection of the fascia.

10. 2.5-3.0mm drill bit and drill guide positioned on the femoral ISOMETRIC point, which is just cranial to the distal pole of the lateral fabella Drilling the femoral tunnel from the femoral isometric point Lateral view of the stifle

11. 2.5-3.0mm drill bit from the femoral ISOMETRIC point emerging on the medial side of the femur under the caudal edge of the medial vastus muscle Cranial view of the stifle on completion of the femoral tunnel

12. The pointer is on the cranial aspect of the tibial extensor fossa. Identifying the tibial isometric point on the lateral aspect of the tibia

13. 2.5-3mm drill bit and drill guide positioned on the tibial ISOMETRIC point, which is the tubercle on the cranial aspect of the extensor fossa Drilling the tibial tunnel from the isometric point

14. 2.5-3mm drill bit from the tibial ISOMETRIC point, directed in a lateral to medial direction emerging on the medial aspect of the proximal tibial Cranial view of the stifle on completion of the tibial tunnel

15. Long threading needle and nylon loop used to pass the prosthesis through the tibial tunnel Cranial view showing the start of threading the 250 lb Liga-Fiba loop starting on the medial aspect of the tibia

16. Cranial view showing the 250 lb Liga-Fiba loop threaded through the tibial tunnel in a medial to lateral direction

17. Tie-down button Threading needle Cranial view showing the 250 lb Liga-Fiba loop threaded through the femoral tunnel

18. Threading needle removed. Toggle to be inserted Cranial view showing completion of inserting the 250 lb Liga-Fiba loop but before insertion of the toggle and tensioning.

19. Toggle inserted Cranial view showing the insertion of the toggle and the start of tensioning the 250 lb Liga-Fiba loop.

20. Lateral view showing the isometric position of the 250 lb Liga-Fiba loop before and after tying off.

21. Tie-down button Medial view of the tibia showing the the 250 lb Liga-Fiba loop being tensioned prior to tying down

22. Medial view of the tibia showing the the 250 lb Liga-Fiba loop secured by tying over the button and the ends cut