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NanoNeedle™ Scope 2.0
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Pitcher's Recovery

Aaron J. Krych, MD (Rochester, MN), demonstrates meniscal root repair using the SutureLoc™ implant and a FiberStitch™ 1.5 implant to augment the repair.&nbsp;

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Meniscal Root Repair Using SutureLoc™ and FiberStitch™ 1.5 Implants

Speaker  This is Aaron Critch from Rochester, Minnesota. And I want to show you how we performed this root repair with our suture lock and 1.5 fiber stitch configuration. Today we have a left knee. And here you can see we're looking in the medial compartment. And this is a typical root tear or radial tear near the root. And today we want to show our suture lock root repair with fiber stitch augmentation for this very common case. So in this in this case you can really appreciate the root footprint anatomy. So the first thing we want to make sure is that we can see well. So we've already taken a little bit of the PCL synovium. We've lengthened the MCL a little bit. And here we're in good shape to work. So the first thing is to make sure that we have good mobility. And you can see this is one that really doesn't have much extrusion. So we're in good shape. Now we're going to think about the biologic Preparation. So it's very important that we prepare this as bleeding bone so that we get our onlay fixation. Different ways to prepare the bone here. I'm just using a simple curette, but we can use the power rasp, other types of rasps to help. But it's very important step that we make sure we're getting to bleeding bone because we want our meniscus to heal to that construct. We don't need a socket anymore. We can get all onlay fixation and healing. Speaker  But again, it's very important to prepare this to bleeding bone. So here we've got a nice curetted base. Now we want to remove any soft tissue. This is the SE 50 reaches back here into the footprint. Very well. We just don't want anything to hold up our suture lock passage. So I'll just make sure to take that out. But it's a very good anatomic landmark of where we want our two four pin to come out. So the first step is to place our augmentation suture. And we're going to do that with the one five fiber stitch. So we're going to place our portal skid. And then we'll take our fiber stitch and bring this in. Now the fiber stitch will serve dual purposes here. So one is to augment this meniscus to the posterior capsule. The second is this will provide our rip stop sutures for our suture lock root repair construct. So I don't want these sutures right on the edge. I actually want to start them here because we need to bring that meniscus over to the footprint a little bit. We want to make sure we're thinking about centralization and extrusion through our anatomy. So we'll place the first fiber stitch through the capsule. And then here we really want a nice broad footprint of the fiber stitch. So I'll try to get as close to the edge as I can. And that will provide a little bit larger backstop for our rip stop construct. Speaker  So here we'll place our our second throw. There are other ways to perform rip stop sutures. You can tie a freo a free two suture using the knee scorpion. You can also use somewhat of a Mason Allen construct on the suture lock itself. But here we're just going to tension to the capsule. Here I want to make sure I don't over tension the construct. We want to keep the mobility of that meniscus. We can get it back to its root footprint. But this does a nice job because we get a double suture construct for our rip stop. So what's nice about using the fiber stitch is it's relatively quick and we don't have to think about any suture management. We can just get this out of our way. For the remainder of the case. So now we've got our passport cannula in our medial portal. So we'll just take a look at our fiber stitch here a little bit more closely. So we actually have a nice circumferential rip stop suture configuration. And now we'll move on to the rest of the route repair. So we'll take our point to point guide next. We have this set at 70 degrees. We like this point to point guide because it does a very nice job of recreating the anatomy. It's very important to be precise. We know that if even if we're off five millimeters with our root origin, we won't recreate the biomechanics of the meniscus. Speaker  So another feature of this guide is that it can swivel. So in this case we're going to drill from the medial portal to the anteromedial tibia. So some swivel there helps significantly. And then once this is set, then we can make our small skin incision. So we've got a great view here with our panel scope. We can really see the recreation of the anatomy. You can see where we decorticated to what would be bleeding bone in our knee. And we're going to drill now our 2.4mm cannulated drill pin. So we'll watch this drill pin come up. And this is great at this point to point guide really has a lot of accuracy, really helps us get into the right location. So at this point we'll uncouple and uncheck our 2.4mm Cannulated pin. So here we're going to pass our nitinol wire loop. Through our 2.4mm Cannulated drill pin. What's nice here is this is all one step. We don't have to exchange a pin. Makes it very efficient and streamlined. So we're going to take a Grasper. We'll go through our previous cannula and go ahead and grab that. And then we'll get the cannulated pin out. So now one tip is that we like to exchange this wire for a fiber link. This fiber link suture shuttle tends to be a very smooth way to shuttle our suture lock through our tibia. Speaker  Sometimes the wire can cause a little bit of friction and get hung up. So just to ensure that doesn't happen, we'll use our fiber link. So we have our suture lock implant ready to shuttle. So you can see on one side our repair and conversion sutures and on the other side are tensioning suture. So when we shuttle this, we want to make sure that we have enough of the sheath to shuttle, but not too much. So we want this folded over just beyond where our sutures come out. And then we're going to convert this through our tibia. Once we have all those sutures out, one little trick is we can take a little hemostat or mosquito just to prevent these sutures from converting. So one of the important steps is to deploy our implant right underneath the subchondral bone. So here we're going to deliver it right through our 2.4mm drill hole. And I can really feel that pop. And then I want to make sure that this implant and anchor are right underneath the subchondral bone. So we can see there's a tensioning loop, and then our two converting sutures come out the tibial part of the implant. So we're going to take our tensioning loop right now. And we're actually going to deploy the anchor. So right now that anchor is balling up. And then we want to make sure it's right under subchondral bone. So I'll actually do a little bit of back and forth where I'm pulling the anchor against Subchondral bone. Speaker  I'll bunch it up a little bit more. I'll pull it against the subchondral bone. So that way we ensure that it's right up where we need it to have our fixation. So at this point, I'm going to clamp our suture sheath just to make sure we don't accidentally convert or run one of those sutures. And then for suture management we'll take a suture grasper. And I actually like to park everything out the lateral portal because that just helps maintain everything, avoiding any suture entanglements or potential issues. So we'll make sure we've got our two blues, our two whites in the conversion. We'll pull everything out Our lateral portal. So now we have all of our sutures. Doctor. Lateral portal. So now it's dealer's choice. If you want to do the white repair suture the blue repair suture first. I tend to have consistency with my team. So I'll always do the white in the back and the blue in the front. So now we'll take our knee scorpion and we'll pass our sutures. So we'll just load the end of the suture in the knee scorpion. And what's nice about using our one five fiber stitch as our rip stop construct is now we can place two simple sutures. So this first one we want way in the back. And I use the edge of the knee scorpion as our guide in terms of medial to lateral. Speaker  How much meniscus that we want loaded in the construct. So now we'll grab our white and black converting suture that's parked in our lateral portal. And again, just keeping everything kind of tidy with our suture management. So there's a nice loop and there's a colored dot here. So we know exactly how much suture to fold over and convert through our tibia. And then while that's being loaded we can find our working end of the suture down here on the tibia. So here you just want to make sure we separate our two converting sutures. So I'm going to pull the white and black. And that easily converts through the tibia. Now we'll tension this suture just a little bit just till we get the slack out so that we have room with our next suture. We want to tension just a little bit more. And we really want the suture to come off the sides. I'm having my assistant pull a little bit of slack out of that repair. And I want this to come on the side of the meniscus. And once you see it sitting in back, that's a perfect amount. So once we have that provisionally tensioned, then we're just going to replace our clamp here just for safety. So we don't run the sutures. Then we're going to take our grasper and grab our second repair suture. This is our blue one here. So we'll pull that out our passport and we'll get that loaded in our knee scorpion. Speaker  So we're ready for our second suture pass. So we're going to come in place our second simple suture. And here we want a nice spread. So you can see where our first one is. We want a good bite of tissue. But we want a nice suture bridge between the two. So now we're going to pull this out our portal. And we have a small girth hitch which is very easy to deal with. We just clear the loop. And then we'll grab our conversion suture. So we have both those outer passport cannula. And again we're lining up that black mark on the suture. While we're doing that we're finding our second conversion suture in the sheath. So our blue and white is here. So we're going to convert our second repair stitch. And now we have our suture construct set. So I'm going to have my assistant grab one blue and one white. And we're going to take the slack out of our blue repair suture first. And we're going to get this lined up. So sometimes what I'll do is I'll grab the meniscus. This is a nice pearl because I really want these rip stop sutures to work. So now we're adding some provisional tension. We'll add more in the blue. And you can see that blue is kind of sitting in the back. So we're just going to grab it here. Speaker  We'll keep pulling on the blue. So now you can really see our our ripstop configurations. At this point I'm going to move to a probe. And again we really you can see how this meniscus is detention right now. We need to get back to our root origin. So at this point we're going to sequentially tension. And that's one of the great advantages of this implant as we can tension and retention. So we're going to go ahead and continue to tension this down. And you can see how important that ripstop fiber stitch is. So that keeps our sutures from coming through degenerative meniscus tissue. This does a nice job. Remember we decorticated all of this cartilage. So this is compressed against bleeding bone. And you can see this does a nice job of bringing the meniscus back in. So we don't have extrusion issues. And again you can really see that ripstop configuration. One of the advantages. If we had more surgery to do at this point, we could retention when we're done. So for example, if we had an ACL, we could come back and retention. If we're all done at this point, we can also trim the sutures. But the fixation is right here at the subchondral bone. We don't have fixation lower on the tibia. So again any combined surgery with ACL with PCL we don't have to worry because we have direct suture lock anchor fixation. So really we have a nice ability to tension retention. Speaker  You can really see how our rip stop here is critical. And that does a great job. We're just going to check that out with our probe. Look at how that suture lock just locked. This whole meniscus root right into place. Really gives us a lot of confidence for healing, for rehabilitation. But really it gives us a nice wide footprint of compression. So you can see we've got the suture in the back. We've got the suture in the front. So this entire area of meniscus is being compressed to bone. So really overall a huge advantage over our previous transtibial pull through. But really, really a great construct with our one five fiber stitch and our suture lock. So we can see our construct. And what we're going to do is we're going to do our final tension. We're going to bring the knee now to about 80 or 90 degrees sometimes. You know, it'll be a little bit tighter at 30 and a little bit looser with that femoral rollback. So here we're going to do our final tension now at 80 or 90 degrees. And you can see how we have complete compression of our meniscus root repair. So once we have our final tension the construct now we can simply trim all the sutures from the sheath. Again. Remember our fixation is in the joint at the subchondral bone. And now all of this tibial real estate is available for other procedures.

Meniscal Root Repair Using SutureLoc™ and FiberStitch™ 1.5 Implants

JumpStart® antimicrobial wound dressing with Advanced Microcurrent Technology is used for the management of surgical incision sites. Embedded in the dressing are microcell batteries made of silver and zinc, which generate an electrical current and kill a broad spectrum of harmful pathogens, including multidrug-resistant and biofilm-forming bacteria, to help reduce the risk of infection.1
Reference 
1. Kim H, Park S, Housler G, Marcel V, Cross S, Izadjoo M. An overview of the efficacy of a 
next generation electroceutical wound care device. Mil Med. 2016;181(5 Suppl):184-190. 
doi:10.7205/MILMED-D-15-00157

JumpStart® antimicrobial wound dressing with Advanced Microcurrent Technology is used for the management of surgical incision sites. Embedded in the dressing are microcell batteries made of silver and zinc, which generate an electrical current and kill a broad spectrum of harmful pathogens, including multidrug-resistant and biofilm-forming bacteria, to help reduce the risk of infection.1 

Reference 
1. Kim H, Park S, Housler G, Marcel V, Cross S, Izadjoo M. An overview of the efficacy of a 
next generation electroceutical wound care device. Mil Med. 2016;181(5 Suppl):184-190. 
doi:10.7205/MILMED-D-15-00157

JumpStart® Antimicrobial Wound Dressing

JumpStart® Antimicrobial Wound Dressing

Walter R. Lowe, MD (Houston, TX), demonstrates a BTB ACL reconstruction using the BTB TightRope® SB implant and the InternalBrace™ technique. The FiberSnare® guidewire is used to shuttle the FiberTape® suture through the cannulation of the FastThread™ screw to allow for independent fixation of the FiberTape suture.
 
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-tobone fixation.

BTB ACL Reconstruction Using the BTB TightRope® SB Implant and the InternalBrace™ Technique

What you see here is the equipment and graft needed to do a bptb ACL reconstruction with internal brace technique. And the fixation we're showing you is the bptb tightrope soft button for fixation on the femur. What you see on the left side of this is the bptb tightrope with soft button. What you see, the blue and white sutures are just like the old bptb tightrope for pulling the graft into the tunnel. You see the yellow soft button. Okay. And then off to the right side of the soft button, you'll see a tiger wire suture. That is really the only difference here from the old technique. And that tiger wire is what we're going to use to keep equal tension and keep this soft button elongated as it passes through the femoral tunnel. What you see below with the two drivers is the tap for the fast thread peek interference screw down below you see the interference screw with the fiber snare guidewire placed up through this screw, where we will use this to pull the internal brace down through the interference screw on the tibia for later fixation. This is the cadaveric specimen we're going to use to demonstrate the BTB soft button. I've taken the liberty of preparing this specimen so you can see femoral tunnel. I drilled this with with a flip cutter. You can drill it with your technique. As long as we know tunnel links to use a tightrope type fixation. Tibial tunnel was drilled with the flip cutter guide, but a full tunnel was drilled for this demonstration out the tunnel. So we'll start. And you can see we've already passed the wire to pull our graft into place. So we're ready to do that. So you see our suture. We're going to shuttle the implant in. And this is just like the old BTB for tightrope, where we're shuttling in the white and blue sutures to pull the graft into place. So now you'll see the tightrope soft button Slowly coming into place here, but said this part you can see looks just like we're using the old tightropes. So we've got the white sutures, we've got the blue sutures that are the guiding suture for the new. So on the tibial side, we're just holding on to the tiger suture. Everything else can just lay on the leg at this point in time. As we're getting ready to pull this in, you can see from our outside shot that the tightrope loop has been lengthened. So we want to set the soft button on the femur before we engage the tibial side of the graft and the tunnel. So I just flipped scope to the medial portal so we can see this better. And we're on the pano view. We're passing the graft with tension on both sides. So the same person right now should control both the femoral side and the tibial side. And you'll see this soft button the yellow coming into play. And now this tension is keeping on the tiger. Down below is keeping that button elongated as you see it. Go through to the lateral femoral cortex. So now to check the fixation. Just like old ways, I'm pulling on the internal brace. We're letting a little pressure off of the tiger. So that lets the soft button essentially ball up on the lateral femoral contact. So now that we've passed this we're just going to demonstrate, let's say something happened on the femoral side where the buttons outside the IT band. You got big dimpling or something. And you want to pull this button out. So what we're going to do is pull equal tension on the blue and white and on the tiger below. So that's going to elongate that button so we can pull it out. You see that. And now we can go through the same thing with equal tension. Will pull it back up. And then with tension on the femoral side, I will pull back on the internal brace. And that will set it up against the lateral femoral cortex again. So now we're ready to pass the graft using the tape grasper. Now I'm through my anteromedial portal and I am going to get the internal brace out of our way. So I'm viewing laterally now because the step I've done before, we start to engage the tightrope and pull our graft into place as I've moved the internal brace out through the intermediate portal. So with the internal brace out through the anteromedial portal, my assistant is just holding a little tension as we start to pass the graph, you can notice that I'm orienting the bone plug up into the tunnel, and we're slowly working it up, and you can see the bone plug coming into place. So now we have our graft oriented how we want it, and now I'm just checking the length of the graft on both sides. And it's in my thermal tunnel, which is good. Let's leave it there. And it's in my tibial tunnel. So that's sort of the picture I would like to see at this stage. And so now we're ready for tibial fixation. So at this step we're going to remove the tiger wire suture. And we're just going to keep gentle tension on the IB or internal brace right now as we pull this suture out. This is the fiber snare guidewire I've just put over the top of the tibial bone plug and the tibial tunnel. And so now since I have a passport here, I just need to retrieve the snare part. Out through the anteromedial portal, and we'll load our internal brace onto it later. Next we're just going to tap and the tap for the fast thread peak screw, and I'll take it all the way over the top of the bone plug. You can sort of feel when you come past it. So now I'm going to position the leg out, you know, close to full extension 1015 degrees. So now I'm, you know, got it. Tension distally and I'm putting the fast thread peak screw up. And so once we have the fixation on the tibial side then now using the fiber snare guide we're pulling the snare part of it down through the screw. You can see the tip of the interference screw right there. And now we're going to pull the internal brace through the screw. And it's very important that screw is you know the opening is tiny. So we make sure the internal brace we have the small ends of it as we pull it in. And so you can see it docked to it now. So we're going to finish the case by fixing the internal brace on the tibia in full extension with the swivel lock. So as we get ready for the fixation of the internal brace, it is really and critically important to move the knee into full extension. So now that we have graph fixed on both sides, internal brace fixed on the tibial side will cycle the knee a few times and then we'll retension out near full extension on the femoral side. You can see we got a little bit you know, and you can do this as many times as you want. So that's the final picture.

BTB ACL Reconstruction Using the BTB TightRope® SB Implant and the InternalBrace™ Technique

Katherine J. Coyner, MD (Farmington, CT), demonstrates how to use the SurgeonVault® surgeon-patient communication tool to effectively manage cases, annotate images, and send patient reports.

SurgeonVault® System Demonstration

Speaker  Hi, I'm Doctor Kathy Coyne, a professor from UConn health. I want to show you today how I use the Arthrex surgeon vault in combination with the Synergy Vision Imaging system to communicate with my patients after surgery. From a practical standpoint, what works really well for me is how streamlined this process is. I can export the case media wirelessly from the O.R. tower directly to my iPad, and often have the patients post op report created before I even leave the operating room. That report includes intraoperative images and video, as well as a brief video explanation of the case from me. The rehab protocol specific to that patient all combined into one secure digital report. The first thing I'll do is I'll find the QR code. I'll then link that to my iPad. It'll then ask me to join the network. I'll join that. It's now pairing from the tower to the iPad. Once it's paired, I will then hit export on the tower screen. I will go to my iPad and you can see that they're now being sent over. I then disconnect and then I'll be able to access the case media. Once I'm ready to create the patient report, I log into the Surgeon Vault app and pull up the case. Speaker  I then pull up the template that I want to use for this particular case. This was a meniscus root repair. This automatically organizes all the images and video in the way I like to present them. Here is a little personalized message to the patient. Exactly what was performed. I can also create what's called a surgeon video. I just want to let you know that surgery went great. I'm getting ready to go talk to your family, but I wanted you to know that we were able to repair your meniscal root. There's a procedure overview about the specific parts of the case. If it was something unique that you also want to add, just go to the library where you can easily add procedures or aspects of a case, and that will add it into your own template. I can link specific PT protocols, and this is where I find it to be really helpful for them to be able to share this with their physical therapist. So we're all working off the same information. So then if I go back up to the case media here, there's a lot of options from this screen where I get to the annotation part of this. Speaker  And on the left hand side you can see all the different annotations. But most easily I can just draw an arrow and you have these pre-populated labels where I can then choose what to annotate. I can flip between images and videos extremely easily. I can see what my initial meniscus tear looked like, and be able to explain that to the patient very easily. And then ultimately, when I feel that everything is annotated appropriately and I'm comfortable with how everything looks, I come back to this screen and I'm ready to send this report and everything will get embedded into a secured email for me. Surgeon vault is far more practical and secure than sending patients home with paper printouts that are often misplaced or never reviewed. I can tell when the patient actually has already opened their report. It really has unlimited cloud based storage, and for me, it creates this powerful, organized library that I can use for teaching files, as well as really high quality presentations. Overall, integrating Surgeon Vault with the Synergy Vision system has really made my postoperative workflow much more efficient and really has improved how I communicate with patients. Thanks for watching this video.

SurgeonVault® System Demonstration

Designed to provide anatomic contour with precise instrumentation, the Arthrex Proximal Tibial Plating System features 4 unique plate styles, equipped with advanced variable-angle locking capabilities and KreuLock™ locking compression screws, to optimize treatment of proximal tibial fractures.

Arthrex Variable-Angle Proximal Tibial Plating System

Arthrex Variable-Angle Proximal Tibial Plating System

At the Sports Medicine Fellows Forum, Harris Slone, MD (Charleston, SC), reviews causes of ACL reconstruction failure and outlines a systematic, evidence-based approach to revision ACL surgery, emphasizing tunnel management, graft selection, and alignment and addressing concomitant pathology to optimize outcomes.

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Approach to the Failed Anterior Cruciate Ligament (ACL) Reconstruction

OrthoPedia: Approach to the Failed Anterior Cruciate Ligament (ACL) Reconstruction

The PARS Achilles Midsubstance SpeedBridge™ implant system is a percutaneous, minimally invasive technique used to repair Achilles tendon ruptures. Using color-coded 1.3 mm SutureTape, the PARS system makes it easy to create a percutaneous locking stitch in the Achilles tendon, while staying inside the paratenon sheath.

Achilles Midsubstance SpeedBridge™ Surgical Technique

When using the parse jig for the Achilles mid substance SpeedBridge technique, a percutaneous incision is made in a transverse manner just proximal to the palpable rupture. Alternatively, a small longitudinal incision can be utilized. The tendon is grasped and the jig is inserted with the inner arms inside the peritoneum of the Achilles tendon. The first parse needle is placed in the number one hole in the jig to stabilize the construct, while passing the other needles and sutures in sequential order. Lastly, the white SutureTape is then passed through hole number one. The jig can then be removed, which pulls the sutures out of the incision. Separate out each of the five sutures, the white, blue, and black suture tapes, as well as the two green and white FiberLink sutures. Each suture should be tested by pulling light tension through ten cycles to confirm appropriate hold in the tissue. On both sides, past the blue SutureTape under and around both green and white. Fiberlink SutureTak twice and back through the loop, then advance each loop back through the tendon using the free end of the green and white FiberLink sutures. This creates the locking stitch. Two stab incisions are made one centimeter below the superior aspect of the posterior calcaneal tuberosity. Medial and lateral to the Achilles tendon. Within these two stab incisions, insert the guidewire utilizing the drill guide with the white centering sleeve at 45 degrees from the centerline of the Achilles in the coronal plane, and 45 degrees from posterior to anterior in the sagittal plane. Guidewire placement can be checked under fluoroscopy. These two holes are drilled with a 2.6mm drill and tapped for later SwiveLock insertion. A banana. Suturelasso is passed through the distal stump of the Achilles and out of the rupture site. The SutureTape from the proximal portion of the tendon are then passed through the distal stump and out of the stab incisions distally. The suture tapes are then loaded through the eyelet of the Rd 3.9 biocomposite SwiveLock anchors. The foot is plantar flexed 10 to 15 degrees to approximate the tendon ends. The SwiveLock anchor is placed into the prepared hole to secure the suture tapes. The laser line feature on the SwiveLock shaft can be utilized to confirm when the anchor is flush, or two millimeters countersunk. The same steps are repeated for the suture tapes on the contralateral side. The incision is closed. Jumpstart antimicrobial dressing can be utilized and the result is a secure knotless repair of the Achilles tendon rupture.

Achilles Midsubstance SpeedBridge™ Surgical Technique

This animation reviews the features and benefits of the FibuLock® PRO nail system, including longer-length nails, headless cortical screws, color-coded instrumentation, and a new modular jig.

FibuLock® PRO Fibular Nail: Features and Benefits Animation

FibuLock® PRO Fibular Nail: Features and Benefits Animation

Sanj Kakar, MD (Rochester, MN), shares a surgical pearl for using the NanoNeedle™ scope to mitigate iatrogenic cartilage injuries in the radiocarpal joint.

SpeedPearl: Accessing the Radiocarpal Joint With the NanoNeedle™ Scope

Speaker  Given its small diameter and flexibility, the Nanoneedle mitigates any echogenic cartilage injury. Typically, I create the three four portal first as my viewing portal and the six portal for instrumentation. For the over-the-top tfcc repair procedure, however, it's important that these portals are reversed since the scaphoid tends to flex and pronate with scapholunate instability. I typically create the ulnar Midcarpal portal first, followed by the radial Midcarpal portal.

SpeedPearl: Accessing the Radiocarpal Joint With the NanoNeedle™ Scope

Peter Borden, MD (Torrance, CA), demonstrates repairing a small rotator cuff tear using Self-Punching Double-Loaded Knotless 2.6 FiberTak® soft anchors.

Small Rotator Cuff Repair Using Double-Loaded Knotless 2.6 FiberTak® Soft Anchors

Hi, this is Peter Borden from Los Angeles, California. I'm going to demonstrate with you today the use of the 2.6 FiberTak anchor. Using two anchors for a simple rotator cuff repair. This is a left shoulder, and we have a small laterally based tear. We are going to plan to put one anchor here and one anchor here, right on the edge of the greater tuberosity here. We are going to repair that in a single row fashion. For this case we're utilizing the NanoScope. We've got this ultra wide NanoScope view currently of the greater tuberosity and the small cuff tear. You can see the extent of the cuff tear, but you can see the entire greater tuberosity from front to back in this one view. I can show you with a press of a button that we can cycle through a 70 degree view, so we can look at it from the side standpoint. I can also cycle away from that and do a standard 30 degree view as well. But notice how when we go to the Pano view, we just get a much more global view of the greater tuberosity. Here we've added an ASL portal for suture management. I would like to be able to put both anchors. One anchor here and one anchor here. We're going to go ahead and retrieve our working sutures one at a time, out our lateral portal, and then we'll take the Scorpion. I'm going to add the working stitch to the side loader as we come in. So I'm going to go ahead and take a feel and see how much cuff tissue I want to grab. And I want to pull and reduce. I'm going to go into the anterior extent of the tear. That looks good. I'm going to do one there and let's go ahead and pull that. So we got the first pass done. I'm going to move that out of our working portal for suture management. So now we'll retrieve our blue white working stitch. We will add the second working stitch to the Scorpion. We're going to hold our suture and do our second pass, making sure we stay on the correct side of all the sutures. And we're going to come in and we're going to make an analogous pass. And I'm going to take all these and for suture management purposes, and we're going to take everything out of our ASL portal. There's our passes. So now we're localizing our posterior anchor placement here. So I want to be right off the edge. Kind of similar to my other anchor. And then I'll check the anchor again and make sure I can lift the arm up and I can. So we placed our anchor. We're going to retrieve the black and blue working suture. Now we're going to load a Scorpion passer. We will take a look at our spread. So I don't want to hit the other suture from the first anchor. So I'm going to keep an eye on everything. I'm going to go in, go above it, look and see where my other pass was. There's my other pass. I'm going to go just adjacent to that. So we're going to come in and we're going to go ahead and take our second pass. We will fire it, retrieve it. So we got two sutures there. We're ready to convert. So I'm going to go in I'm going to retrieve this guy. We have the loop suture for conversion of the anchor. At this point I'm going to go ahead and take this. Put it through the loop. And we're we'll make sure that it's where the purple mark is. That's the purple mark. Both sutures are through the shuttle loop, and I've got this ready to go. So I will go ahead and convert this. We will utilize the shuttle suture in order to put a little tension on the loop on the working repair sutures so that we have a little counter tension and this little counter tension that we're doing on here. It just helps us keep this from getting all twisted up. And as I bring it in, look how nice and straight it kept my repair sutures on that tissue. And now that I've got this scenario here, I could remove this suture that was helping me maintain the orientation of the sutures. And now we're going to take both of these sutures, and we will go ahead and seal that down to bone. We will go ahead and use the Mega loader to load our repair sutures in the cutter, and we'll come in and we'll go down to the anchor, give another little gentle tug. Now we'll do the same thing with the other sutures. So that's perfect. We will cut this suture and get out of here. We've got this single row, lateral row repair of the rotator cuff. We've got great fixation of the cuff tissue to the greater tuberosity.

Small Rotator Cuff Repair Using Double-Loaded Knotless 2.6 FiberTak® Soft Anchors

Peter C. Yeh, MD (Stoneham, MA), shares a surgical pearl for using a weighted clamp to optimize graft passage during all-inside ACL reconstruction.

SpeedPearl: All-Inside ACL Reconstruction Using a Weighted Clamp

All-inside ACL reconstructions require a level of precision and preparation, as proper graft and suture management are keys to ensuring a smooth case. Here's a simple but very effective way to pass the graft into the femoral socket. Rather than having an assistant's hand pulling on the tibial shuttle loops, I use two clamps to weigh down the tibial shuttle loop suture that comes out of the Am portal and tibial incision, taking advantage of gravity to tension it down and out of the way. The heavier the clamps, the better. This allows for ease of graft passage, but more importantly also frees up an assistant's hand to do something else to further the case. One clamps both sides of the tibial shuttle, stitch both the Am portal side as well as the tibial incision side. For extra weight, I put an additional clamp on just the suture loop coming into the Am portal to make it even heavier. This allows tension on the suture and allows for the passage of the graft without worry that the tibial shuttle sutures will get pulled in.

SpeedPearl: All-Inside ACL Reconstruction Using a Weighted Clamp

The consolidated trays for the Univers Revers™ total shoulder system are designed to provide a cost-saving solution that preserves patient-specific optimization and enhanced operative workflow.

Univers Revers™ Total Shoulder System: Maintaining Global Patient Parameters With Fewer Trays

Speaker  Shoulder arthroplasty is evolving and so are we at Arthrex. We're giving surgeons a streamlined path to surgical excellence. Fewer trays with the same versatility you've come to expect. All to help you treat your patients better. The result? A dramatic reduction in O.R. waste and significant cost savings without compromising implant modularity or patient optimization. Our new consolidated system lets you perform a standard reverse case with just two trays and an augmented glenoid with only three trays, saving you space and streamlining your workflow, all while continuing to use the implants you're familiar with. Backed by over a decade of clinical data. Fewer trays. Same implant options. More efficiency.

Univers Revers™ Total Shoulder System: Maintaining Global Patient Parameters With Fewer Trays

John Zvijac, MD (Miami, FL), demonstrates the use of the NanoNeedle™ scope 2.0 and the PassPort Button™ cannula with auxiliary lumen for Nano shoulder arthroscopy labral repairs.

Labral Repair Using the NanoNeedle™ Scope 2.0 and the PassPort Button™ Cannula With Auxiliary Lumen

Speaker  Hi, I'm John from Miami, Florida, and today we're showcasing a label repair technique using the Nanoneedle scope 2.0 and the accessory Lumen Passport. This setup allows for ultra minimally invasive access and enhanced maneuverability. We've already established our portals, and the accessory Lumen Passport is positioned to facilitate suture management and instrument passage. You'll see how this design improves efficiency and flexibility during the repair. Here is what the accessory Lumen Passport looks like. We have a center hole for instrumentation, and then there is an accessory lumen, which allows for passage of a multitude of micro instruments for suture management. Here we see the nanoneedle scope in the posterior shoulder portal and the accessory passport lumen anteriorly in a rotator cuff interval. A little pro tip the accessory portal. If you can leave this inferiorly or posteriorly, it makes it a little bit easier for suture management. It's not that big of a deal. You can always put it in any position, but that's a little pro tip to help as you're moving this along. You can see the soft tissue bankart lesion that's occurred. This is the labrum all the way down. And we're well past the 6:00 position to allow for bringing the capsule both superiorly and laterally onto the articular surface. The labrum often falls not only medially but inferiorly while you're doing these type of surgeries. Speaker  So it's important to free all of this up for proper mobilization and tensioning. We'll be repairing this labral tear with the 1.8mm knotless fiber tack anchor. This is being done through the central lumen of our passport. And now we're going to pass the suture retriever through the accessory portal in our passport. You can see it coming through, and we can easily pass our stitch with the use of a scorpion through our central portal. And now we're going to just easily shuttle our loop stitch through our center portal. And now we're ready for shuttling a repair stitch. Keeping very nice suture management, preventing entanglement of the stitches intra articularly. We're going to take this stitch out through our center hole to allow for final cutting of the stitch. Here we're using the flush cutter, and we can just bring this down to central portal. And we can cut our stitch flush. And we're ready for the next stitch. The repair is completed with precise suture placement and minimal disruption to the surrounding tissue. The accessory Lumen Passport enhances suture management and expands our instrument options for suture passing during a label repair. Combined with the Nanoneedle scope 2.0, we're moving closer to an ideal solution for the ultra minimally invasive arthroscopy.

Labral Repair Using the NanoNeedle™ Scope 2.0 and the PassPort Button™ Cannula With Auxiliary Lumen

Benjamin G. Domb, MD (Chicago, IL), demonstrates a hip capsular closure using the SutureCast™ suture passer and LoopLoc™ knotless implant. Dr. Domb provides surgical pearls for suture management and tensioning of the LoopLoc implant to complete the closure.

Benjamin G. Domb, MD (Chicago, IL), demonstrates a hip capsular closure using the SutureCast™ suture passer and LoopLoc™ knotless implant. Dr. Domb provides surgical pearls for suture management and tensioning of the LoopLoc implant to complete the closure.&nbsp;

Hip Capsular Closure Using the SutureCast™ Suture Passer and LoopLoc™ Knotless Implant 

Speaker  My name is Benjamin Dome. I'm the medical director at the American Hip Institute. And today we will be demonstrating capsular closure in the hip using the suture cast passing device and the loop lock capsular closure device. The suture cast can load and expel up to 40mm of suture under the capsule. In order to load it, we switch the switch forward and then put the suture into the jaws, and we put it all the way into the apex of the jaws beneath the teeth. And then we load the suture like so. And again, if we fully retract the button, then that pulls in up to 40mm of suture. Once we've passed through the capsule, we can similarly eject that 40mm of suture like so. In order to pass the suture through the other side of the capsule, we pass the suture cast through the other side of the capsule, extend the jaws, and then use the teeth on the jaws to grasp the suture. So we want to grasp the suture very close to the apex of the jaws, and then retract like so, and pull it through the other side of the capsule. So here we're going to load the end of the fibre link from the loop lock into the suture cast. So we place it like so into the apex of the jaws, and then retract this all the way again. It can retract up to 40mm. We will then come in through the mid anterior portal. Speaker  We're going to grab the capsule just beneath the rectus femoris. So this is the indirect head of the rectus femoris here. And this here is capsule. We grab capsule just beneath the rectus femoris. And this is on the acetabular side. So we penetrate through the capsule here. And then we can inject our suture like so. And then we'll come out with the suture cast. I'm going to come in through the distal anterolateral accessory portal, which gives me a good angle to grab the capsule on the femoral side. We'll come in through the capsule on the femoral side here. And we'll use the jaws to grasp this suture. Like so. And then we pull the suture all the way through. At this point I'm going to bring both sutures into the same cannula. That. My assistant will hold on to the loop lock like so pinching the white tab against the black card. And we're going to pull through the capsule. Hold the scope please, Until we see the end of the loop block here. And at this point we'll cut. So I'll cut the fiber link. So now we take the suture off of the tab one. And we're going to pull out the suture from tab two. And we want this suture to come all the way out of the card out of tab two. And then we pass the end of this suture through the loop. Of the loop block. Speaker  And then we pass it through the wire loop attached to the white tab. And at this point we pull through using the white tab. And now we are about done with the card. And we have these two ends which we need to even up. So we're going to pull tension on that suture until our ends become even. So now with our ends close to even, we put our finger in the middle here and pull on the middle so that we have even everything up. So a pearl to minimize the friction as the loop lock is tightened, is to place a retriever into the joint and to grab the loop on both sides. So we grab the loop here and we grab the loop here. And in this way we are actually setting up a construct where the Friction will be against the retriever rather than the sutures having friction against one another. So we can lock the retriever there and then proceed with tensioning. Tensioning can be performed one suture at a time, or it can be performed with both sutures at the same time. And I'll demonstrate the latter. So let's just hold like that, please. The retriever, our assistant will hold the retriever. And I'm going to tension both sutures at the same time here bringing the mechanism down into the joint. And then when we are near, we will release the suture retriever and take it out and complete the tensioning of our loop lock. Speaker  And that completes the capsular closure in this location. We can now use a closed ended cutter to cut the remaining suture. And the closed ended cutter will pass down right on to the loop block device. So here's another view showing that capsular closure right beneath the indirect head of the rectus femoris, which has been preserved in its entirety. We'll now move on and do a second loop block for demonstration purposes. And it's interesting to note that one option is to put the first loop block in and not tension it entirely. Then pass the second loop block and then tension both sequentially. In this case, for demonstration purposes, we've tightened the first one entirely and we'll now place the second. As I open the suture cast device, note that the jaws actually open side to side in a horizontal fashion rather than vertically. Again, we'll pass the end of the suture from the fiberlink into the jaws. There. The horizontal opening makes it easier to catch the suture without catching capsule. So here we're going to come again through the acetabular side of the capsule and take our bite. And coming inside the joint. We can view as we expel the suture. And then we will come through the femoral side of the capsule. Here. Take our bite. Extend our jaws. And grab our suture and then pull it through. Hold the scope, please. As before, we pass this fiberlink all the way through. Speaker  The capsule until we see the loop lock. We'll cut the fiber link here and now. We will take off tab number two. Take the end of the suture. Pass it through the loop lock, then pass it through that nitinol wire attached to the white tab and then pull the white tab through. That. At this point, we detach from the card. And we even up our ends. So when the ends are all the way, even then we can put a finger in the middle of the loop and make sure we have pulled all the slack out of the loop. And at this point, I'm going to tension this by tensioning both at the same time. And we'll see that that slides the loop lock device all the way down to complete the fixation. And at the end we can do a little bit of tensioning of one and tensioning of the other, cut our ends and. When we pass the closed cutter down, we can actually use it as a pusher and apply some additional tension before we cut. And that completes our repair of this capsule using two loop lock devices. This accomplishes two limbs of suture around the capsule in each of the leaflets. We have an excellent closure, low profile knotless devices. So we do not have not stacks, which can potentially be a place where scar tissue can occur. And we get excellent closure with very high strength and security.

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Meniscal Root Repair Using SutureLoc™ and FiberStitch™ 1.5 Implants

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JUL 22

JumpStart® Antimicrobial Wound Dressing

JUL 21

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NanoNeedle™ Scope 2.0 Gains National Spotlight Through

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