Arthrex Notes – Flashcards
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How many patents are pending?
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1,100
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As of AATC there have been how many product innovations?
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10,826
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Arthrex does all orthopedics except for?
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Spine
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The first instruments made by reinhold were:
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The biter, Grasper, legholder, aiming guide, and cannulas
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FY17---->
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2.27B
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how many studies a year in a lab?
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80
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what percentage of products are manufactured in the USA?
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95%
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We control the product from ___________ to ____________
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infancy to packaging
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What is pumped into the product? What is the only bi-product?
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Ethelyne Oxide, Steam
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Where are all of the hand instruments from?
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Walnut, California
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shipping over ______ units to ___________ countries
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700K, 100
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How many loaners per year go out from ALC?
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14,000
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What are the expectations of a technology specialist? Why?
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To educate, challenge, and inspire Why? -differentiate from competitors -adapt the growing complexity -change perceptions -align our solutions w/ customer needs
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what are you from 0-6 months
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Rep
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what are you from 6-12 months
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Specialist
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what are you from 24+ months
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Consultant
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Product Prioritization
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-55% (SL+Kits, PL, Biceps repair) Shoulder -59% (TR, Screw, All disposables) Knee -48% (Anchors, Ankle Fx/TR, Tenodesis) Dex -63%(Blood, Pre-const. grafts, Aflex) Bio -86%( pump tubing, shaver, synergy) Capital -72% (Univers + Apex, Revers, Unipfi) Arthroplasty
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The top 4 revenue producing products account for over ____% of total sales?
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58%
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80% of quota is
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shoulder, dex, knee/hip
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Soft tissue company
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-34% shoulder -75% knee/hip -53% Dex -43% biologics -78% arthroplasty
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Rev influencers of tomorrow
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-1 Bio 2011=7%of total sales -2. Synergy 2016=15% of total sales -3. Arthroplasty 2017= 23% of total sales
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Expectations
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1. Know your products/procedures 2. Arthrex History and story 3. Build relationships w/ surgeons and staff 4. Schedule and participate in local and offsite labs 5. Learn the customer engagement (selling) process 6. Pick a product that you can personally grow 7. TC program participation 8. Incorporate sales tools and resources 9. Set short and long term goals 10. Teamwork- be a team player
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We sell ____, not _______
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procedures, products
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How many staff members for Med-Ed?
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30
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How many in Med ed?
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12K
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How many Arthrobox units sold so far?
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400
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AGU benefits and advantages
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-less than 10 mins, every topic -400 clinical videos
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Impact of the AGU
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-training for new hires -review for surgical courses -videos for pre-course trainings -videos for monthly ace tests -topic reviews -personal learning -standardization of ortho knowledge -tremendous cost savings -New Product educational events -better patient care
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Is "why" important?
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-the right thing -relationships -Financial -Get behind the cause
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What are the five P's?
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Proper Presentation Prevents Poor Performance
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Respect your customers _________
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Time
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Planning and Prep
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research your customer, who are you selling to? -how do they define value -current product and technique -personal info -personalty type
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Develop a pre-call plan
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-Clearly define goals and objectives -what products and procedures will you discuss -What questions will you ask -objections -resources you will need
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What else should you do before making a call
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-get organized -prepare a back-up plan -practice/ rehearse the call in advance
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Building Trust and Rapport
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-have social skills -make them comfortable and get them talking -be 100% engaged -don't forget the staff
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Understanding customer needs
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-Uncover their needs don't assume them -plan and ask specific, open-ended probing questions. -paraphrase all points -identify dominant wants, needs, and challenges -don't leave until they acknowledge the need and then agree to explore solutions.
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presenting value based solutions
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- uniquely -address, articulate, differentiate
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Why are objections a good thing?
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It shows they are interested
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3 keys to overcoming objections
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-do your homework -don't allow objections to become argumentative -identify -> isolate specific objections
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Reinhold started Arthrex how long ago?
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35 years ago
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FiberWire was the...?
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First high strength suture on the market
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Which #'s of FW do we offer?
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5 2 1 0 2-0 3-0 4-0
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AR number of suture tape
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AR-7500
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load Suture Tape at ____mm displacement
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3mm
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Instead of being round the #2 suture is _______
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braided
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What is Fiber Tape?
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-#2 FW with a 2mm over-braid -30% more resistant -200% larger footprint -blue, tiger, blue collagen -tapers to #2 FW
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What are the features of Labral Tape?
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-37% more resistant -1.5mm coreless
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Fiber Wire Cart
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-highlight of the portfolio -96 boxes of suture -part of a promotion
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Gemini Cannula
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-Instability (joint work) -has its own switching stick -6572
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Suture Lasso Quickpass and SD
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-1.8mm tip
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Suture Snare
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-3 thumb positions
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Fastpass Scorpion SL
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-Solid front jaw helps avoid previously passed sutures -multifunctional -easy onestep suture loading -fits down 6mm cannula -16mm grasp -13995N
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What percent of the shoulder anchor market share do we have?
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59%
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What percent BC?
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75%
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70%
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Knotless
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We are the largest ________ supplier
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anchor
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SLAP tears are giving way to ___________
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biceps tenodesis
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______% of instability anchors used in 2015 were knotless
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50%
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Link is a good alternative to
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LabralTape
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LabralTape #2 has 63% higher
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tensile strength
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With FiberLink tension doesn't increase when
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impacting
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FiberLink can tension from malleting if
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- anchor isn't touching the inserter -eyelet isn't at the bottom of the hole -laser line isn't buried
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1 perc kit for every ______
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six cases
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Sales conversations should move from talking about _________ & ___________ to more big picture stuff
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features and benefits
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Arthrex began by championing __________
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Arthroscopy
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Shoulder products are sometimes expensive so we need to compete on _____________
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story
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Who developed the first suture anchor?
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Mitek
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We always address the big problems with ___________
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RCR
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We were the first to vent ______________
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Anchors
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___________ should be used when there is poor tissue quality
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Aflex
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Shoulder Anchor Facts
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-$396 millions in shoulder SA's - makes up 62% of all shoulder revenue -70% knotless
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Corkscrew facts
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-legacy technology -3.5, 5.0, 6.5 w/ or w/o needles -Titanium and Bio (PLDLA)
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FT and Internal Driver facts
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-better fixation -higher insertion torque -rarely require tapping -all competitors have an option -bc, peek, bio, titanium -4.5 5.5 6.5 -triple loaded, blue, white, tiger -needles, needle punch, tiger tail
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Ar-1927BC facts
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-85/15 -suture eyelet in 5.5 and 6.5 double loaded - material eyelet- 4.5 and triple loaded - 4.7 massively vented with tape -3 loaded
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A double loaded SL is a ___________
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CL
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Legal Dispute- KFX only impacts __________________
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2 row bridging repairs with knotless lateral anchors not single row cuff or labral constructs
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5 steps of lateral row tensioning
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1. eyelet to the edge of the socket 2. remove slack 3. apply tensioning 4. advance driver into the socket until the anchor body contacts bone 5. check tissue tension
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Average operating time for knotless vs knotted
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knotless= 70 min knotted= 89 min there is a 19 minute time difference on average (at $62 a minute for OR time this could save $1200 worth of time) -usually 125 cases per year so in total this could save the doctor 40 hours a year worth of time.
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How much does a minute of OR time cost
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$62
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Notes on Subscap wet demonstration
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-largest cuff muscle -inserts on the lesser tuberosity - the attachment is thinner as you go down -35% of the time a supra/infra is torn the subscap can be torn. ( used to be a lower percentage) -mobile biceps->torn subscap -medially from anterior scapula to lesser tuberosity
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Distance between the tip of coracoid and humeral head is
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8-11 mm
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need to debride to _____________
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rotator interval thorougly
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Comma tissue------->
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vertical tissue as part of entive* anterior sling. It keeps the biceps in place and attaches to the subscap.
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length tendon relationship---->
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where the tendon needs to go to bone
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ASC cannula over _________
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biceps
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establish a plane w/ a(n) _____________ in between MGHC and subscap.
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elevator
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axillary nerve goes ______________ subscap
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under
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you can medialize the subscap 5-7mm and not affect the __________ of the shoulder
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biomechanics
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Keys to successful closing
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-use close ended questions to ask for a commitment that moves toward your preplanned objective -these questions ask for a clear call to action w/ defined expectations on what you are asking the customer to do. -converting customers is often a multistep process that is made up of incremental closes along the way
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what to do after gaining commitment
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-ask for a few cases -bring two reps to be able to give surgeon 100% -inservice -approve it/eliminate road blocks -change the reference card -get it stocked -follow up on the patient progress -cut the cord
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Fiber Tak double row notes
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-for docs who do double row now with soft anchors medially -labral tape fixed to sheath-> does not slide + tiger tape that does slide -down to lateral SL's -need 3 medially to have equivalent strength to SB bc labral tape instead of fiber tape
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Fiber Tak RC notes
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-2+3 loaded w/ sliding suture tapes
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SCR Notes
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-over 5,500 cases per year -early/mid results are promising -widespread acceptance -great opportunity to educate
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SCR Traditional
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-debridement -partial repair -biceps tenotomy -latissimus dorsi transfer -allo "bridging" techniques -reverse arthroplasty
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What procedure is biologic and joint preserving?
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- SCR
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SCR reduces ___________
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- superior translation, centering the humeral head onto the glenoid allowing the deltoid and the other shoulder muscles to function better
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Aflex notes
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-Sterile -3 year shelf life -rapid revascularization -ready to use -97% dna removal -strong -new 3mm thickness -facia latae= 180N
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Aflex= ________N
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550
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how many Aflex sold
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5700
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Aflex Review
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-Human Skin: made of 3 layers (epidermis, dermis, hypodermis) -2 layers (papillary and reticular) -harvested with dermatome from the back or thigh
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What is decellularization?
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removal of donor cells, the goal is for the patient's body to recognize the graft as native
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What is left behind after decellularization?
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- A matrix to be remodeled. Think of it as an empty home.
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Matracell process notes
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- (LifeNet) -over 97% of DNA is removed -use mild detergents to clean and remove cells -rinsed to remove residuals -glycerol and saline to preserve and allow room temperature storage -treated with low dose gamma radiation -high temps= fast moving molecules=break down of structure -no prep time
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Graft Jacket notes
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-30 min to prep - refrigerated -dehydrated -not sterile
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Graft Jacket pearls
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-1 minute saline rinse -shiny side down -rub blood on it to see if it absorbs -59-86 degrees F
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Value based selling
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1. Value Migration (change over time) 2. Value is position-specific -looks different to each party involved 3. Product features have no inherent value -product benefits do
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what values do we offer in orthopedic surgery?
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1. Reducing waste and increasing efficiency 2. Shifts primary focus from pure cost reduction to decreased costs and improving outcomes 3. Measuring and reporting outcomes 4. Restructuring with musculoskeletal care. (patients will gravitate to those with better outcomes) 5. The future is patient focused care "bundled care"
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What values do you provide?
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-Expert in changing technology -Case support -Team model (big deal for account support) -No-charge instrumentation -Consignment support -Med Ed opportunities -Funding support -Referrals -Networking
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long head of the proximal biceps
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- tuberosity of the radius and facia of the forearm -flexes and supinates the forearm
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Proximal biceps- Pectoral Major
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-origin: sternal half of the clavicle, sternum, ribs -60-80mm groove length
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Smokers are _______ times more at risk for tendon rupture
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7
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_______ tears are the #1 pathology w/ biceps
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Subscap
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Proximal biceps products
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- sales are up to $60m -65% are button sales -Tension slide can be used with all buttons -advantages: strongest fixation with buttons, least displacement with the screw, may lead to earlier recovery
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Biceps PIN notes
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-max supination - aim drill 30 degrees over ulna -avoid over retraction on the radial side
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Knotless distal biceps repair notes
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-KTR attached to a biceps button -3.7 mm hole -require fibertag -focus on ziploop users -Top of groove is a closed eyelet -bottom of groove is a forktip
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Pilot headed reamers feature a built in guide for ____________
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one step drilling
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Top of the groove notes
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-easy to find -LT relationship -can incorporate into RC repair -closed eyelet
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AC joint reconstruction and Clavicle FX
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-TR -Twin tail TR -DogBone -Graftrope -ACCR
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AC tips/pearls
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-drill close to the base of the scapula -clean the base of the coracoid -70 degree scope
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Dimensions for DogBone
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10mm long, 8mm wide -wide ears help distribute force evenly
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Single tape is just as good as the _________________
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native ligament
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AC kit saves _________
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15 minutes per case
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(flexible obturator AR-2275) Medial limb goes posterior to act as __________, Lateral goes anterior to act as ____________
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Conoid, trapezoid
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Knotless AC repair
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-2 ktr preassembled - white and black/white -insert protect sutures -3mm cannulated drill
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Clav plate
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-incorporate coracoid fixation in the plate -suture eyelets for cerclaging fragments -DX screws, 2.7 and 3.5 cortical and locking
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Coracoid fixation
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-Additional and backup fixation for distal clavicle fx -type 11B fx -poor bone quality -additional fixation -knotless coracoid fixation -1000 N ultimate load
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Hip Arthroscopy
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-Leunig and Gonz did PAOs and then saw lesions and deformities -Open procedures for FAI had high morbidity rates -Hip is a constrained joint, requires specialized instruments. -steep learning curve
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Bony landmarks for Hip Arthroscopy
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-iliac crest -anterior superior iliac spine -Greater trochanter
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What is vector?
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A force having direction as well as magnitude
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What is an AL (hip arthroscopy)
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-blind portal -fluero guidance -perc kit -1cm ant to sup edge of the GT
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What is PL (hip arthroscopy)
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-1cm post to most sup of GT
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MAP (hip arthroscopy)
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-made under dir viz -approximately 45 degree angle int and med to AL
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Anterior (AP) (hip arthroscopy)
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-rarely used -intersection of inf ASIS and ant GT line -can be aided by the portal access guide which references off the scope
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DALA
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even flatter access to rim
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FAI
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Cam/Pincer
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Cam
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Pistol grip deformity
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Hip product facts
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-2016 = 158k arthroscopes -16.3% CAGR -14% growth in hip sales FY11 -12.4% growth FY16
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(Hip) Sales Opp per case
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-Diagostic: $1100-$1600 -With repair: $2100-$2800
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(Hip) What are the 2 principle components?
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-Central -Peripheral
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What should we minimize traction down to?
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1 hour or less
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Blunt Geometry on Cannula
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-Slightly longer than SN -Reusable, not PEEK like Stryker and cost effective
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notes on capsule cut blades
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-double radius -high grade stainless steel -monoblock -detachable handle option -bends before it breaks -cuts better than the samuri
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What is the cause of arthritis in young patients
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FAI
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Alpha angle for CAM
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50 is defect
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Labral and suture tape pull out
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#1--------123N #2--------136N L Tape----174N
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(Gluteus Medius Repair) Greater Trochanteric Pain Syndrome
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1. Troch burs 2. Glut tend tear 3. Snap Hip
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Gluteus Medius Repair notes
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-R cuff of the hip -Medius, Maximus, Minimus
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(Gluteus Medius Repair) 4 conversation starters
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1. Access- Capsulatory: (safe, mobile, biceps-meniscus) 2.Hip Labral Scorpion: (small hole, fast pass, atraumatic) 3. Capsule Close 4. Trim-it: (cannula, polyvinyl, atraumatic)
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What is SOS
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-the first global registry in orthopedics -specialized registry an a clinical data registry -able to participate with other health programs -53,000 patients and 6000 physicians
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QPP
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-APM's -MIP's -sports medicine is not as much medicare -public and private players
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QPP: MIPS
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1. Quality 60% performance measures PRO's 2. Improvement activities (engagement of patients, outcomes graphs and surveys) 3. Advanced patient care 4. Costs
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Comprehensive Care for Joint Replacement
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-Bundled payment model -67 locations
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What are the Ortho sub specialties?
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1. shoulder and elbow 2. knee 3. hip 4. DEX 5.Spine
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Graftlink benefits
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-strong and adjustable -longer graft diameter -simplified pacing -fixation in any degree - re-tensioning
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TR notes
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-eliminates math and graft in socket -60mm (can lengthen it) -versatile -RT
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How does TR work?
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-Chinese finger trap -two loops interlinked -90 degree bent buckle -one piece of suture
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Graft-pro notes
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-posterior mini hammy graft harvest -hamstring donor site delivery tube (ar-1280-01)
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BC IS
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-2nd largest rev generator in knee and hip ($23m) -to PlDLA 30 Biphasic Calcium Phosphate Ceramic (goes away in about 3 years faster than PLIA, no crystalline byproducts
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Rate of breakdown for BC
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PGA>PDLG> PLGA>PLDLA>PLLA
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Osteoblast poliferation
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-Arthrex--> 1200 -Milagro--> 800 -statistically more osteoblasts proliferated on surface of the Arthrex Biocomposite material than Milagro. -New bone growth at 26 weeks
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In 2017 Arthrex is coming out with a ____mm screw, wider threads
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20
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Because BC screws drill out like bone there is no need to ______ your patient
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2 stage
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1996cd-1 is
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ratcheting -you should knotch screw to get it started -keep screw inline with tunnel
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ACL notes
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-critical for internal rotational stability -105 papers written on ACL since 2013 -15%-20% of ACL patients need augment -AM bundle (A/P translation) -PL bundle (rotation) -no advantage with double bundle ACL -positive pivot shift has been shown to detect ACL lesions in 98% of cases
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Segond FX notes
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-1% of ACL cases -Distal insertion point of ACL -grade 3 pivot shift -revised ACL reconstruction -chronic ACL deficiency -High risk (female, hyper extension, soccer, field hockey)
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Meniscus repair solutions
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-Meniscus pain is the most common indication for knee surgery -Medial (more common than lat, older = degen tears) -Cateral (younger pop, more common in acute)
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S Cinch benefits
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-smaller implants -less trauma -ergonomic -one handed operation -better suture-> less cut through -stronger delivery needle
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Knee scorpion
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-low profile -fastpass technology -0 + 2-0 FW -reusable -disposable needle -3mm in height -all inside -all suture -suture lasso needle
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Meniscal Pathology Instrumentation Set
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-new guide hooks on back of tibia and helps you pick offset -like AC joint guide -2.7mm grasper
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Handheld Arthroscopy Instruments
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-new part of knee number -we are market leader -not a cyclical sale
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how to succeed
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1. identify your audience (OR director, SPD, Surgeon, Etc.) 2. Focused team member (repetition) 3. Know your products 4. Know your competition
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Mega Biter 5.5 m width
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-up curve -straight -low pro -smooth -L and R
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We have the best warranty, we don't resharpen we ________
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replace
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Allo Graftlink benefits and features
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-reduced OR time -No donor site morbidity -consistency -Sterile
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Versa Graft benefits and features
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-Preassembled allo tendon for use wth the lateral ankle recon implant system -over 28k ankle instability -semi T> gracilis> pero longus. tibialis
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DBM notes
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-Stimublast -70% of cortical bone is mineral content in DBM they are washed away by acid wash
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What is left after DBM wash?
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- collagen and proteins -matrix
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Osteoconductivity
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- type 2 collagen matrix provides a scaffold -osteoconduction is the provision of a scaffold for the growth of new bone
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How does bone grow?
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-slow -osteobasts cannot jump across a void but slowly full from outside in -DBM bridges this gap
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Reverse Phase Medium
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-DBM is like sawdust after the demineralization process -the RPM allows DBM to be more viscous at body temp
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features of our DBM
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-terminal stability -RPM (better handling) -every lot tested -pre mixed -stored at room temp -pricing -ability to mix -1 to 2 years shelf life
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turn on shaver before the _______
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Dual Wave
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Shaver system notes
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-made in USA -2010 = $208M -2016= $283M
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Top 7 AR-8400
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-EX -BE -DS -DC -BC -TD -CDS
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Who was the first to vent anchors
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Arthrex
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Aflex for poor tissue quality
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-don't want to use as bridge because you are not restoring anatomy
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Suture Anchor notes
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-$396m in Shoulder SA -62% of all Shoulder rev
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Corkscrew notes
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-Legacy technology -most affordable -3.5, 5.0, 6.5 with or without needles
