Provided for accurate and reliable soft tissue tensioning and gap balancing for preservation of bone stock, stability and implant positioning for optimum function.

The approach enables maximum visibility of the joint space throughout the procedure for confirmation without excessive on-table and radiographic checks.

Advanced instrumentation

Ligament tensioning technique for optimum tension in the soft tissue envelope with lowest profile construct and minimal bone resection

Intuitive instrument layout for OR efficiency and ease of use

Reduced learning curve with a fully jigged procedure from start to finish and instruments that produce repeatable results.

Soft tissue balancing technique for validation of component positioning, ensuring stability and maximised ROM

Precise alignment and precise preparation instruments for restoration of alignment, stable fixation and protection of tissues including malleoli

1. Flavin et al. Foot Ankle Int. 2013; 34(10): 1340-48.

2. Haddad et al. JBJS-Am. 2007; 89(9): 1899-1905.

3. Coester et al. JBJS-Am. 2001; 83(2): 219-28.

4. Fuchs et al. JBJS-Br. 2003; 85: 994-8.

5. Leardini et al. CORR. 2004; 424: 39-46.

6. Affatato et al. J Biomech. 2007; 40: 1871-76.

7. NJR for England, Wales, Northern Ireland and the Isle of Man. 13th Annual Report. 2016. www.njrcentre.org.uk

8. Ingrosso et al. Gait & Posture. 2009; 30: 132-7.

9. Cenni et al. Clin Biomech. 2013; 28: 79-87.

10. Giannini et al. CORR. 2010; 468(10): 2746-53.

11. Giannini et al. J FootAnkleSurg. 2011; 50: 641-7.

12. Bianchi et al. JBJS-Br. 2012; 94(6): 793-8.

13. NJR Implant Summary Report. August 2016: Summary.Report.AP_Talar_Box.15/08/2016.11:20.

MatOrtho Limited | 13 Mole Business Park | Randalls Road | Leatherhead | Surrey | KT22 7BA | United Kingdom.T: +44 (0)1372 224 200 | info@MatOrtho.com | For more information visit: www.MatOrtho.com

Part No. ML-300-037 L | Issue 3ARTG192629

Product Brochure

Balanced Natural Movement

BOX®

Total Ankle Replacement

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M

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TibialComponent

MeniscalComponent

TalarComponent

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5mm6mm7mm8mm

BOX® Total Ankle Replacement

Implant and sizing options

Designed for longevityA more natural gait and function

Confidence in results

The BOX® Total Ankle Replacement stands apart from other contemporary devices. Its design is based on original research into the movement and stability of healthy ankle joints and the role of the ligaments in controlling and limiting joint movement.

The unique bearing geometry restores a more normal pattern of movement in the ankle with large coupled rotations. It works without imposing a non-physiological fixed flexion axis, resulting in an excellent range of motion and better function.

Physiological freedom of movement for the normal and traumatised tissue envelope

Uniquely allows inversion / eversion to further relieve degenerative effects on neighbouring joints associated with other TARs or arthrodesis

Enables physiological AP translation of the flexion axis compatible with the collateral ligaments for a more natural flexion

Deep sulcus saddle-shaped talar bearing for maximum ML stability

Allows for natural IE rotation coupled with flexion

Coupled rotations and varying inclination of the flexion axis throughout ROM for a more natural gait and function

Complete stability throughout ROM with double-convex encapsulation for the meniscal bearing, ligament tensioning technique, full conformity throughout ROM and allowance for normal inversion / eversion

Meniscal bearing translates AP during flexion, remaining centred on the load-bearing vector for increased ROM

4th generation design with greater freedom of movement than other TAR devices

Designed to treat primary or post-traumatic arthritis

1mm incremental meniscal bearing inserts

Total flexibility and choice with size range and tibial and talar component cross-size compatibility

Patients with end-stage arthritis can now be treated with the most advanced total ankle replacement (TAR) to achieve pain relief with more normal levels of mobility, function and gait, (where alternative options fall short) [1] as well as avoiding long-term complications associated with reduction in mobility of the tibiotalar joint [2-4].

The BOX® Total Ankle Replacement was designed specifically to allow a more natural freedom of movement and level of stability at the tibiotalar joint for a more normal gait [5]. This is achieved with a design that permits physiological coupled rotations in all degrees of freedom [5], maintaining full conformity of the articulating surfaces throughout the ROM and in all functional positions, [6] and to relieve neighbouring joints from the degenerative effects associated with loss of mobility [2-4].

The BOX® Ankle has been in clinical use since 2003 and its use is growing [7]. The BOX® Ankle consistently achieves significant improvement in functional scores and ROM [8-12], and is demonstrated to enable a more normal gait [8,9]. Excellent mid-term results are demonstrated. Registry data reports for a cohort of 404 ankles, maximum 6 years (mean 2 years) postoperatively, that just 2.5% have required further operation, 60% of which required only a change of meniscal component [13]. Multicentre study data reports over 97% survivorship at 3 years [10] and 96% at 4 years [11] with no failures due to aseptic loosening. A high rate of patient satisfaction is also reported [12].

Combining all key principles for long-term stable fixation, with full congruency throughout ROM for stability and low wear, the BOX® Ankle sets a new benchmark for the success of TAR.

Anatomically profiled components based on radiographic morphology data and experience with previous prostheses

Low-profile resurfacing design does not require gross bone removal that could lead to weakness and entry route for wear particles

Enhanced cementless bone fixation with proven as-cast beaded fixation and HAP coating for long-term stability

Full area contact throughout ROM for complete stability and low wear with minimal thickness bearing

Maximum preservation of bone stock with ligament tensioning technique for the lowest profile construct, limiting exposure of metaphyseal cancellous bone and separating the malleoli from the talus

Low-profile talar fixation pegs for ease of insertion and long term stability

Proven materials and articulating couples