Fixation technique. Schematic illustration showing the anchorage of the PGA-HA annulus-implant in the annulus defect. Four sutures are pre-fixed at the corners of the implant. With an inside-out-technique the implant is attached to the inner wall of the annulus fibrosus. Ideally, the suture penetrates the annulus close to the vertebral endplate. The sutures are then fixated by surgical knots at the outer surface of the annulus.