Name: SpeedBridge™ Rotator Cuff Repair Cadaveric Demonstration
Uploaded: 2014-05-30T00:00:00Z
Channel: Arthrex

Stephen S. Burkhart, MD, (San Antonio, TX) uses knotless BioComposite™ SwiveLock® with FiberTape® to complete a strong, low profile, double-row supraspinatus repair that reconstructs the rotator cuff footprint and maximizes contact between the tendon and bone. He demonstrates the use of FiberLink® sutures to address potential dog ears. Dr. Burkhart also highlights the use of the side-loading FastPass Scorpion™ SL to easily pass and retrieve sutures and uses a PowerPick™ to prepare a bleeding bone bed in the rotator cuff footprint.

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VID1-00133-EN | A | SpeedBridge™ Rotator Cuff Repair Cadaveric Demonstration

Stephen S. Burkhart

Human

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.

Operationstechnikvideos

Surgical Technique Videos

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

Vídeos de técnicas cirúrgicas

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

Videos de técnicas quirúrgicas

SpeedBridge™ Rotator Cuff Repair Cadaveric Demonstration

All right. Well, I'm going to show you some of the instruments we're going to use here. So we've got a SpeedBridge kit here. It comes prepackaged with a four anchors that you need. It's got a disposable punch. This is a PowerPick the standard PowerPick. There's also now an XL PowerPick with a longer tip to it. But this is for making your little bone vents sort of microfracture bone vents in the tuberosity. This is that triple damn cannula. It's got this side stopcock here, but it doesn't have a cap that goes over it like the older cannulas. And because of the triple dam configuration inside, it doesn't tend to squirt. Here's a passport cannula. We used a couple of these as we were preparing. You'll see those in some of our portals. This is a TigerLink for passing sutures. If you want to pass everything through a single point you shuttle sutures through. Or the other thing we use it for is making that cinch loop where you pass it through, and then bring the free tail through the loop and it comes down and forms a forms a loop like so. This is our fast pass Scorpion. If you look at the lower jaw here, you see its side loads instead of loading in the front. What happened with that forked lower jaw is that sometimes that would tend to catch on other sutures, or it would catch on a flap of tendon. This one doesn't tend to do that because it has that bullet nose to it. Of course, it has the trap door on the top to capture the suture as your needle comes back down, and it'll catch it in that upper jaw. So this is a right shoulder. We've got a posterolateral viewing portal and a posterior portal, which is always where I start. But then I made a posterolateral so you can see better. This is my lateral working portal. And then I've got an anterior accessory working portal here too. And then we have two accessory lateral portals and needles in one. And then where the sutures come out from the other accessory lateral portals for just placing percutaneous anchor insertion. So I'm going to go ahead and start out putting my scope in this posterolateral portal. We've made a crescent shaped tear here and we've placed our posteromedial anchor already. You see, here's our articular margin. We'll place an anteromedial anchor up here. Now, before we do that, we're going to make a couple of events with our PowerPick. It's probably not the best angle always to come in this way because it's pretty oblique. So sometimes I'll use one of these accessory portals, but you've got to maintain traction on those sutures. And now we come in at a little better angle. I don't like to make a lot of holes, and you want to start it spinning before you bring it down so it doesn't tend to walk. I'll usually just put 2 or 3. I don't think you need to put a huge number of these in, but just to kind of show you how that works, because your anchors are vented and you're going to get some marrow elements coming up through the vents in your anchors. So the next thing I'm going to want to do is we're going to place our anteromedial anchor. So I've got a needle up coming just adjacent to the acromion. Here's our articular margin. I'm going to want to go right at the articular margin, and then we'll bring our punch in. Okay. Pull the needle out now and just go ahead and make a hole there for me. Hit that. We're going up to the SwiveLock. We're going to go with the SwiveLock immediately. Okay. So now we'll pull that out. So we'll go straight down there now. So you tap it to your first threads hit. Then you hold this thumb pad on the outside and go ahead and turn it. You turn it till you bury the hole anchor. Now I'm going to want to turn my thumb pad clockwise. But first I've got to unwrap these sutures from the thumb pad so they don't twist around the shaft of this thing. I'm going to turn up my thumb pad clockwise. And what that does, it backs that sleeve off so I can see if my anchor is slightly countersunk like I like it to be. And it is. So now we'll just undo that. So we'll take that safety stitch out, and now we'll just take our driver off on the anterior one. Also we'll take out our safety stitch. We don't need that. So this FiberTape retriever has that radiused post to it. So it pulls these sutures out with very little frictional effect relative to standard suture retriever. So that's what you want to use with FiberTape. And now we load. This is a side loading Scorpion. So you see you don't have to activate that needle or do anything special with your trigger. You just put it in that slot and then you go ahead and place your suture. And so we're passing both of these at once. Now I like to go about 2 or 3mm lateral to the muscle tendon junction. So we're going to come out to about there. We'll capture that. So now we'll take the slack out of that. And so what I want to do then is bring these back up top. So they'll be out of my way and I can work with my other sutures. And now we have that merged in. We're going to cut that off. So now we have two separate tails. And now we'll do the same thing with our tiger tapes in the front. We'll bring these out and we'll pass them. We'll have to load these into our fast pass Scorpion the side loading lower jaw and we'll go. About 2 to 3mm lateral to the muscle tendon junction. Pull that through and let's pull it up. And then once again we'll cut off that merged end. What we're going to do next is we're going to load a FiberLink onto our Scorpion. There's a loop on the other end. Remember that one? We're going to be able to make a cinch loop out of it. So the dog ears tend to occur just posterior and just anterior to our four anchors here. And this also is roughly where the rotator cable attachments are. So I'm going to go back here. And this is just basically a single row pass back where the dog ear would be. Okay. So now you see how we pass the free end through the looped end. And so I'll pass that through one of our accessory percutaneous portals. And then we'll do a dog ear reduction stitch in the front. So now you've got our cinch loop in the front. Next we'll have our tape retriever. And what I want to do is I'm going to go ahead and put our anterolateral anchor in. So we'll take one tape from each of these pairs. And then we'll get a tape from the posterior pair. I like to use a rigid cannula when I'm placing my lateral row. Because you see what I'm doing I use this plastic cannula like a guide. And I can see how does that fit down there the best without any dog ears. And it's just right there is perfect. So let's go ahead and punch a hole right there. I'm maintaining some traction so that I keep the sutures out of the way of that punch. And we're going to go ahead and punch a hole right there, and we punch down to the SL. Okay, good. And now while that's still in there, we'll go ahead and load our sutures into the eyelet of our other SwiveLock here. Okay. So what you want to do? You want to tension these before you get it down there. And that will help to get your anchor eyelet straightened out, too. And I'm going to bring it down to the hole. And now just tap that in there. So now we turn that in. Go all the way down. And hold the handle of the inserter while I turn the thumb pad clockwise. And you see it's slightly countersunk, which is where I like it. We don't have any dog ears left in the front, so I'm going to go ahead and take that safety stitch out here. Okay. And then we'll just take our inserter out. And now we'll load up our tape cutter. Okay. So now we're going to take these other two remaining tapes. And then the remaining cinch loop. Now what we can do is change our rotation and our abduction to get it where we want to. So can you see how that gives me a little bit better view here. And I'd like to go probably right about there. Yeah. That's going to be just about right. Go to the second mark. Okay. Good. So even these limbs up by cutting them off makes it easier to load that way. We have this orange tab that helps us to load it through the eyelet. We can load all three at once. Okay, so take out the punch. Individually. Tension those. Hold them all three tension together and we'll push it down in. You hit it till the first thread comes down to the bone. Hold the thumb pad. Turn the handle of the inserter. I'll turn the thumb pad. We're slightly countersunk, which is where I like it. Take out the traction stitch. Now we'll take out the inserter. Now we'll cut the tapes. And then we'll come on down. Cut these. All right. So now we want to look at it. And you see how we've got a nice footprint. No dog ear in the front. No dog ear in the back. And that looks about perfect. And generally perfect is good enough.

SpeedBridge™ Rotator Cuff Repair Cadaveric Demonstration

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Scorpion™ Suture Passers

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SpeedBridge™ Double-Row Technique

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