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INFORMATIONSMATERIALIEN FÜR KUNDEN

During Spine Evolutions, Wade K. Jensen, MD (Afton, Wyoming), reviews surgical tips and targeting techniques for the transforaminal approach to endoscopic discectomy.

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Surgical Technique and Tips for Endoscopic Transforaminal Approach During Discectomy

OrthoPedia: Surgical Technique and Tips for Endoscopic Transforaminal Approach During Discectomy

Misty Suri, MD (New Orleans, LA), presents a case of rotator cable reinforcement with biologic tuberoplasty for the treatment of a massive irreparable rotator cuff tear in a 72-year-old male. Dr. Suri discusses his patient selection criteria, simplified technique for combined rotator cable reinforcement and biologic tuberoplasty, accelerated postoperative rehab protocol, and perceived benefits of this procedure.

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Biologic Tuberoplasty With Cable Reinforcement for Massive Irreparable Rotator Cuff Tears

Hi, I'm doctor Misty Suri from New Orleans, Louisiana. I'm very excited to share a case with you of a massive, irreparable rotator cuff tear that I treated with a biologic tuboplasty combined with a cable reinforcement. So our patient is a 72 year old, retired, right hand dominant male. He fell while playing catch with his grandson. He fell on his outstretched arm and his pain was worse at night with attempted forward head activities. He had pain and he wasn't getting better with conservative management. His prior medical history was diabetes, glaucoma and hypertension. His range of motion was pretty good. He did have painful forward elevation. His subscap was intact. His strength was four out of five to his supraspinatus and infraspinatus. His AC joint was tender and his Vas score was 5.5 out of ten, and his pain score was 20 out of 100 on x ray. He did not have significant glenohumeral arthritis. He was a Hamada type one. On our coronal cuts for the MRI, we can see the significant atrophy to the rotator cuff. This would not be amenable to a rotator cuff repair. On our sagittal view here we can see the positive tangent sign with the significant atrophy to the rotator cuff as well. So what are the options for this type of patient? Debridement. Partial repair. Subacromial. Spacer. Superior capsular reconstruction var biologic Tuboplasty plus cable reinforcement or a reverse shoulder arthroplasty due to the patient's preserved joint space. For me, the procedure of choice would be biologic tuboplasty plus cable reinforcement. Combining the biologic Tuboplasty with cable reinforcement allows mean coverage of the greater tuberosity with a cushion, thereby preventing bone to bone contact, and also reinforcing the cable insertion points has been shown to improve shoulder biomechanics. Let's take a quick look at the surgical steps for this technique. Here we are viewing from the posterior portal with our grasper from the lateral portal pulling on a rotator cuff tissue. We can see the rotator cuff tissue is thin. It's friable. It's not of great quality. Not a very substantive in nature, and would be a significant risk for rotator cuff retear in the event of an attempted repair. Now we're debriding and preparing the bony bed of the greater tuberosity, and then measuring the size of the defect and graft to reinforce the cable. We'll use a two millimetres fibertape in a baseball stitch configuration moving from anterior to posterior. The appropriate tension for me is where I can place the fiber tape to exit the cuff in close proximity to the swivel lock anchor site in the greater tuberosity, to secure the fiber tapes at the anterior and posterior margins. We will use the tangible knotless swivel lock anchor. As you can see here, this is viewing from the lateral portal. This is the posterior insertion point right next to the native rotator cuff. There tensioning down that rotator cuff but not over tensioning it. Using the knotless mechanism of the swivel lock, we shuttle the four millimeter thick, pre-cut Arthur Flex graft to the prepared site, and we can see in a ratcheting type motion the graft moving nicely into the defect. Here are some other views. This is a lateral view. And now looking from the posterior aspect we can see the tuboplasty in combination with the cable reinforcement post-operatively. It's an aggressive rehab protocol. We start therapy at about one week after surgery. At three weeks. We're doing active assisted motion, and at six weeks we're doing full active motion and strengthening. And the goal is by three months to be moving the shoulder with a pain free range of motion. Here's our patient six weeks out of surgery, his Vas score has decreased to one. His pain score has increased to 40 and he's quite happy. So my experience so far is I've done 25 patients, have 12 month follow up on average for these patients, with the longest being two years out. We've had significant improvements in pain function and strength. The right patient for me in my hands is a painful shoulder that's non-arthritic non pseudo paralytic, has good range of motion with no advanced arthritis, with an intact or repairable subscap tear. In my practice, the biologic tuboplasty with cable reinforcement has enabled me to manage the challenging problem of a non-arthritic massive, irreparable rotator cuff tear with a cushion using a simple, fast and reproducible technique. As most of these procedures are performed at a surgery center, they're pre-cut. Four millimeter graft makes this a cost effective solution. Last but not least, my patients have experienced significant pain relief, allowing them to progress through my expedited rehab protocol. Thank you.

Biologic Tuberoplasty With Cable Reinforcement for Massive Irreparable Rotator Cuff Tears

Benton A. Emblom, MD (Birmingham, AL), repairs a gluteus medius tendon using a double-row tendon compression bridge.

Endoscopic Double-Row Gluteus Medius Repair Using the Gluteus Medius Repair System

I'm Benton emblem. I'm an orthopedic sports medicine surgeon in Birmingham, Alabama at Andrews Sports Medicine and Orthopedic Center. What we're going to demonstrate today is a partial thickness gluteus medius tendon repair. I see a good bit of these in middle aged women between 50 and 60 that have lateral hip pain, that often complain of discomfort for a year at least, that are treated empirically for gluteus medius tendinitis and or trochanteric bursitis. An MRI typically is obtained and shows a partial thickness gluteus medius tendon tear. These can be easily repaired endoscopically with a 30 or a 70 degree scope from the trochanteric space utilizing knotless suture anchors. We're going to demonstrate the repair of a partial thickness gluteus medius tendon tear, utilizing the 2.6 Knotless gluteus medius Tendon repair Kit. In this kit includes the drill guide and drill. The two anchors knotless 2.6mm the Millimeters the cutter. And in this instance we're going to utilize two additional anchors to create a two row or double row configuration repair. So we're established in the trochanteric space of the hip. This is a right hip proximal distal. Our two portals that we've created so far are a mid lateral portal. This is approximately four centimeters or a finger four fingerbreadths distal to the kind of the mid greater trochanter. And this is our standard anterolateral portal. So what we've done up to this point is we've prepared the trochanteric space by doing a complete bursectomy. We've identified the gluteus Maximus sling right here, which is our distal posterior landmark. And then this is our gluteus medius gluteus minimus muscle tendon complex. And this is the vastus lateralis. If you note the vastus lateralis has a very distinct sheen to it. And it's typically what I call the lighthouse of the trochanteric space. So in some in some cases of partial gluteus medius tendon tears, if the tendon length is pretty short, we'll typically do a single row knotless compression bridge construct and others where the tendon length is more substantial. We'll do a two row where we'll utilize four anchors. In that case, we'll typically develop an X footprint configuration by putting two anterior anchors and two posterior anchors. In that case, we'll take our anterior superior anchor and feed it and couple it with the posterior inferior anchor. And then once that's converted, we'll take our anterior inferior anchor here and convert it and couple it with the posterior superior anchor. So we'll put our first anchor in here. Oftentimes you have to manipulate the leg so that the trajectory of the drill is appropriate to prevent from skiving. So in this case you can notice that this drill guide is aiming somewhat tangentially to the proximal aspect of the femur. So we're going to have our have our assistant internally rotate the femur so that it'll bring the proximal femur a little bit more internally positioned. So we'll put our first anchor in right here which is going to be our anterior superior anchor. This is going to be the knotless 2.6mm FiberTak. So we're going to drill here. And when we insert this anchor we will by hand ensure that we have the anchor started into the pilot hole. And then we'll gently tap it with a mallet. So the backside of the guide will go flush with the handle of the inserter. And you just pull straight back after you've. Gotten the suture undone. And I just do a gentle pull not to try and deform the anchor, but just to make sure that we're well seated in the bone. So now we've established our are proximal posterolateral portal to insert our posterior anchors. So we've placed our most superior anterior anchor and our most inferior posterior anchor. And now we will convert these anchors creating a compression bridge configuration. So we'll take a loop grasper. And what we have to do here is we're trying to take this stitch here and take it to that anchor and that blue stitch there and bring it to this anchor. So what I like to do is I'll take the loop Grasper push the suture somewhat into the field. I'll grab the round stitch here and I'll run over. And I will basically grab the blue stitch here. And pull these out through the anterior lateral portal. And then we'll come back in through our posterior portal, grab our round stitch here and move forward. And grab our blue stitch. Carefully watching the SutureTape down here to make sure that the conversion stitch doesn't unload itself. And now we're going to convert our posterior stitch by converting it through the looped shuttle. We're finishing the conversion. We're sequentially tensioning each limb of the compression. Suturebridge. So we now have a nice tensioned bridge from anterior to posterior. And this is one limb of our x. So now we've placed our other two anchors to create the create the second limb of the X of the two row compression construct. We'll come in with our loop Grasper. And just like we did the first time, we'll grab our round suture and come posteriorly and grab our blue repair stitch. And we'll come back in our posterior portal and grab our posterior round conversion stitch. And then come to the anterior inferior anchor and grab its appropriate repair suture. And then just like in the first limb, we'll convert the knotless mechanism and convert loosely so that we don't over tension one limb of the compression bridge and then sequentially tension that creating a two row compression bridge in an X configuration. So this is our final construct. After we've converted two pairs of the 2.6 Knotless FiberTak creating a x shaped two row compression bridge. You can see here we've got our anterior superior anchor, our anterior inferior anchor with our posterior superior anchor and our posterior inferior anchor. And as our assistant externally rotates the leg, you can see as the gluteus medius minimus complex comes under tension, you can see this configuration remains taut and provides excellent compression of the partial thickness gluteus medius tendon tear.

Endoscopic Double-Row Gluteus Medius Repair Using the Gluteus Medius Repair System

Sanj Kakar, MD (Rochester, MN), shares a surgical pearl for using the NanoNeedle™ scope 2.0 to access the thumb CMC joint.

SpeedPearl: Accessing the Thumb CMC Joint With the NanoNeedle™ Scope 2.0

Speaker  Accurate diagnosis and assessment of the articular surface of the thumb CMC joint is particularly important, for example, in fractures and when managing thumb CMC arthritis. However, this joint is tight. Given its complex anatomy, and so this is perfect for the nanoneedle scope given its lightweight, small and flexible design. The Nanoneedle allows for safe entry into the thumb CMC joint. I typically create the one new portal first and to provide greater working space, the portal is created next.

SpeedPearl: Accessing the Thumb CMC Joint With the NanoNeedle™ Scope 2.0

Seth I. Gasser, MD (Tampa, FL), shares his firsthand experience with the Synergy Power™ system—highlighting how it streamlines workflow within a facility and why it is his preferred powered instrument solution in the OR.

Dr. Seth I. Gasser Surgeon Testimonial: Synergy Power™ System

Speaker  Energy. Power has really changed the way our team works and functions. It's streamlined the work process, including setup times and surgical times with just two hand pieces. It covers our broad range of needs throughout any procedure. It's reliable. Powerful. Versatile. The frequent changes required often during surgery are quick and easy, with a unique design of the hand pieces. It's very easy for the scrub tech to make a quick change. I don't worry about them having difficulty, and my focus is really on the surgery and the patient because I'm confident that the equipment will work as it's supposed to. It provides a balance of comfort and performance. It has a lighter feel. And it's the kind of comfort that really adds up over the course of long, difficult cases. Arthrex has been a leader and innovator as long as I've been in practice over the past 33 years. They've answered all of our questions, guided our setups, trained the staff, and really made sure everything ran smoothly before we started. And this is just another example of how Arthrex has made it easier for me as a surgeon to treat my patients better.

Dr. Seth I. Gasser Surgeon Testimonial: Synergy Power™ System

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

Sanj Kakar, MD (Rochester, MN), shares how the NanoNeedle™ scope 2.0 can aid in visualization during wrist arthroscopy procedures.

SpeedPearl: DRUJ Arthroscopy Using the NanoNeedle™ Scope 2.0

Speaker  The trampoline hook and suction test provide an indirect assessment to the foveal insertion of the Tfcc, which is the most important static stabilizer of the Druj. Given how tight the DJ is, the Nanoneedle provides an ideal indication for its use to examine this space and the Foveal insertion of the Tfcc. Using the percutaneous kit, you can access the DJ in a safe and efficient manner.

SpeedPearl: DRUJ Arthroscopy Using the NanoNeedle™ Scope 2.0

At the Orthopedic Technology and Innovation Forum, John J. Christoforetti, MD (Bethesda, MD), and Benjamin G. Domb, MD (Chicago, IL), review the evolution and application of knotless all-suture anchor technology in hip arthroscopy, highlighting its advantages in reproducibility, safety, and adaptability to the anatomical constraints of the hip joint.

Femoroacetabular Impingement (FAI) and Labral Tears: Literature Review on All-Suture Anchor Outcomes in Hip Arthroscopy

OrthoPedia: Femoroacetabular Impingement (FAI) and Labral Tears: Literature Review on All-Suture Anchor Outcomes in Hip Arthroscopy

The Arthrex ElbowLOC® positioner is a modular, upper extremity positioner that gives the surgeon the choice of supine, lateral, or supine-suspended positioning for elbow surgery, as well as a wrist traction device for wrist and hand arthroscopy. The ElbowLOC positioner is easy to use and set up, and housed in a space-saving single autoclavable tray.

The Arthrex ElbowLOC® Elbow and Wrist Positioner

The Arthrex ElbowLOC® Elbow and Wrist Positioner

The Arthrex Graft Gun features an optimized design for enhanced visualization of graft delivery during minimally invasive and tubular spine surgeries. It is validated to deliver 100% autograft chips.1
Reference
1. Arthrex, Inc. Data on file (APT-1022220). Naples, FL; 2025.

Arthrex Graft Gun

Arthrex Graft Gun

The MaxForce™ MTP fusion system features a unique gear mechanism along the plate, allowing for controlled, dialed-in compression across the joint. Featuring 18 different plate options of varying sizes and curvatures for primary and revision cases and multiple Arthrex plating-screw and cross-screw options to best address patient needs and anatomy, the MaxForce MTP fusion system provides a comprehensive solution for 1st MTP arthrodesis.

MaxForce™ MTP Plating System Features and Benefits Animation

MaxForce™ MTP Plating System Features and Benefits Animation

Julie Bishop, MD (Columbus, OH), demonstrates the innovative bone block cerclage surgical technique for securing a distal tibia allograft to the anterior glenoid for treatment of critical glenoid bone loss. This subscapularis-sparing arthroscopic cadaveric demonstration shows the procedural steps and technical pearls for safe and reproducible metal-free fixation of the bone graft using interconnected FiberTape® cerclage sutures.

Bone Block Cerclage With Distal Tibia Allograft Surgical Technique

Bone Block Cerclage With Distal Tibia Allograft Surgical Technique

The BioACL™ technique augments ACL reconstruction with an unmatched combination of the patient’s own biology, the highest-quality biologics, and the proven technology of the QuadLink™ technique with the InternalBrace™ procedure to maximize healing potential.&nbsp;
 
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-to-bone fixation.

BioACL™ Technique Animation

The bioassay technique enhances ACL reconstruction by integrating next generation Orthobiologics to improve functional outcomes and reduce tunnel widening. Begin by performing a bone marrow aspiration from the proximal tibia, which will be processed using the Angel system. The Angel system uses proprietary 3D sensor technology to develop a customized, patient specific formulation of CRP from BMA. Prepare for Autograft bone collection by connecting the Graphnet device to suction and an arthroscopic shaver. Identify the desired femoral tunnel location and advance the flip cutter three reamer. Introduce the arthroscopic shaver with the graphnet tissue collector attached into the joint and ream the femoral socket while collecting bone debris, The autologous bone debris will be collected in the graphnet sterile chamber. This autologous tissue is highly viable, demonstrating osteogenic significant capacity. Transfer the collected autogenous bone to a sterile dish and add five cc of pure demineralized bone matrix. Titrate three cc of c PRP from BMA prepared with the angel system into the dish. The bio composite mixture is complete and ready for delivery. On the back table, prepare the quad link ACL graft. Elongate the femoral tightrope to ensure the quad link ACL graft sits outside the joint after passing the femoral tightrope button. This positioning allows clear visualization of tunnel fill. The tightrope two implant is preloaded with fiber tape. Suture for the internal brace technique. Begin ACL graft passage by pulling in the femoral tightrope button through the socket and flipping onto the cortex with the elongated femoral tightrope. The quad link ACL graft should be sitting outside the joint from the medial portal, insert the delivery cannula preloaded with the ACL composite and completely fill the femoral tunnel, then move to the lateral portal and deliver the composite into the tibial tunnel. The bio composite graft compresses around the quad link ACL graft. Fully filling both tunnels with this composite has demonstrated a reduction in tunnel widening. Post reconstruction. Fully seat the quad link ACL graft into both femoral and tibial tunnels. Complete internal brace. Final fixation in full extension. After cycling the knee several times, complete femoral and tibial tightrope. Final tensioning.

BioACL™ Technique Animation

The Arthrex Knotless 1.8 FiberTak® soft anchor is our smallest knotless anchor option. This animation demonstrates the unique tensionable knotless technique for arthroscopic glenohumeral joint instability. With a curved guide and 1.8 mm flexible drill, use the Knotless FiberTak soft anchor to create a small, low-profile knotless repair.

Shoulder Labral Repair With the 1.8 Knotless FiberTak® Soft Anchor

The Arthrex knotless FiberTak soft suture anchor is designed with a unique tension able knotless technology, allowing the user the ability to control and tension the repair under direct visualization. A curved guide is introduced through a cannula. After locating the position on the bone surface. A flexible 1.8mm drill is introduced to create the bone socket, leaving the guide in place. The knotless FiberTak anchor is inserted and impacted until the handle is flush with the guide. Remove the handle and drill guide, leaving the number two repair suture and two shuttling suture. Set the anchor by grasping all suture limbs and pull at a slow, consistent pace until the anchor is firmly set in bone. Retrieve the repair suture through the anterior-superior cannula with a suture retriever. Using a QuickPass SutureLasso, pass a nitinol wire loop through the labrum. Retrieve the wire loop and insert the repair suture through the wire loop. The wire and suture are retracted back to the tip of the lasso and shuttled through the tissue. Retrieve the repair suture and the looped end of the two shuttling suture. Load the repair suture through the suture loop. Fold the repair suture limb at the indicator mark on the suture. Pull the tape end of the shuttling suture to shuttle the repair suture. Use repeated light tugs to pass the repair suture through the knotless mechanism. Continue to tension the repair suture until the desired repair is achieved. The suture tail is cut flush, creating a secure, low profile knotless repair.

Shoulder Labral Repair With the 1.8 Knotless FiberTak® Soft Anchor

At the Orthopedic Technology and Innovation Forum, Paul Brady, MD (Knoxville, TN), discusses key diagnostic and surgical principles for managing subscapularis tears and associated biceps pathology, emphasizing improved visualization techniques, knotless anchor repair methods, and strategies to optimize healing.

Managing the Subscapularis and Biceps Tendon

OrthoPedia: Managing the Subscapularis and Biceps Tendon

What's NewMAY 16

OrthoPedia: Surgical Technique and Tips for Endoscopic Transforaminal Approach During Discectomy

What’s New This Week and Prior

MAY 15

Biologic Tuberoplasty With Cable Reinforcement for Massive Irreparable Rotator Cuff Tears

MAY 14

Endoscopic Double-Row Gluteus Medius Repair Using the Gluteus Medius Repair System

MAY 13

SpeedPearl: Accessing the Thumb CMC Joint With the NanoNeedle™ Scope 2.0

MAY 12

Dr. Seth I. Gasser Surgeon Testimonial: Synergy Power™ System

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