Name: Total Shoulder Arthroplasty (TSA) Subscapularis Repair Using FiberTape® Suture Tendon Compression Bridge Kit
Uploaded: 2018-05-17T00:00:00Z
Channel: Arthrex
Description: Patrick J. Denard, MD, (Medford, OR) performs a subscapularis repair using the FiberTape® tendon compression bridge kit.

<p>Patrick J. Denard, MD, (Medford, OR) performs a subscapularis repair using the FiberTape® tendon compression bridge kit.</p>

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VID1-01254-EN | B | Total Shoulder Arthroplasty (TSA) Subscapularis Repair Using FiberTape® Suture Tendon Compression Bridge Kit

Patrick J. Denard

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A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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Surgical Technique Videos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

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Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

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Total Shoulder Arthroplasty (TSA) Subscapularis Repair Using FiberTape® Suture Tendon Compression Bridge Kit

This is the FiberTape tendon compression bridge kit. Here we have a FiberTape and a TigerTape. The two ends of each suture are wedged together with a large needle, and on the other end there's a pre fashioned half racking suture, which is pre-placed with a nitinol wire for suture passage. There's two millimeter drill to pass the sutures through bone tunnels. There's two number two fiber wires, which can be used for tagging soft tissue and also for rotator interval closure. There's a free needle with a nitinol wire as well. And then finally, this is a separate reusable instrument which is a suture tensioner. The FiberTape tendon compression bridge can be used in many situations. Here we're going to demonstrate using this in a standard length stem. We have a osteotomy of the lesser tuberosity which has been created. And then I've previously broached the humeral canal. The first thing we need to do is drill two holes in the bicipital groove, superiorly and inferiorly. And I'm going to draw one hole medially medial to the tuberosity osteotomy. In the case of a colorless stem, you want to drill two holes. But again, in this case we're using a stem. So we're going to drill one hole here immediately. So first we're going to drill our superior hole in the bicipital groove. This is a two millimeter drill. We don't want to drill a second hole in fairly in the bicipital groove. And then again medially medial to the tuberosity. We're first going to pass our inferior suture from lateral to medial. We're going to go through the bicipital groove hole first. And then we'll go through our hole that is medial to the tuberosity. We want to remove the slack from the suture so that this flag sits flush down against the bone. And we need to unwind the suture from the flag. But we need to make sure it stays on this dowel as it goes down. Now we're going to pass the TigerTape through the superior hole alone. The medial aspect of this is going to go around the stem. Again, we unwind from the flag and deliver the dowel down to the bicipital groove. But making sure the suture stays on the dowel. Now we want to place the stem, and we want to make sure those sutures go posterior to the stem. So here are the stems delivered into the canal. And we want to make sure all the slack is removed from the system. I'm going to start inferiorly with the FiberTape and then superiorly with the TigerTape. The stem is locked into place and then we'll place our humeral head. An option at this step is to provisionally close the rotator interval. The next step is to pass our sutures medial to the tuberosity. We're going to first pass the FiberTape inferiorly. We're going to go just medial to the bone. This is followed by our TigerTape superiorly. We then remove all the slack. And then we can cut these limbs apart so they're separated. Now that we have these sutures passed we want to deliver these through our half racking hitch. We use the nitinol loop to do this. We're going to pass a superior one first. And the suture ends are tapered so they can be delivered through the flag. Here you can see the dowel and the nitinol wire were removed as I pull those through. And then we'll repeat that process inferiorly. Once these sutures are delivered through the half racking hitch. I can alternately tension and reduce the osteotomy down. I'll first do this by hand. Once I'm happy I've removed provisional slack, I can remove the remainder of the slack in the system with this suture tensioning device. Suture tensioning device has two holes here for the sutures. So we deliver one suture through the hole, and then the second suture can go through the slot. We want to wind these sutures around the thumb pad. One suture on each side. We can then hold the thumb pad and turn the handle clockwise. As we wind this handle We'll see the slack being removed from the system and the suture tightening down there. We can see it sucking in very nicely. At this point. We want to place half racking hitch to lock the suture in place. The placement of one of these allows us to secure the construct. And we can also retention at this point, if we'd like, we then move superiorly again. We can see the slack being removed from the system, and the tuberosity is nicely reducing to the bone. We go to we're satisfied that all the slack is removed. Once that slack is removed, we can back it up with a half hitch. And at this point we can retention if we'd like, inferiorly. Or we can secure the final construct with another alternating half hitch. The limbs are cut short. We can close the rotator interval. At this point I tend to close the rotator interval in all cases. And if we do this with a slight external rotation, we do not find that it limits external rotation Postoperatively. Additionally, it provides support for the subscapularis repair. So here you can see our final FiberTape tendon compression bridge repair. You can see its efficient low profile. All the slack is removed from the system. In this case we did an osteotomy and we can barely even appreciate that line after completion of the repair, because we've been able to remove all the slack from the system. One of the nice things about this repair is it can be used with a variety of implants, whether that's a standard length stem, a short stem, or a stemless device. It can be also be used with a variety of approaches to the subscapularis, including a subscapularis peel or an osteotomy, as we did in this case.

Total Shoulder Arthroplasty (TSA) Subscapularis Repair Using FiberTape® Suture Tendon Compression Bridge Kit

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