Recorded at: ESSKA Congress Covidiens system is in essence a throwback to the all-suture, twin needle Acufex device, the company clearly nailing its colours to the mast by avoiding the hard plastic implants that have characterised many systems in the interim. house for sale wedgewood ave riverview, nb; prestonwood country club wedding cost; can you use robinhood and webull at the same time; Call For Best Price 888-502-2348, Acufex Meniscal Repair Flexible Fifteen Set, OB35 13.6m ASGB coachbuilt triple expanding trailer. The screw can be viewed through the cannula window. A complete system for meniscal root repair includes the meniscal root marking hooks, the Knee Scorpion suture passer, and meniscal root repair kit with PEEK SwiveLock anchor. 24,38 Though at first glance this may seem like a very high failure rate, it is worth noticing more than half of these studies had a failure rate . A running program (treadmill) is employed at about 4 months. Both the meniscus arrows and the T-fix devices showed a trend of increasing failure rate with longer follow-up (Figs 1 and 2). When the original FAST-FIX Meniscal Repair System was introduced in 2001, it set the benchmark for non-invasive, all-inside repairs. Onsite or virtual inspection available. 34. Bid today on 246 lots of medical equipment. 100 for an appointment. This device comes in 6 and 8 mm sizes with either a 27- or 34-degree delivery needle (Fig. Arthroscopy 2001;17:34, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window). Screws may be advanced or removed if desired. Operative Arthroscopy, 2nd ed. polymer bars and a zero polyester nonabsorbable suture that has a pre-tied sliding knot that can be tensioned with arthroscopic assistance. Use the needle catcher to guide needles away from neurovascular structures. Spindler KP, McCarty EC, Warren TA, Devin C, Connor JT. All-inside techniques obviate the need for additional incisions and decrease the risk to neurovascular structures. This releases the first suture retention bar on the outside edge of the meniscus. Asik M, Sen C, Erginsu M. Arthroscopic meniscal repair using T-fix. In tears where the vascularity is not readily obvious, clinical judgment must be made as to the appropriateness of the tear for repair. Venkatachalam S, Godsiff SP, Harding ML. Innovasive 7223 Orthopedic Meniscal Repair System Gray Left Up Cannula. Amperage In this video, Dr Duncan Meuffels discusses the all-inside meniscal repair technique. This activates the spring mechanism. Anteroposterior, lateral, Merchants, and intercondylar notch radiographs should be performed to rule out other joint derangements. view more, Acufex - 12609 - Meniscal Stitcher Thimble 13. 12. Thanks to its preloaded implants, pre-tied sliding knot, and innovative pusher/cutter device, this innovative system lets you deploy two implants vertically or horizontally on either side of the meniscus, tighten the suture, and trim the excess. Accessibility Covidien has announced the launch of the AS Meniscal Repair Device which the company says enables orthopedic surgeons to perform all-inside, minimally invasive arthroscopic surgery to repair a torn meniscus in the knee using what it calls the gold standard all-suture method of fixation. To more fully evaluate a tear of the superior surface of the medial meniscus, a posteromedial portal or a 70-degree arthroscope placed through the intercondylar notch can be used. Arthroscopy 1999;15:770772, 17 Anderson K, Marx R, Hannafin J, Warren R. Chondral injury following meniscal repair with biodegradable arrow. Loose repair devices may detach from meniscal tissue. Download scientific diagram | The Meniscal Viper Repair system. Figure 3-5 (A) The meniscus is secured with the fixation teeth of the insertion sheath and positioned for fixation. Loose devices should be removed and replaced. Next, the gold trigger is moved forward to advance the second implant into the proper position on the delivery system needle for placement of the second bar. We performed an evidence based review of the outcomes of all-inside meniscus repair devices. Linvatec Zone Specific II Meniscal Repair System. This device is developed for all-inside meniscal suture. The distance of the tissue penetration of a . Add 3 to 5 mm to that measurement plus 1 mm for capsule penetration. Use the ergonomic handle to advance and retract 2-0 SutureTape with meniscal repair needles in 1 cm increments. A torn meniscus is one of the most common injuries to the knee with reportedly more than 840,000 injury-related procedures performed annually in the United States, albeit most of these will be meniscectomies rather than repairs. Using the criteria above, this process of exclusion yielded 30 manuscripts. Gill SS, Diduch DR. Outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction. (From Cooper D, Arnoczky S, Warren R. Meniscal repair. On the contrary, Koukoulias et al24 reported a 5% failure rate with the same device at 73 months. Repair of meniscus tears in ACL-deficient knees has a much higher failure rate than patients undergoing meniscal repair with stable knees. 22. ?We will notify you as soon as 10. MRI does not accurately predict those tears that will be amenable to repair. Midterm results of meniscal repair using the BioStinger meniscal repair device. Before The screw comes mounted on a cartridge. 72201252 ACUFEX DIRECTOR Anatomic ACL Guide System, 72202437 Anatomic ACL Double Bundle Instrument Tray. Barber FA, Herbert MA. We are BMT Medical Devices Pvt Ltd. Miscellaneous Surgical Orthopedic Instruments Acufex - Depuy - Mitek. Ellermann A, Siebold R, Buelow JU, Sobau C. Clinical evaluation of meniscus repair with a bioabsorbable arrow: a 2- to 3-year follow-up study. Complete knotless fixation of the sutures with the 4.75 mm PEEK SwiveLock anchor. From this initial search we were able to narrow our search using the following MESH headings: (meniscus) AND (arrow OR t-fix OR fasT-fix OR screw OR biostinger OR staple OR mitek OR biostinger OR tack). SN-L293. Tekyard Medical closeout auctions take place on DOTmed.com. Clinical Orthopaedics and Related Research455:134-141, February 2007. Endoscopic meniscus repair using the T-Fix suture device (Acufex Microsurgical, Inc, Mansfield, MA) allows ease of suture placement for meniscus stability without the problems associated with . - We are temporarily unable to ship medical products to the state of California. Acufex - 013382 - MPN: 013382 The entire superior surface of the lateral meniscus is typically visible. Warranty Moatshe G, Cinque ME, Godin JA, Vap AR, Chahla J, LaPrade RF. Figure 3-2 Stepwise progression of FasT-Fix device implementation. Potential market for new meniscus repair strategies: evaluation of the MOON cohort. 36. Acufex (3) GMDN Term. In his presentation he covers the biomechanics of the meniscus, indications for this technique and meniscal repair, complications that may occur and how to avoid them, technique and he presents outcome data from this technique. Enter your search keyword. The sheath is loaded through the cannula, and the central fragment of the meniscus tear is secured with the fixation teeth at the tip. Bohnsack M, Borner C, Schmolke S, Moller H, Wirth CJ, Ruhmann O. acufex meniscal repair system. Dimensions l x w x h (inches): 54 x 16 x 78 | Weight (lb): 620 | Showroom aisle: 004 | Showroom Commercial Body Solid EXM 3000LPS Multi Gym FDA And CE Nod For AliveCors Heart Monitor For iPhone, First Green Light For Miracors Picso Coronary Sinus Occlusion System As Study Says Its Safe. The AS Meniscal Repair Device has improved my operative efficiency by delivering a high level of reliability and success., Covidien is setting new standards for consistency and reliability with this innovative, new design, said Peter Marshall, Director of R&D, Covidien. Request PDF | Proximity of the Neurovascular Bundle During Posterior-Lateral Meniscal Repair: A Comparison of the Transpatellar, Anteromedial, and Anterolateral Portals | Purpose: To compare the . Unable to load your collection due to an error, Unable to load your delegates due to an error. Length Of Electrode Lead Trailer Option, Hyd/Air/Elect to Rear w/Air Cushion 2023 Machinio Corp., a subsidiary of Liquidity Services, Inc. [Expired] Smith & Nephew Fast-Fix AB Straight Needle, [Expired] Smith & Nephew Ultra Fast Fix AB Straight Needle, [Expired] Smith & Nephew Ultra Fast Fix AB Curved Needle Delivery,Split, Body Solid EXM3000LPS Home Gym -2 Stack Multi Gym. Power Supply Voltage Knee flexion and weight bearing are advanced as tolerated after 4 weeks. June 16, 2022; Posted by waggoner ranch map NBH (3) Device Packaged As Sterile Knee flexion should not exceed 90 degrees during the first 4 weeks after meniscal repair. Property of and Proprietary to DOTmed.com, Inc. Ramappa AJ, Chen A, Hertz B, Wexler M, Grimaldi Bournissaint L, DeAngelis JP, Nazarian A. CLAIMS . Failure strength of new meniscus repair arrow technique: biomechanical comparison with horizontal suture. Please email at auctions@tekyard.com for an appointment. Street No 8, Himayat Nagar, Hyderabad - 500029. 1 Select the needle most appropriate for the tear you are repairing. Arthroscopy 2001;17:7780, 16 Menche D, Phillips G, Pitman M, Steiner G. Inflammatory foreign body reaction to an arthroscopic bioabsorbable meniscal arrow repair. Our e-learning platform contains high resolution images and a certified CME of the Meniscal repair using Smith and Nephew fast-fix 360 system and knee arthroscopy surgical procedure. Overall meniscal repair Meniscal root repair only Projected 10-year costs were 33% less ($31,528-$22,590) for meniscal root repair compared to meniscectomy.56 Select the appropriate-size device and delivery needle. Some error has occurred while processing your request. Injury of the anterior cruciate ligament (ACL) can lead to knee instability associated with damage to other knee structures and the increased risk of degenerative joint disease.This has led to the frequent use of intra-articular tissue grafts for ACL reconstruction tissue grafts for ACL reconstruction Advance the screw until the driver knob touches the cannula and the screw is flush with the meniscus surface. It also features clear, laser-etched depth markings on the specially coated needles, allowing for precision in depth of penetration. Remove the obturator and grab the central portion of the tear with the top teeth of the cannula or stilt on the straight cannula. Complete radial tears are typically not suitable for repair because the circumferential collagen bundles of the meniscus have been disrupted and there is little hope of functional restoration. We also found no notable differences in the reported failure rates of various devices with the length of fol-lowup. 24 ), Pin/Wire Racks ( Find many great new & used options and get the best deals for Acufex Meniscal Stitcher at the best online prices at eBay! Koukoulias N, Papastergiou S, Kazakos K, Poulios G, Parisis K. Clinical results of meniscus repair with the meniscus arrow: a 4- to 8-year follow-up study. Arthrex offers two meniscus root marking hooks based on surgeon preference. Endoscopic meniscus repair using the T-Fix suture device (Acufex Microsurgical, Inc, Mansfield, MA) allows ease of suture placement for meniscus stability without the problems associated with ancillary incisions such as neurovascular compromise. Unsatisfactory clinical results of meniscal repair using the meniscus arrow. According to Warrens zone system for the classification of meniscal tears. Clin Sports Med 1991;10:529547. Background:The cross-sectional area (CSA) of the anterior cruciate ligament (ACL) and reconstructed graft has direct implications on its strength and knee function. From basic science and clinical outcome studies, a tear in the red-red zone has higher healing potential than a tear in the white-white zone because of the limited vascularity in this area.12,34 All of these variables are not accounted for when comparing different clinical studies. Clinical evaluations of these devices consisted largely of case series. Tears within this zone are known as red-on-red tears, where both sides of the tear are vascular. Central, avascular meniscus tears have poor prognosis for healing. Data is temporarily unavailable. Shop by category. We are distributor of medical Devices. (From Mitek Meniscal Repair System Instructional Brochure, 2000. Attach the sheath to the front of the Dart gun handle; pull back the T section until a click is heard. For tears with a significant posterior component, place the first Arrow in the posterior portion of the tear and the second Arrow in the center. Pagnani MJ, Cooper DE, Warren RF. The Dart system comes with a flexible probe with indexed measuring lines to help determine proper Dart size. Device failure for all of the all-inside meniscus repair devices ranged from 0% to 43.5%28,38 (Table 2). Arthroscopic techniques include inside-out repairs, outside-in repairs, and all-inside repairs. Arthroscopy. The FasT-Fix (Smith and Nephew, Andover, MA) is a suture-based repair device that is composed of two 5 mm polymer bars and a zero polyester nonabsorbable suture that has a pre-tied sliding knot that can be tensioned with arthroscopic assistance. Open meniscal repair was done by to close the mouth of surgically open intrameniscal cyst with the help of 2.0 FiberWire horizontal sutures were taken by inside out technique and meniscus repair was done. The Mitek meniscus fastener is a double T-shaped device (polypropylene or PLA) that is delivered via a loaded needle and gun system. 2017 Nov;45(13):3104-3110. doi: 10.1177/0363546517719244. S/N We are sorry but you must be a DOTmed user to save searches. Branch offices at Vijayawada, Vizag, and Tirupathi for effective coverage of territory Our principals are smith & nephew, Adler, Eucare, DOU, TriCell Bio, Star, etc. Has some marks. You can drill independent and diverging bone tunnels on the femoral and tibial side of the knee joint with consistent, reproducible separation. It also serves to stop small cartilage fragments from flaking off are causing a reactive effusion. Probes corresponding to cannulae may be used to determine proper cannula selection. For application, measure the distance across the meniscus tear. FOIA Coblation is a technique that uses radio-frequency to create highly-energised particular vibration to stabilise articular cartilage and prevent fissuring of the joint surface. We also found no substantial differences in failure rates with length of followup. hellcat vs p938; simple small front yard landscaping ideas low maintenance; jenny's super stretchy bind off in the round; senate democratic media center Comparable Outcomes After Bucket-Handle Meniscal Repair and Vertical Meniscal Repair Can Be Achieved at a Minimum 2 Years' Follow-up. Zone 0 is the meniscosynovial junction. 35. Clin Sports Med 1991;10:529547, 2 DeHaven K. Meniscus repair. And the devices used to fix these repairable tears continue to evolve. Open techniques are infrequently used because arthroscopic approaches to meniscus repair have reduced the risks associated with open surgery, led to shorter operating times, and enabled surgeons to repair portions of the meniscus which were difficult to reach with an open approach. Formal physical therapy is employed for about 12 weeks after surgery. OMNISPAN System Surgical Technique DePuy Synthes Mitek Sports Medicine 3 SURGICAL TECHNIQUE Meniscal Repair System The OMNISPAN Meniscal Repair System consists of a single-patient, multi-use applier and needles with pre-loaded implants in 0 (straight), 12, and 27 options. Using feedback from our surgeon customers, we designed the AS Meniscal Repair Device to deliver optimal performance to address one of the fastest-growing orthopedic procedures performed today.. For all other tears place the first Arrow in the center of the tear initially. Quantity Asik M, Sener N. Failure strength of repair devices versus meniscus suturing techniques. Vertical tears, bucket handle tears, flap tears, and horizontal tears can be approached using a temporary "anchor stitch" to stabilize the meniscus before T-Fix repair. The site is secure. Patient outcomes following T-Fix meniscal repair and a modifiable, progressive rehabilitation program, a retrospective study. Oberlander MA, Chisar MA. tom brady net worth 2021 forbes; personalised celebrity messages uk; environmental perspective of covid 19; what to do instead of douching; Repair of meniscal tears with the absorbable Clearfix screw: results after 1-3 years. Loose fragments and frayed edges should be debrided and smoothed. 2009 Jul;22(3):180-6. doi: 10.1055/s-0030-1247746. The concave, curved retractor efficiently retracts tissue and directs the needles for easy retrieval. With an all-suture method of fixation, the AS Meniscal Repair Device eliminates any migration risk of broken tacks or anchors which could cause damage inside the knee and may lead to increased operative time during removal. Arthroscopic meniscal repair with use of the outside-in technique. Limited weight bearing, with two crutches, is employed over the first 4 weeks. Institution: The Worcestershire Acute NHS Trusts, Uk. vladislav doronin ekaterina doronina. Subscribe to get full access to this operation and the extensive Knee Surgery Atlas. Complex tears, degenerative tears, or tears with multiple cleavage planes usually do not heal well, and repair does not typically restore the load-bearing characteristics of the meniscus. Meniscal root avulsions are a challenging injury causing meniscal extrusion and loss of hoop stress distribution, which can lead to the development of knee arthritis.1 Securing the meniscus in a small bone socket has proven to be an effective means to restore hoop stresses and improve outcomes.2 The FlipCutter II reamer and meniscal root marking hook allow for a minimally invasive RetroConstruction repair technique that helps preserve bone while securely fixing meniscal tissue. Use the ergonomic handle to advance and retract 2-0 SutureTape with meniscal repair needles in 1 cm increments. The stability of the repaired meniscus should be confirmed after placement of any meniscal repair device using a probe. Meniscal Root Repair ; Ear, Nose and Throat; Orthopaedic Reconstruction; Robotics and Digital Surgery; . Hantes ME, Zachos VC, Varitimidis SE, Dailiana ZH, Karachalios T, Malizos KN. 2012 Jun;20(2):101-5. doi: 10.1097/JSA.0b013e3182515d79. Albrecht-Olsen P, Kristensen G, Burgaard P, Joergensen U, Toerholm C. The arrow versus horizontal suture in arthroscopic meniscus repair: a prospective randomized study with arthroscopic evaluation. Used ACUFEX Meniscal Repair Kit Acufex Meniscal Repair Kit With Sterilization Tray Surgical Instruments For Sale - DOTmed Listing #2335491: Acufex Meniscal Repair Kit With Sterilization Tray Kit . It is ideal for the central posterior horn tears that are difficult using conventional techniques. In: McGinty J, Caspan R, Jackson R, et al., eds. Biodegradable arrows for arthroscopic repair of meniscal tears. Arthroscopy. Published clinical results of meniscal repairs are variable because of different inclusion criteria. 11. The low-profile Knee Scorpion instrument simplifies suture passing in tight recesses of the knee. Based upon our review we cannot make any conclusions regarding which devices have the lowest failure rates. Manufacturer: Body Solid. Catalog Number: 014549/014550. Published studies indicate that meniscal repair results in nearly half (32% vs 57%) the prevalence of long-term OA progression compared to partial meniscectomy. Consequently, the repair of certain types of meniscus tears is theoretically preferable to partial meniscus excision. Repair of tears that are less than 3.9 cm have a much lower failure rate than repairs of larger tears. Designed to freshen the edge of the meniscal tear prior to repair. If the needle tip is just palpated, then use a 13 mm Arrow. The barbed meniscal repair devices available include the Dart (Arthrex, Naples, FL) and the Arrow (Bionix, Blue Bell, PA). Each meniscus is divided into radial thirds represented by the letters A to F. The meniscus is then subdivided into circumferential thirds represented by 1, 2, or 3. Petsche TS, Selesnick H, Rochman A. Arthroscopic meniscus repair with bioabsorbable arrows. 014550. Kind Of Pump For the meniscus arrows, Lee and Diduch27 did report higher failure rates (29%) with the same cohort of patient with longer followups at 79.2 months. (C) Intraoperative photo of the repair device approximating the tear. CE Mark Al-Othman AA. Learn the Meniscal repair using Smith and Nephew fast-fix 360 system and knee arthroscopy surgical technique with step by step instructions on OrthOracle. 13.6m long outside broadcast triple expanding trailer coachbuilt by Allen key SW 6 It has a low profile shaft. 3-6-584/F, Near Sai Baba Temple Lane, Commercial Body Solid EXM 3000LPS Multi Gym Starting at $104/mo with Affirm. Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country. Letters, biomechanical studies, animal studies, in vitro studies, duplicate studies and non-English language papers were excluded. Please enable scripts and reload this page. If the split cannula is used, the curve of the needle must be inserted at a 90-degree angle to the split, The inner fragment of the tear is pierced with the needle and advanced to the depth set by the limiter for horizontal repair or through the outer fragment for vertical repair. This scatter chart shows the trend of increasing failure rates with longer followup for the T-fix device. 9. Sound Level, Db SECTION I: SYMPOSIUM: Evidence-based Medicine in Sports Medicine, Demographic Data for All-inside Devices Included in Systematic Review, Results of Clinical Studies for All-inside Devices Included in Systematic Review. Select the proper-length Arrow for each part of the tear and arrange on the back table before proceeding. Endoscopic meniscus repair using the T-Fix suture device (Acufex Microsurgical, Inc, Mansfield, MA) allows ease of suture placement for meniscus stability without the problems associated with ancillary incisions such as neurovascular compromise. 31. For application, measure the distance across the meniscus tear. 3. Bid today on 82 lots of medical equipment. To cut the tensioning suture, rest the tip of the knot pusher against the knot and pull the gold trigger of the FasT-Fix system. Description. For the meniscus arrow and T-fix device, there is a trend toward higher failure rates with longer followup. Needles are available in two configurations, curved and straight, to meet surgeons diverse repair needs. The decision to proceed with meniscal repair is made following a thorough arthroscopic assessment of the knee joint. Lastly, clinical studies were gathered using a PubMed search and additional information was found through cross-referencing. Body Solid EXM3000LPS Home Gym -2 Stack Multi Gym. Available in two styles: Acufex is a registered trademark of that corporation. With the rising popularity of these new all-inside meniscal repair devices, it is necessary to assess the effectiveness of various all-inside surgical interventions used in the treatment of meniscal tears. Tears can only be repaired if they are not deformed and easily reducible. Epub 2013 Oct 10. If a meniscal repair cannot be adequately achieved using all-inside methods, a suture-based repair should be employed to increase the likelihood of a successful repair. Quinby JS, Golish SR, Hart JA, Diduch DR. All-inside meniscal repair using a new flexible, tensionable device. Place additional Arrows from anterior to posterior to anterior, alternating around the centrally placed Arrow at 5 mm increments, The Arthrex Dart is a flat, flexible, barbed device made of DLDA copolymer PLA-coD and L-lactalide, The Dart uses a delivery gun system. They are designed to approximate the sides of meniscus tears and resist pullout or deformation through mechanical engagement of barbs in the meniscus tissue. Select the cannula that allows the most perpendicular approach to the tear. To assemble the gun, depress the red and silver triggers, and slide the T-handle assembly into the back end of the gun. The failure rates ranged from 0 to 43.5%. 1. vw golf door lock problems. 1991;7(3):297-300. doi:10.1016/0749-8063(91)90131-g, 2. Prospective long-term followup is important to determine the failure rates of all-inside meniscus repair devices. Figure 3-1 The zone system of meniscal tears. Barber FA, Johnson DH, Halbrecht JL. Submit a, ACUFEX 013382 SURETAC and TAG Systems Shoulder Accessory Kit For Sale, ACUFEX 013351 Suretac Surgical Driver For Sale, Access and use of this site is subject to the terms and conditions of our. (B) The red safety trigger is depressed, and then the main trigger is pressed to deliver the dart across the tear. Meniscal repair using the inside-out technique with cross stitch. Given the increased popularity of these new all-inside meniscal repair devices, we performed a systematic review to assess the failure rates of all-inside surgical devices used in the treatment of meniscal tears. Featured: - FIRSTPASS MINI Family of Suture Passers- NOVOSTITCH PRO Meniscal Repair System- FAST-FIX 360 Meniscal Repair SystemIncluded in portfolio image: -. All of the studies, except one1 in this review, have a minimum followup of at least 6 months (Table 2). We did not search EMBASE or other databases. Call For Best Price 888-502-2348. Traumatic tears are more suitable for repair than degenerative type tears. Coblation is a technique that uses radio-frequency to create highly-energised particular vibration to stabilise articular cartilage and prevent fissuring of the joint surface. For more information, please refer to our Privacy Policy. Use the needle catcher to guide needles away from neurovascular structures. 16. Suturing unit, single-use (3) Orthopaedic fixation plate, non-bioabsorbable, sterile (2) Polyolefin suture, multifilament (2) FDA Product Code Name. 3-7A, B). Sold as pictured. New In Box . Common symptoms of meniscus tear include knee pain, catching, locking, giving way, and swelling. Federal government websites often end in .gov or .mil. 27. The end result is a single loop of suture with a clever self-locking knot on the meniscal surface. For Arthroscopic bankart and SLAP lesion repair. Not for use with plastic cannulae. Seventy-seven percent of studies identified were case series; 10% were retrospective, comparative studies; 6.5% were prospective comparative studies and 6.5% were prospective randomized studies (Table 2). Oper Orthop Traumatol. The device with the longest average followup is the meniscus arrow with Lee and Diduch27 reporting an average followup of 79.2 months. Bionx Meniscus Arrow Inserter Such loose body formation may put the intraarticular structures, including the articular cartilage, at risk. This presentation gives a high level of detail about routine knee arthroscopy, using a pump and a 30 degree scope. Patients undergoing concomitant anterior cruciate ligament (ACL) reconstruction and meniscus repair have a higher success rate for meniscal healing as compared with patients with isolated tears. government site. Picture 1 of 6. Figure 3-2 (Continued) (D) Insertion of second implant. The .gov means its official.