MAUDE Adverse Event Report: ARTHREX, INC. KL FBTK RC,(BLK/BLU)FT & (BLU/BLK)#2 MTS; ARTHROSCOPIC ACCESSORIES

Model Number	KL FBTK RC,(BLK/BLU)FT & (BLU/BLK)#2 MTS
Medical Device Problem Code	Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/19/2024
Type of Reportable Event	Malfunction
Event or Problem Description
On 01/19/2024, it was reported by a sales representative via e-mail that an ar-3653ttsp knotless 2.6 fibertak® rc soft anchor pulled out.This occurred during a rotator cuff repair on (b)(6) 2024, where a 2.6 knotless fibertak rc was prepped using a 2.6 drill and 2.6 drill guide for a medial row anchor placement on the greater tuberosity.The anchor was inserted in standard fashion, set in standard fashion, and then the tapes from the anchor were passed through the rotator cuff.When attempting to implant the lateral row anchor with the tapes from the 2.6 medial anchor, the 2.6 knotless rc pulled out.The case was completed with no effect on the patient.
Additional Manufacturer Narrative
The contribution of the device to the reported event could not be determined as the device was not returned for evaluation.The root cause of the event could not be determined from the information available and without device evaluation.If the device becomes available for evaluation, a follow-up report will be submitted.
Additional Manufacturer Narrative
Additional information: g3, h3, h6.Based on the information provided, which may include the device (if available and returned), pictures, videos, event descriptions, and any additional information from the field, arthrex concluded that the most likely cause of the reported failure is user error, specifically improper bone preparation and/or improper surgical technique with the device.The complaint allegation was not confirmed.The device was not received for evaluation, and no picture of the failure was received.

• Brand Name: KL FBTK RC,(BLK/BLU)FT & (BLU/BLK)#2 MTS
• Common Device Name: ARTHROSCOPIC ACCESSORIES
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• Manufacturer (Section G): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• Manufacturer Contact: jared engle ; 8009337001
• MDR Report Key: 18678230
• Report Number: 1220246-2024-00888
• Device Sequence Number: 17681107
• Product Code: MBI
• UDI-Device Identifier: 00888867370081
• UDI-Public: 00888867370081
• Combination Product (Y/N): N
• Initial Reporter State: ID
• Initial Reporter Country: US
• PMA/510(K) Number: K203268
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial,Followup
• Report Date (Section B): 06/02/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: KL FBTK RC,(BLK/BLU)FT & (BLU/BLK)#2 MTS
• Device Catalogue Number: AR-3653TTSP
• Device Lot Number: 15175864
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/19/2024
• Supplement Date Received by Manufacturer: 05/14/2025
• Initial Report FDA Received Date: 02/09/2024
• Supplement Report FDA Received Date: 06/02/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 12/05/2023
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown