More than 500 companies from around the world filled the seemingly never-ending aisles of technical exhibits at the annual American Academy of Orthopaedic Surgeons meeting in New Orleans this year. For outpatient surgery, ACL reconstruction was a hot topic, with 2 companies debuting new tools and techniques for the anatomic approach. Manufacturers also displayed new solutions for everything from intraoperative imaging to patient positioning to fluid management. Here's an overview of some of the highlights of AAOS 2010.

Joint reconstruction & repair
The big trend in ACL reconstruction in recent years has been the shift in technique from a traditional, vertical approach to a more anatomic, lateral location for the femoral tunnel, which is believed to better promote long-term, rotational stability of the knee. The only problem is that the anatomic femoral tunnel is difficult to achieve with much of the existing technology we have for ACL reconstruction, which is why the major manufacturers have been working on creating new instruments tailored to this approach. In recent years, Arthrex and Smith & Nephew have each come out with different systems for anatomic ACL reconstruction (Arthrex's RetroConstruction and Smith & Nephew's Acufex Director Anatomic ACL Guide System), and within the past year, Conmed Linvatec and Stryker unveiled their new solutions, both of which were on display at AAOS. Each system takes a slightly different approach to achieve the same goal.

Conmed Linvatec's new Bullseye Femoral Footprint Guides are used for locating, sizing and drilling anatomic femoral tunnels with a medial portal approach. The angled, oblique face sits flush on the femoral condyle, letting the surgeon see the outline of the tunnel diameter to be drilled and the resulting true oblique insertion of the graft before drilling. The guides are designed to accomplish both anatomic single-bundle and double-bundle ACL reconstructions. The system is priced at $599 per guide, with guides available in 5mm through 11mm sizes, in whole millimeter increments.

Stryker named its new VersiTomic Flexible ACL System after its 2 defining characteristics: versatile and anatomic ACL reconstruction. The system is versatile because it allows trans-tibial or anterior-medial femoral drilling for BTB or soft-tissue ACL reconstruction and can be used with either interference screws or extra-cortical fixation methods. And it's anatomic, Stryker says, because with the VersiTomic Flexible Reaming System, the surgeon can place an anatomically correct femoral tunnel, independent of the tibial tunnel location, without hyper-flexing the knee. The system consists of VersiTomic flexible reamers (featuring a unique puzzle-piece shaft design), flexible guide pin, left and right aimers and footprint awl. Stryker declined to provide pricing information.

In other joint repair news, Smith & Nephew has improved upon its Fast-Fix Meniscal Repair System, adding 360-degree actuation and a spring-action design to give surgeons greater flexibility in deploying implants with either a vertical or horizontal hand motion on either side of the meniscus. In addition, the Fast-Fix 360 ($359) features a stiffer, more low-profile needle shaft and a built-in, adjustable depth limiter. The company also debuted 2 new suture anchors at AAOS: The Bioraptor Knotless Suture Anchor for torn labrum repairs in the hip and shoulder, which is designed to help the surgeon determine the final suture tension and tissue shift after implantation ($375); and the Twinfix Ultra PK Suture Anchor for shoulder rotator cuff repair, which uses a fully threaded design to ease insertion and increase fixation strength ($299).

Fluid management
As a surgeon I don't have to deal with this nearly as much as the other members of the OR team, but I know from the grumbles of our nursing staff that effective fluid management is a problem, particularly during arthroscopy, that just won't go away. Here are the solutions vendors had to offer at AAOS.

You want options? You got 'em with the new 24k Pump from Conmed Linvatec. The 24k ($8,476) can operate as a simple inflow-only pump or an inflow/outflow/shaver suction pump; you can operate it with in-line pressure sensing or with true intra-articular pressure sensing; and you can choose either a pulsing "wave mode" or a continuous "smooth flow" to deliver fluid to the surgical site, depending on the type of procedure. With these options, Conmed Linvatec says the 24k helps provide a clear field of view for the surgeon without the need to manually operate stopcocks or the suction lever on the shaver handpiece, all the while maintaining distention and hemostasis in difficult shoulder, 2-portal or 3-portal knee arthroscopies.

Unlike other self-contained fluid waste suction and collection systems that feature reusable canisters, Cardinal Health's ORwell Fluid Collection and Disposal System has a 20L, single-use, disposable collection disc and liner system, minimizing the potential for cross-contamination between cases and ensuring the system is clean for each and every patient. The disposable disc is easily removed and discarded at the end of the fluid waste disposal process, and no specialized cleaning processes are required between cases — staff can simply place a fresh collection disc into the unit and wheel it back into the OR. Created in collaboration with OR nurses, infection control specialists and other frontline health professionals, this new solution for the safe handling of high-volume surgical fluid waste is designed to meet the needs of today's fast-paced healthcare environment, says Cardinal.

Cannuflow calls its Squid 3-in-1 suction adapter ($19.50) "the missing accessory for fluid management." With it, you can connect up to 3 devices, such as a burr, shaver and radiofrequency wand, to 1 drain hose to control fluid flow from within the sterile field. Cannuflow also featured its new TwoVu ST6-H ($40) scope sheath, which slips over an arthroscope's sheath to provide continuous fluid inflow and outflow during hip arthroscopy.

The latest in imaging, power, positioning & warming

• Aesculap's Acculan 3Ti power tools are built to last. The 2 standout features of these orthopedic handpieces are their sturdy, titanium housing, which helps ensure their longevity, and high-performance non-sterile battery, which the company says doesn't need changing during a regular knee or hip replacement surgery and lasts up to about 400 recharging cycles. The sensitive control unit for each handpiece — essentially a small computer — is housed inside the battery for maximum protection and reliability. Acculan 3Ti is priced at $40,000 for a full standard set of tools, but prices vary depending on custom configurations.
• Allen Medical had versatility in mind when it designed its new Intraoperative Arm Positioner and Universal Head Positioner, both on display at AAOS. The lightweight arm positioner ($4,995), designed for any shoulder procedure in the beach chair position, attaches over the drape and allows smooth, fluid positioning of the arm with complete range of motion. Since patients come in all different shapes and sizes, the benefit of Allen's new Universal Head Positioner ($699) is that it's designed to support each patient's unique anatomy securely and comfortably, providing complete adjustability, versatility and ease of positioning for any size patient undergoing upper extremity procedures in the beach chair position.
• Canon/Virtual Imaging has entered the C-arm market, introducing its RadPRO Mobile C-arm on the show floor at AAOS. The device offers high image quality and flexible configurations designed for prolonged operation. Specifically, the RadPRO's unique dual cooling (it uses both a fan and liquid cooling mechanism) and dual power engineering options you perform longer procedures with confidence knowing your work won't be interrupted by inconvenient disruptions and equipment overheating, says Canon.
• HotDog's latest line of patient warming products includes an Underbody Warming Mattress and a Torso Warming Blanket, plus a Multi-Function Controller that can run multiple warming blankets and the underbody mattress simultaneously. The advantage of this configuration, according to HotDog, is that it requires minimal coverage of the patient's surface area while still achieving results via HotDog's conductive fabric. The company is also touting the infection control benefits of its conductive patient warming solution, suggesting that it eliminates the potential contamination risk posed by forced air warming systems.
• Karl Storz's Vitom 20 Exoscope system aims to improve visualization of the surgical site during mircosurgeries. Mounted outside the body, the Exoscope captures and magnifies an image of the surgical site onto a screen, letting the surgeon perform in a manner similar to endoscopy, looking straight ahead at the screen instead of hunched over his work. Designed to enhance workflow efficiency, visibility and ergonomic functionality, the Vitom 20 can be used either as a complement or as an alternative to other visualization methods during microsurgeries. Karl Storz declined to provide pricing information.