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Die 2.6 FiberTak®-Softanker-Technik

Die 2.6 FiberTak-Softanker sind als mit SutureTape 2-fach und 3-fach geladene Anker verfügbar, die mit einem geführten Applikationssystem und einer/m 2.6 mm Bohrer bzw. Pfriem ausgestattet sind, um das Loch im Knochen zu minimieren. Diese Anker bieten die Vorteile, klinische Erfahrung und die Produktunterstützung von Arthrex, die Operateure zu schätzen gelernt haben.
Der knotenlose 2.6 FiberTak-Anker umfasst einen spannbaren knotenlosen Mechanismus, der die Steuerung und Anpassung der Fadenspannung unter direkter Darstellung ermöglicht.

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

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All-Suture Anchors for RCR

Patrick J. Denard, MD (Medford, OR), demonstrates how to use 2.6 FiberTak® RC anchors and 4.75 mm SwiveLock® anchors to complete a knotless double-row FiberTak SpeedBridge rotator cuff repair.

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FiberTak® SpeedBridge™ Rotator Cuff Repair

Today I'm going to demonstrate a rotator cuff repair using the FiberTak SpeedBridge construct. Laterally we're going to use the Knotless SwiveLock anchors our workhorse anchor. Medially we're going to demonstrate the Self-punching two six FiberTak RC anchors. These anchors have a fixed FiberTape with joined tails to simplify suture passing. This is a self-punching version that can be placed with or without a guide. You can utilize the laser marks adjacent to the bone for placement without a guide or laser marks more proximally. When it is placed with a guide, this self-punching aspect is very nice because it simplifies the steps for rotator cuff repair. So here we have a right shoulder. This is a large rotator cuff tear. In my mind, this is a tear that's amenable to a three anchor medial row repair. And I like the FiberTak RC anchor because this allows us to place three anchors with minimal violation of the footprint. So we can maximize footprint contact area without violating the bone as much as compared to hard body anchors. Here's our anterior anchor placed adjacent to the articular margin through an ASL portal. Next we're going to place a middle anchor. We're going to use a self-punching aspect to this to save steps. You can see the depth is marked on the inserter to confirm appropriate depth of placement. We can also set the anchor by gently pulling the tapes to bring the sheath up against the bone. Finally, we're going to place our posterior anchor through a percutaneous portal. In this case, we will use a guide. A spinal needle is used to determine the adequate angle of approach. We make a stab incision to help introduce the guide. And now we're going to reference the marks closest to the handle to confirm adequate depth of insertion. At this point we have all three middle row anchors placed. And we have the option of incorporating the suture tapes within each anchor sheath. But in this case we're going to go with an entirely knotless construct. So we remove the suture tapes leaving us with three sets of fiber tapes, one from each anchor anterior, middle and posterior. And you can see these are color coordinated to really help distinguish them in the joint. Next we're going to pass these sutures through the rotator cuff. So we retrieve a FiberTape out the lateral cannula. This FiberTape has joined tails so that it can be loaded onto the Scorpion and allow a single pass of both limbs simultaneously through the rotator cuff tissue. I like to pass from posterior to anterior once the suture is passed, we want to retrieve this out. The same portal used for anchor placement. We'll then move to the middle anchor and pass the sutures in the same manner. Finally, we retrieve the FiberTape from the anterior anchor and pass those through the anterior aspect of the supraspinatus tendon. Now we have all three sets of FiberTape pass through the tissue anterior, middle, and posterior. Next, we need to cut the ends of the FiberTape to separate the two FiberTape limbs. We retrieve one of the limbs from the anterior anchor out the ASL portal. The other limb is left out the lateral portal. We then need to retrieve one limb from the middle and the posterior anchor. We're first going to place our posterolateral anchor. We'll insert the punch to the laser line. The sutures are loaded through the eyelet of the swivel lock, and while hovering the eyelid above the socket, we will remove all slack from the construct. We will then insert the anchor. We use a FiberTape cutter to cut the sutures adjacent to the anchor. Now we're going to retrieve all the remaining limbs out the lateral cannula and place the anterolateral anchor. We punch to create our socket. Again, all three tapes are passed through the eyelet of the knotless SwiveLock, and with the eyelet above the socket, remove the slack from the fiber tapes. Once the slack is removed, we insert the anterolateral anchor. So here are our Knotless construct is completed, but we're going to assess the anterior cable. We want to reinforce that anterior cable, which is really important. Biomechanically. So we're going to cut those FiberTape limbs. And with this Knotless SwiveLock, we're going to retrieve the repair stitch and pass this through the anterior cable outside the shoulder. We're going to load the repair suture into the loop, and shuttle the loop through the body of the anchor to engage the knotless mechanism within the SwiveLock anchor. You see, this is going to nicely reduce the anterior cable. And while tensioning this I like to use an instrument such as a post cutter to provide a counter force to the bone or anchor as we tension the knotless mechanism. Here's our final repair. Viewed through a posterior portal, you can see we have three medial anchors taken out the two lateral anchors and a knotless construct. This construct allows us to get broad compression across the footprint, which is nice for a large tear such as this rotator cuff tear. Thank you.

Gautam P. Yagnik, MD (Miami, FL), performs a SutureBridge™ double-row rotator cuff repair in this cadaveric demonstration. The self-punching 2.6 FiberTak® anchors, preloaded with SutureTape, are passed, tied, and secured laterally with 4.75 mm BioComposite Knotless SwiveLock® anchors. Dr. Yagnik completes the repair by securing a posterior dog-ear with the tensionable knotless suture from the lateral Knotless SwiveLock anchor.

SutureBridge™ Repair With Self-Punching 2.6 FiberTak® and Knotless SwiveLock® Anchors

Here we are today. We've got this fairly large sized rotator cuff tear. This is a left shoulder. We're in the lateral decubitus position. We're going to demonstrate our rotator cuff repair using our Self-punching 2.6mm FiberTak anchors. The footprint of these anchors is very small. It's only 2.6mm. Traditionally with our techniques, because of the larger anchors, we've only usually put two anchors. But with these smaller footprint anchors, I like to spread out my anchors. And a lot of times I can get three anchors here on the medial road, which I think helps to distribute some of the load, take some of the tension off the repair, and bring in our Self-punching 2.6mm double loaded FiberTak anchor. Once we've brought the anchor into the shoulder, you can see it has this nice sharp tipped inserter. It really grips very nicely onto the bone here. We can go ahead and place our first anchor. I like to place the first anchor anteriorly as close to the articular margin as I can. So we'll go ahead and impact this now into the rotator cuff footprint. And you can see that our laser line. This broad laser line is coming down. And this will tell us, once this gets flush to the bone, that we've reached the appropriate depth for the anchor, remove the inserter. Now, there's a couple of features of this anchor that I like a lot. The self-punching nature. We have a nice small rectangular slit here. Not a big broad round hole. Helps our anchor grab the bone and really gives really solid fixation. Pull up on this very gently with a little bit of firm pressure, just to make sure we seat the anchor. These are double loaded sutures, so for this technique we'll only need one of the sutures. So we'll go ahead and remove the black and white suture and leave our blue and white suture for our first anchor. I like to work anterior to posterior. So I'm going to grab this first suture limb. I'll have my assistant grab the other limb because remember these are sliding sutures. So I'm going to go ahead. Bring this out. Now load that up on a Scorpion. And then what we'll do is we'll bring this we'll pass this through the cuff and we'll retrieve it out the anterior portal. The Scorpion is nice. Kind of pull on the tissue and see where I want to place this suture. I want to make sure in this case, we did not release the biceps. So I want to make sure I don't grab my biceps and pass my suture. I'll retrieve this out the lateral portal, and then we'll go ahead and retrieve that second suture. Load this up in the Scorpion. Bring this in and we'll pass this again. Check for our biceps. Place this stitch right next to our first stitch. Working again anterior to posterior for good suture management. I like to park everything out. The answer portal. Now we can. At the end, we will go retrieve these sutures and tie them down a nice horizontal mattress fashion. You localize it again with the spinal needle. This anchor we're going to use drill guide Inserter. Bring this in through that percutaneous portal. This allows you to place your anchor again. This is a self-punching anchor. No need to drill or punch this anchor, but the guide does help prevent the anchor from catching on any soft tissue. So we're going to go ahead and bring our anchor down. Remember, this is a self-punching anchor and our key for our depth of insertion here is this broad laser line that's proximal. So we'll go ahead and we'll start impacting this anchor. Until we get down to that laser line that way we know we've placed the anchor the appropriate depth. So I give a little tug here just to make sure we set the anchor. And you can see here I'm pulling up, you know, with a pretty significant amount of force. And we're moving the whole humeral head. So really nice fixation for this second anchor. We're going to go ahead and remove the blue and white stitch and leave our black and white stitch behind. Check our placement here. And we're going to be tying our horizontal mattress stitches here. We have room for one more anchor. And you can see on this tear we actually need that additional anchor in order to repair the posterior aspect of this cuff. We're going to go ahead bring our anchor down. Once we get it in the appropriate position. My assistant is going to go ahead and mount this into the humerus. Once again we have we're watching for this broad insertion line. Once that gets flush anywhere on the bone, we can go ahead and remove our inserter. Again, for this one, our last anchor that we placed was the black and white stitch. We're going to go ahead and remove the black and white stitch and leave our blue and white stitch behind. Just suture management. We have our suture tapes passed through the terror. This was a large tear. We've used three anchors medially. We're going to go ahead and retrieve these sutures. We placed our anchors anterior to posterior. But I like to tie posterior to answer. So we're going to go ahead and retrieve these blue and white sutures from the posterior anchor. First finish tying this knot down I really like the SutureTape and knot stacks are very low profile. Lay down very nicely after we tie this knot here, I like to use alternating half hitches. We'll go ahead and save these as we're going to bring these down into our lateral row anchors. So now we have our all three of our row anchors have been placed and tied. You can see we have nice compression nice repair of our rotator cuff tissue down to the rotator cuff footprint. So now we've retrieved one suture from each anchor. Our lateral portal here we've placed it through our SwiveLock and we're going to go ahead and place our lateral row. Anchor brought our punch down here. So we've colored the tip of our punch here. Purple helps us find our hole for the anchor. So go ahead and punch to the second line. And you can see we have this nice marking here. Localizes our spot for our lateral row anchor. Go ahead and bring this in. Bring the tip of the anchor into that hole. We check our tension. If we think we have a little bit too much we may get a little bit off. We don't want to over tension our repair. So with the eyelet out of the hole we go ahead and remove all the tension. Insert our anchor. This is the new knotless SwiveLock with the tension able central suture. Now and cut the suture tapes. But we'll leave our central sutures in case we have a dog ear. Once again, we marked our punch with a marker just so it's easier to find. So go ahead and remove any tension. Here's our final repair construct. We have three medial row anchors placed. We have two lateral anchors. And we still have retained here our central suture in case there's any dog ears. So we're looking here at our repair. And we see posteriorly we do have this small dog ear. And so the way we're going to address this, we're going to take our repair stitch from our lateral row SwiveLock which is also part of our knotless construct. And we're going to pass this through this dog ear and we're going to repair it. So we're going to first retrieve this stitch out the lateral portal. Load this up into our Scorpion. So bring our Scorpion in. Sneak under this little dog ear right here. I'm going to pass our suture and retrieve it out the same lateral portal. So now we have our suture pass through our dog ear. We're going to retrieve both ends of the shuttle stitch out the lateral portal as well. We're going to feed the repair stitch through the shuttle loop and fold it over at the purple mark. And now through this lateral portal we're going to go ahead and complete our knotless mechanism. And so this allows us to dial in our repair here and secure this dog ear. And once we get the appropriate tension cut the suture. And for the final part here, since we don't have any anterior dog ear, we're going to go ahead and unload our shuttle stitch. And then we need to cut our passing suture. So this is our final construct. You can see that we have a nice double row repair, excellent compression of our rotator cuff tendon down to the rotator cuff footprint.

Orthobiologics

Darren A. Frank, MD (Pittsburgh, PA), discusses his experience fixating ArthroFlex dermal allografts with Knotless 2.6 FiberTak® and Knotless SwiveLock® anchors to augment partial- and full-thickness rotator cuff tears.
ArthroFlex is a registered trademark of LifeNet Health.

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Rotator Cuff Augmentation With ArthroFLEX® Dermal Allograft

Hi, my name is Darren Frank from Pittsburgh, Pennsylvania. Today we're going to talk about dermal allograft augmentation of rotator cuff repair with ArthroFLEX dermal allograft graft. Augmentation of rotator cuff repairs has increased in popularity, with multiple options available including allograft and xenograft options. My experience primarily has been with the ArthroFLEX dermal allograft and augmentation of rotator cuff repairs. There are really two applications that I use this for in my practice. The first is augmentation of formal repairs with tenuous or poor quality tissue. The second is augmentation of partial or interstitial tears that are not significant enough to require formal takedown. The rationale for using the dermal allograft in these cases is using a biologic tissue to reinforce the native tendon, which may be of poor quality or partially torn. The first case is a 54 year old, right hand dominant gentleman with a one year history of right shoulder pain. He did have a history of previous right rotator cuff repair in 2000. He had acute aggravation of his pain within the last two months with weight lifting activities. He complained of night pain and difficulty with overhead activities. On exam he had decreased range of motion zero to about 90 degrees of forward elevation. Passively his motion was normal with discomfort. He had weakness, particularly in forward elevation. Three out of five. Forward elevation. Strength with a positive drop arm sign. He had positive provocative maneuvers as well. A representative MRI cut here shows post-surgical changes with some artifact from the previous anchors in his humeral head. There was an obvious full thickness recurrent tear with some tendinopathy seen of the retracted tendon stump medially. The patient desired surgical management. I thought that was appropriate. Having failed a conservative course, we offered him an attempted arthroscopic revision. Possible dermal allograft augment or superior capsular reconstruction if the tendon was irreparable. So this is a right shoulder lateral decubitus position. You can see the tendon stump fully torn. There's some interstitial tearing and some delamination. We're going to use a standard SpeedBridge technique with two medial anchors. These 4.75 SwiveLock anchors are loaded with knotless mechanism at the core instead of the usual sutures. So we'll place both of these anchors medially, and you can see the knotless sutures exiting from the core. We'll pass the tapes in the usual fashion through the tendon medially, Just anterior to the anterior most tape. We're going to pass a FiberLink suture for shuttling of the core sutures, which will be used for our medial fixation of the graft. This is the same process happening posteriorly. The white tape can be seen in just posterior to that. We're going to pass a link for shuttling. The sutures are passed through separate passes in the tendon medially to avoid any tangling. Once we have all the sutures passed, we're going to create our bridging construct in the usual fashion. We'll place two additional anchors, one poster laterally and one anter laterally to complete our bridging construct. Once this portion of the repair is complete, we will begin sizing our dermal allograft. You'll be able to see the knotless sutures as they exit, just posterior and just anterior to this construct. At this point, we'll use a measuring device through the posterior portal, and we'll measure the dimensions of our graft, which will then be prepared outside the cannula. These medial knotless sutures will provide our medial fixation of the graft. So here the graft is delivered in the subacromial space. We tension the anchors medially, and then we'll fix the graph laterally with additional anchors using the links in the corners. Care is taken to tension this graft over the underlying repair. These are 3.5mm SwiveLock anchors used for our fixation laterally. And this is an optional portion of the technique. We're using the remaining sutures from our medial anchors to get some compression over the graft. This is just anchored down using a 2.9mm PushLock to give you some additional compression of the construct. So when that's complete, we have a nice repair. The tenuous tissue is augmented with the dermal allograft viewed from posteriorly as well as from the lateral arthroscopy portal. This particular patient is about three months out from his surgery. Currently he has full active range of motion, which is a significant improvement from his 90 degrees of forward elevation preoperatively. He has minimal to no pain, and he has excellent rotator cuff strength that grades five out of five going into the strengthening phase of his formal therapy. The next case is going to be an example of a partial thickness tear that failed non-operative treatment that we augmented with a dermal allograft in a trans tendon fashion. This is a 54 year old right hand dominant female with a chronic history of right shoulder pain. She had undergone multiple rounds of non-operative care, including rest and activity modification. She had two cortisone injections with physical therapy and failed to see significant relief. She continued to have refractory night pain pain with overhead activity. She had weakness in forward elevation that graded four out of five. Rotational strength was normal. She had discomfort with impingement maneuvers. Her MRI showed a partial thickness tear with interstitial tearing of the tendon. Here's a representative cut of her MRI. You can see the partial thickness tearing, particularly on the bursal side. She desired surgical management. I thought that was reasonable. Having failed a conservative course, I offered her arthroscopic repair versus debridement. We talked about the possibility of augmenting the partial tear with the dermal allograft after debridement. So this is also a right shoulder lateral decubitus position. You'll see debriding the undersurface of the rotator cuff. There's not a significant amount of footprint uncovering from this vantage point. These are 18 gauge spinal needles that I'm going to use to assess the width of the footprint. These are brought in through the tendon and then just brought out slightly laterally and docked in the humeral head. You can see up in the subacromial space, there's our two spinal needles, one anteriorly and one posteriorly that we've placed. We're going to breed the bursal sided tear and see that while there is some partial thickness tearing, it is not a substantial tear requiring take down and formal repair. We're going to replace the spinal needles with our anchors. These are 2.6mm knotless FiberTak anchors. They're placed through the tendon and into the bone. The guide can be pressed down through the tendon onto the greater tuberosity, and the anchors are passed without difficulty. The scope can be placed into the joint to ensure that there's no encroachment on the articular surface. And there is none visualized here. Ensuring that our anchors are up on the greater tuberosity. We're then going to measure our dimensions and anterior to posterior and medial to lateral. The graft is then prepared outside the cannula and delivered in a similar fashion to the first case, fixed medially with our knotless suture construct, and with links and additional anchors laterally. Viewing the Viewing the construct from the posterior portal as well as the lateral portal. You see excellent tension over the partial thickness tear and a satisfactory augmentation. This particular patient is over two years out from her surgery. We followed her at regular intervals for about six months. At her last visit, she was pain free with full function and was very happy with her outcome. This is a second look of a full thickness tear that was augmented with dermal allograft. You can see some mild fraying of the native tendon medially, but excellent integration of the allograft onto the underlying repair. This is at about four months after surgery, so the dermal allograft can be used as an augment to rotator cuff repair. It is bio integrative. I'm using it in repairs with poor quality tissue or in partial tears, with tendinopathy and interstitial tearing not significant enough to complete and perform a formal repair. Recent animal studies have shown some promising histologic and biomechanical properties of this repair, and we look forward to following these patients as we go forward.

Patrick J. Denard, MD (Medford, OR), demonstrates a double-row, knotless upper border subscapularis repair and biceps tenodesis using SwiveLock® and Knotless 2.6 FiberTak® anchors.

Knotless Double-Row Subscapularis Repair With Biceps Tenodesis Using SwiveLock® and Knotless 2.6 FiberTak® Anchors

So I want to share with you my technique for double row repair of an upper subscapularis tendon tear, using a complete list knotless technique. This is a left shoulder I'm viewing from a posterior viewing portal. I have a cannula in 82 five threaded cannula in the antero-superolateral portal, which is made just above the biceps tendon. We can look anteriorly. We have simulated a upper subscapularis tear. You can see disruption over to the bicipital groove. So this is a full thickness tear of the upper SpeedScap. This is a type two lafosse tear a tear that in my mind is amenable to a double row repair because it extends over laterally. But we have a limited footprint to work with. So I'm going to show you a relatively bone preserving technique. My first step, once I've identified that tear, is to place a tagging suture in the biceps tendon. So I'm going to load a suture in the middle of a penetrating device. I'm going to pass through the tendon, and I'll drop that loop on the back side and go back and retrieve it. We want to be careful not to incorporate any soft tissue, but by retrieving that loop out the same cannula, we can then pass the free ends through the loop. To create a half racking suture. We can see how you can pass those limbs through the loop, and we'll alternate tension to bring that half racking suture down to the biceps tendon. So alternate tension and that'll cinch the suture down to the tendon. So I'll pull those sutures in line with the tendon. And then I'll cut the biceps tendon at the base. We want to cut flush with the glenoid. We're going to preserve the labral insertion but just cut the tendon. Now the tendon is free. And we can retrieve that out the ASL portal. Now we have our outside view. We're going to start just distal to where we marked the tendon. We're going to work distal because we're going to do an onlay technique. And this is going to preserve our length tension relationship. So we're going to whipstitch distal. And then we're going to end up resecting the proximal 20 to 25mm. Millimeters. I like to make 2 to 3 passes and work about 2 to 3cm distal. So we're going to resect the proximal portion. Now again this is the proximal 20 to 25mm. And that will help us maintain our length tension relationship. And I've moved the inlay technique because this really gives me a versatile tenodesis where I can incorporate into a SwiveLock for rotator cuff repair techniques, such as the one that we're going to show you here. So it's important as you're working here, to protect the biceps tendon. One trick you can do to facilitate that is to pull up on the sutures on the outside to protect it, and then you can place a snap just adjacent to the skin, and that will prevent the tendon from pulling back into the joint and protect that with the cannula protecting it on the medial aspect. So there you can see our tendon just behind the cannula. So that's going to be safe and out of the way. The next step is we need to open the rotator interval and clear the subcoracoid space so that we can both assess the subcoracoid space and also create a space for placement of our medial anchor. It's the easiest, in my opinion, to first do this with a cautery, and you want to feel for the coracoid anteriorly. Once that space is cleared, we need to then redirect the shaver anterior to the comma tissue. I can then work on clearing the space. I can use a posterior lever push to provide a little more room. And now once I've accessed that space, it's typically advantageous to move to a 70 degrees scope, because this will provide us a better aerial view and be able to see down the subscapularis tendon more thoroughly. So here we have the 70 degree arthroscope. Here's our coracoid. Anteriorly we can now assess the coracohumeral interval. We look for a space of seven millimeters or more. And in this case it's preserved. So we don't need to do a cortical plasty. If this was less than seven millimeters I would do a coracoid plasty taking care to preserve the conjoint tendon anteriorly. So now I'm going to place my medial anchor. I'll use a spinal needle as a guide to determine the adequate angle of approach for my medial anchor. I want to be lateral to the coracoid and just medial to the comma tissue. Again preserving this tissue here. Here we have a good angle of approach. We can then insert our guide percutaneously. And I'll place that guide just in the medial aspect of the footprint. Right where we'd want to bring this tendon down anatomically. This is our two six knotless anchor. This has a number five cordless suture for our repair on the outside there you can see we remove the black tab and pull back on the anchor. Pulling back on the blue repair stitch of this self-punching anchor will help deploy the Self-punching mechanism through my ASL portal. I'm going to retrieve the blue repair stitch. I've loaded this suture on a Scorpion. Typically, I'll use an antegrade pass for my subscapularis teres, particularly on the upper aspect. Again, a little bit of a lever push will help me increase my space. And then we can deploy our suture. And this is a tight space here. So it's helpful to often pull back on the cannula here to clear the jaw of the Scorpion. Okay. We have our repair stitch out the Aso cannula. Now we need to retrieve the shuttling stitch. There's two ends of this shuttling suture. This round end is going to have the loop on it. I like to think taking the round to the repair stitch. The tape is going to be the pulling end. So retrieve the round end to take it to the repair. Now we're going to pass this free end to the repair stitch through the loop of the shuttling suture. We want to pull back to the blue mark. That's about a handbreadth. If you think of that as well. And this is going to help make sure we have the appropriate length for delivering the suture down into the anchor. Now we're going to pull on the opposite end, as you can see being done anteriorly. This is going to deliver the repair stitch down into the anchor. A couple little tugs here will help pull it through. As you can see there, now we just need to take slack out of the system here. So we're going to pull the repair stitch down to the anchor. There you can see my medial row is complete. And I'm going to preserve this lateral limb because now I'm going to incorporate this lateral limb into my biceps. Tenodesis. So now I need to go get those sutures. We'll take the snap off of the biceps tendon and we'll go and retrieve our sutures. I'm first going to retrieve my repair stitch. I'll look around the comma tissue and I'll take that suture out the ASL portal. So now you can picture when I bring that tenodesis down, this is really going to help close laterally and I'll get the biceps sutures at the same time. So typically you can retrieve out this portal through the cannula. But if for some reason we can't find the sutures or if it's hung up, we can use another technique where we just put the retriever through the cannula and go and get our bicep sutures. Now, through the ASL portal, I'm going to complete my biceps tenodesis and my lateral row for my subscapularis. I'm Scapularis. I'm going to create a bone socket just at the top of the bicipital groove. This bone socket is just the anterior of the supraspinatus tendon, and it's going to represent my lateral insertion for my subscapularis. We'll go down to the second line or s-l line for the SwiveLock anchor. Then we'll load our sutures from our biceps and our repair stitch from our two six medial anchor through the eyelet of this 4.75 SwiveLock. So we bring the eyelet just down to the top of the bone socket. And the first thing I want to do here is I want to take the slack out from the medial anchor. So we'll pull on that darker blue suture which is the repair stitch. And there you can see that's really established the lateral aspect of our subscapularis repair. Then we can take the slack out of the two biceps sutures to make sure our biceps tendon is just adjacent to the anchor in this onley tenodesis. Okay, good. Once all that slack is removed, we'll insert the anchor down to down to the threads malleting down just to the threads. Touch the bone and then thread our anchor. We'll check the depth of our anchor by backing off from the thumb pad, and you can see we're flush. We can remove the safety stitch and the inserter, and we'll cut our sutures flush with the FiberTape cutter. So here's a look at our final repair. You can see we've reestablished the footprint medially. And then use that suture out to our lateral anchor. There's the repair stitch coming around anterior to the comma to create our lateral row knotless repair with simultaneous tenodesis, you can see the biceps tenodesis done in an orderly fashion at the top of the groove, restoring the length tension relationship. I really like this technique to get a knotless repair, but also preserving the footprint with these low profile two six anchors and being able to simultaneously perform the biceps tenodesis.

Jeffrey R. Dugas, MD, (Birmingham, AL) performs a SutureBridge™ double-row rotator cuff repair in this cadaveric demonstration. The 2.6 mm FiberTak® anchors are preloaded with 2 strands of SutureTape and are passed, tied and secured laterally with 5.5 mm PEEK SwiveLock® C anchors to complete the repair.

SutureBridge™ Rotator Cuff Repair Using the 2.6 mm FiberTak® Soft Anchor

Today, I'm going to go through a rotator cuff repair on a pretty standard sized tear using two double loaded FiberTak RC. These are rotator cuff anchors that go in through a 2.6mm drill or punch hole. They have two different colored suture tapes. And we're going to put two of these medially, followed by two swivel locks laterally to create a dual layer repair of a standard rotator cuff tear which is supraspinatus and some of the infraspinatus. First thing is we've created this tear right off of the bone. Kind of typical pattern rotator cuff tear. We can see the biceps up here in the front. And we're going to be very careful to avoid that as we pass our sutures. As we look down inside the tear, we can see the articular surface right here. First order of business is to create a surface for healing. So we're just going to abrade a little bit of the bone here. We're not going to decorticate it. We just want to just want to take off the soft tissue. So once we've got it, just the soft tissue removed like that and we're down to bone, you can see there's no soft tissue on there. Now we're ready to put our anchors in. So we do this through an accessory portal. So this anchor this this portal is going to come right off the acromion. We're just going to find a good spot where we get a good angle to the greater tuberosity here. And we're going to be able to see that this is going to be a good angle for insertion. I also like to use this this portal for tying through, because that way I'm tying the knots and pulling on the sutures in line with the anchor, rather than at an acute angle, which will put a little more stress on the anchor. So this is a cannula with a these come with a sharp or a dull trocar. This is the cannula we're going to drill and place the anchor through. So I like to start anterior. It gives me the best view of the biceps. So I can see the biceps right there. I do not want to incarcerate the The biceps. When I'm doing this. I can also see the articular surface down here. So I know that this is right about where I want to put my anchor. The first anchor. So we're going to drill a pilot hole. This can also be done with a punch. So this has a positive stop on it. Drill a pilot hole. Next the anchor is placed through the cannula and just impacted into the bone. And we're going to tap that in. Once it's in, we remove the rubber stop after we pull back gently on the anchor. So that sets the anchor in the bone. So we're just a little tug on it. Remove the rubber. Stop. That allows the sutures to be free, and we can just pull the driver out and remove the cannula. And so I'll test that by pulling on the anchor a little bit just to make sure it doesn't pull back. So I'm going to make sure I can see the articular surface here. So I've got the scope in the in the lateral portal. I want to make sure that I don't violate the articular surface, and I couldn't see it from the backside. So now I've got my first anchor in up here. I'm going to put my second anchor in back here. And I'm being careful not to affect the articular surface. So now I've got two anchors in there. They're separated by about a centimeter and a half. And that'll be the medial row. So now we're going to go back up into the subacromial space to pass our sutures. So I like to pass through the cannula. It helps with suture organization. You can see our two sets of sutures there. I'm going to use a device called a KingFisher, which is going to help me grab the sutures without piercing them. I like to pass from back to front. That way I can know that I've got the cuff pulled anteriorly enough, since the tendons come from the posterior side of the shoulder. So I'm going to remove one of those and we're going to start from back to front. So we load the the Scorpion parser by placing the tapered end of the suture through it. So we're going to make sure we don't have any tissue in the way besides the cuff. We've done a really thorough bursectomy here, which is important if you're going to do these procedures arthroscopically, you can really cause yourself some problems by not being able to see. So I'm going to get back here into good healthy tissue, and I'm going to advance the suture and pull it out of the cannula. And what that's done is pass this suture through the cuff. So I'm going to retrieve these through the accessory portal. And I'm going to use that portal as kind of a repository for sutures as I'm passing these from back to front. So now we've got eight sutures passed at pretty evenly spaced intervals from back to front in pairs. This tissue is grabbed with the Scorpion parser at approximately the depth of the elbow of the Scorpion parser. So it's it's a centimeter and a half, approximately. Which is about the thickness of the cuff attachment on the greater tuberosity. So we're going to start tying these I like to tie from back to front. So I like to tie through this. The portal that I put the anchors in through gives me a direct line of pull to the anchor. So I'm going to pull the first two sutures out. I've passed the rest of them out through my cannula, and I want to space the knots out. So I'm going to choose my post wisely. So in this case I want to put the post posteriorly. So I'm going to shorten the post. And that way I'm putting the knot stack as far back as I can, and I'm going to push as much as I pull. I think it's important not to just yank on the anchors. These are really strong anchors, but every anchor has its limits. And so bone quality is important. And I've tried to get in the habit of pushing as much as I pull as I'm tying these anchors down. So I want to get a good compression. I think it's also okay to pull on the other sutures while we're doing this. That takes pressure off the anchor as you're tying it down. So I also like to switch posts compared to suture. The tape is much easier to use. You don't go home with cuts on your fingers and going through three pairs of gloves, or having to wear finger cots, if you're so inclined. I've found that the tape is considerably easier to use from a trauma to my finger standpoint than the than the standard rounded suture. So I'm going to pull these out one by one. I put I normally put five suture or five knots in each suture. In this case I only did four just for demonstration purposes, but I normally will put five. So I'm going to pull these out laterally and I'm going to go get the next pair. Now I've got our medial row accomplished. I've got all got all the sutures tied. And if I look down in here, you can see that the medial row is down on the bone. So we've re approximated the medial row back. And now we've got all this exposed bone that we're going to cover over bringing those sutures over the top to create compression over our our healing surface here on the greater tuberosity. This is a SwiveLock anchor. What we'll do is we're going to put four sutures through here. The way I like to do it is I like to put the two anterior ones, and then one from each of the middle two into the front anchor and the posterior ones, and one from each of the middle anchors into the back anchor. That creates kind of a crisscross pattern and compression across the cuff. Instead of just having four double strands going straight out it, it creates compression from different directions. So the first thing we're going to do is we're going to pull our for that, we're going to put in the first anchor. And it doesn't matter if you go anterior your first or posterior first, but I'm going to pull those two anterior ones and one suture from each of the tied middle two. Next I'm going to make a pilot hole for the for the SwiveLock. So this is our anterior of the two lateral row anchors. So I'm going to take the punch. This is just a standard punch. And we're going to go to the second line on this. Sometimes you don't even need a mallet for this and some bone because the bone out here can be pretty poor quality. So I'm going to start right about here. I want to be at least a centimeter off the greater tuberosity. And I'm going to impact this into the bone. Go into the second line. Right. Then while that's in place, I've got my KingFisher through the loop. I'm just going to grab my four sutures, pull those through there, and then these will easily shuttle through the eyelet of the of the swivel SwiveLock. So now I've got my four sutures. I want to make sure as I do this, that I hold the sutures this way, which is putting a little tension on them. So my assistant is going to hold that as I retrieve the all that I've made the pilot hole with. And then I'm just going to advance this down. So we're going to tension the sutures individually. So I've got my assistant individually tensioning each of those. And then I'm going to advance the anchor. And I'm going to have her release the tension now. And I'm going to impact the anchor down into the bone. That's it. Then I'll advance the anchor. I loosen the stay sutures. I remove the driver. This stays. Suture can then be removed. That was through the eyelet. And I'm going to cut My sutures. So same thing here. I'm going to pass the sutures through the parser, through the hole in the cutter. This slides down this and then cut it right at the bone. So next we're going to do the same thing. We're just going to take the other four sutures the ones that we didn't pass. So we're going to make a second hole. So our first hole is up there. We're going to rotate the humerus a little bit and get a little further back. So now we're going to go back here I'm going to make my hole. And that's our completed repair. So I think it's important in each of these to check the repair from multiple angles. So I'm going to check it from the lateral side. So this is really what I want to see I want to know that I've got a got a good spread, that my anchors are down. There's no prominence of the anchors. I want to know that I've brought the cuff back to its anatomic origin without over tensioning it. So I want to know that I haven't advanced the cuff past its normal position. I want to know that my knots are tied and they're not prominent, and that I've got a pretty good spread on my sutures. You can see how nicely the tape lays down on the tissue without creating, you know, any kind of a over tension. It distributes the force very nicely and is ultra strong. So that's my top side view. And then I'm going to look inside to make sure I got it back on the articular margin. I also got to make sure I didn't snare the biceps. And you can see that that is nicely tight. Back to the native attachment for anatomic insertion of the cuff. But no over advancement. We didn't realize it and we definitely did not catch the biceps.

Knotless 2.6 FiberTak Soft Anchor, w/ #5 Suture, Self-Punching, qty. 5

Knotless FiberTak, selbststanzend, 2.6 mm, mit#5 Faden, VE5

Self-Punching Knotless 2.6 FiberTak Anchor with#5Suture, VE5

FiberTak, anclaje autoperforante sin nudos, 2,6,con sutura de calibre #

ANCORA DE SUTURA DE SEM NO 2.6 FIBERTAK COM SUTURA N5

2.6 FiberTak SP Soft Anchor with two 1.3 mm SutureTapes (white/blue, white/black), self-punching, qty 5

FiberTak SP-Softanker, 2.6 mm, doppelt geladen, mit 1.3 mm SutureTape(weiß / blau, weiß / schwarz), VE5

FiberTak SP Suture Anchor, 2.6 mm, Double Loaded, With 1.3 mmSutureTape (White / Blue, White / Black)

FiberTak, anclaje de sutura, 2,6, autoperforante,doble carga, caja de 5

ANCORA DE SUTURA AUTO PERFURANTE FIBERTAK 2.6, CARGA DUPLACOM FIO SUTURETAPE 1.3 (BRANCA/AZUL, BRANCA/PRETA)

Disposables Kit for 2.6 FiberTak Anchors (Includes: angled circumferential teeth spear, sharp obturator, and 2.6 mm drill)

Einwegkit für 2.6 mm FiberTakRC- und DR-Fadenanker(mit Spear, Obturatormit Trokarspitze und 2.6 mm Bohrer)

Disposables kit for 2.6 FiberTak RC and DR suture anchors (includes:spear, trocar tip obturator, and 2.6 mm drill)

FiberTak, manguito rotador, kit desechable

KIT PARA ANCORA DE SUTURA 2.6MM FIBERTAK DR

Angled Spear with Circumferential Teeth for 2.6 FiberTak Anchors, Reusable

GUIA PARA ANCORAS DE SUTURA FIBERTAK DR 2.6MM

Punch for 2.6 FiberTak Anchors, Reusable

INSERTOR PARA ANCORAS DE SUTURA FIBERTAK DR 2.6MM

BROCA PARA ANCORAS DE SUTURA FIBERTAK DR 2.6MM

Blunt Obturator for 2.6 FiberTak Spear (AR-3655), Reusable

Stumpfer Obturator für FiberTak DR-Spear

Blunt Tip Obturator, for FiberTak DR Spear

Obturador agudo para guía de broca FiberTak DR/RC

OBTURADOR DE PONTA CEGA PARA GUIA FIBERTAK DR

Sharp Obturator for 2.6 FiberTak Spear (AR-3655), Reusable

Trocar Tip Obturator, for FiberTak DR Spear

OBTURADOR DE PONTA DE TROCAR PARA GUIA FIBERTAK DR

Spear w/Circumferential Teeth and Trocar Tip Obturator for 3.5 mm PushLock and 3.5 SwiveLock anchors, Reusable

Speer mit Zahnkranz für 3.7 mm SutureTak und 3.5 mm PushLock

Spear, for 3.7 mm SutureTak and 3.5 mm PushLock, Trocar Tip Obturatorwith Circumferential Teeth

Guía de broca para SutureTak Ø 3.7mm y PushLock Ø 3.5mm,obturador con

Orientador, para SutureTak 3.7 mm e PushLock 3.5 mm, com ponta em trocar com dentes em circunferência

Fishmouth Spear, Trocar Tip Obturator, Reusable

Speer, für 3.7 mm SutureTak und 3.5 mm PushLock, wiederverwendbar

Spear, for 3.7 mm SutureTak and 3.5 mm PushLock, Trocar Tip Obturator

Guía de broca para SutureTak de Ø 3.7 mm y PushLock de Ø3.5 mm, obtura

LANCETA PARA SUTURETAK 3.7 MM E PUSHLOCK 3.5MM

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