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Knotless Endotendonous Repair System

S U RG I C A L T E C H N I QU E

The Bridge to Better Care

A SIMPLER, KNOTLESS TECHNIQUE FOR FLEXOR TENDON REPAIRS
PONTiS is a knotless flexor tendon repair system with the option of a minimally invasive
surgical approach.
Combined with its simpler procedure, the PONTiS Mulitfilament Stainless Steel (SS) Implant
and innovative instrumentation help to provide increased strength of repair and allows for
early active motion protocol.
For Zone 1 repairs, PONTiS also features an innovative, knotless anchor that enables surgeons
to simply reattach the flexor tendon to the distal phalanx.

PONTiS SOLUTIONS

Standard Flexor Digitorum Profundus (FDP) without Anchors

Distal Phalanx Repair with PONTiS Anchor

Scan to watch the PONTiS Standard Flexor
Digitorum Profundus Surgical Technique animation.

3

STANDARD FLEXOR DIGITORUM PROFUNDUS (FDP) REPAIR
1

FIGURE 1: Using a marking pen make two marks at
1.2cm and 0.6cm.

3

FIGURE 3: Pull the implant through the tendon so
the ends are of even length.

5

FIGURE 5: Take the second implant end and cross the
tendon so the needle enters the tendon close to where
the first needle exited and pull ends tight.

4

2

FIGURE 2: Using the multifilament SS implant make
your first pass through the tendon at 1.2cm.

4

FIGURE 4: Take one end and cross the implant over the
tendon and place the needle through the tendon at 0.6cm.

6

FIGURE 6: Pass each implant end from its exit point
out the cut end of the tendon starting approximately
1mm closer to the cut end. The implant must exit
close to the middle of the cut tendon end.

7

FIGURE 7: Remove the needles by cutting the shrink
tube close to the needles.

9

FIGURE 9: Dilate the pulley system by pulling the
dilation tube back and forth at least 10 times.

11

FIGURE 11: Thread the multifilament SS implant
ends through the large diameter of the aglet. Slide
tendon passing aglet over the tendon end ensuring
the end is fully covered.

8

FIGURE 8: Pass the pulley dilation tube from the
wound into the palm.

10

FIGURE 10: Cut the tube at both ends 1cm-2cm
distance away from incision.

12

FIGURE 12: Thread implant through the lumen of
the pulley dilation tube and place the tip of the aglet in
the lumen.

5

STANDARD FDP WITHOUT ANCHORS
13

FIGURE 13: Clamp the multifilament SS implant at the
distal end of the pulley dilation tube to hold the aglet tip
within the tube at the proximal end. Pull implant ends and
tube, as one, distally to feed the tendon through the pulley.

15

FIGURE 15: The distal tendon may be delivered by
flexing the distal joints. Repeat stitching steps 1-7.

16b

FIGURE 16b: The two proximal implant strands must
enter the proximal opening and the two distal implant
strands must enter the distal opening.
6

14

FIGURE 14: Remove the pulley dilation tube and aglet.

16a

FIGURE 16a: Load the crimp implant into the crimp
holder. Pass each multifilament SS implant end
through the crimp.

17

FIGURE 17: Release the crimp implant by squeezing
the crimp holder.

18

FIGURE 18: Centralize the crimp implant within the
tendon by pulling the two multifilament SS implant
strands exiting each side of the crimp implant.

20

FIGURE 20: Tighten each implant strand individually prior
to using the crimp tool. Assistant will maintain tension as the
crimp tool is used to lock the implant. Insert the crimp tool
transverse to the tendon. The crimp tool must be completely
squeezed until cam-action (bottoming) is felt.

19

FIGURE 19: Place and tie the first epitendonous stitch
at the lateral corner of the repair farthest from the
surgeon. This will control rotation of the tendon.

21

FIGURE 21: Cut the multifilament SS implant limbs
close to the crimp.

22

FIGURE 22: Complete the epitendonous stitch across the palmar surface of the repair by using interrupted stitches.
Take the repaired tendon through 5 or 6 excursions to ensure good motion through the pulleys.

7

DISTAL PHALANX REPAIR WITH PONTiS ANCHOR
1

FIGURE 1: Stitch proximal tendon using Steps 1-7
(pages 4-5). Insert Pre-drill to laser line.

3

FIGURE 3: Insert PONTiS anchor to laser line.

5

FIGURE 5: Use a glidding stitch through the distal
tendon stump. Pass the multifilament SS implant
through the crimp implant. The two proximal implant
strands must enter the proximal opening and the two
distal implant strands must enter the distal opening.
8

2

FIGURE 2: Insert Tap to laser line.

4

FIGURE 4: Grip the wings of the protective sleeve and
pull outward and away from the driver. Remove cap to
expose needles.

6

FIGURE 6: Release the crimp implant by squeezing
the crimp holder.

7

FIGURE 7: Centralize the crimp implant within the
tendon by pulling the two multifilament SS implant
strands exiting each side of the crimp.

9

FIGURE 9: Tighten each implant strand individually prior
to using the crimp tool. Assistant will maintain tension as
the crimp tool is used to lock the implant. Insert the crimp
tool transverse to the tendon. The crimp tool must be
completely squeezed until cam-action (bottoming) is felt.

8

FIGURE 8: Place and tie the first epitendonous stitch
at the lateral corner of the repair farthest from the
surgeon. This will control rotation of the tendon.

10

FIGURE 10: Cut the multifilament SS implant limbs
close to the crimp.

11

FIGURE 11: Complete the epitendonous stitch across the palmar surface of the repair by using interrupted stitches.
Take the repaired tendon through 5 or 6 excursions to ensure good motion through the pulleys.

9



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