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Elevatoren- und Knochenpräparationsset

Das Elevatoren-und Knochenpräparationsset von Arthrex beinhaltet neu konzipierte Instrumentenschäfte und einen modularen Handgriff. Dadurch steht Operateuren bei Eingriffen am Glenohumeralgelenk und im subakromialen Gelenkraum ein optimales Sortiment an Arbeitsinstrumenten zur Verfügung. In einem Set zusammengestellt findet sich eine große Auswahl an Gewebeelevatorien, Raspatorien, Küretten und Chondro Picks.

Shoulder

Arthroplasty Shoulder

Elbow

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

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Epaule & Coude

Matthew T. Provencher, MD, (Vail, CO) describes the versatility of the Arthrex® Tissue Elevator and Bone Preparation System which combines a modular handle with a wide variety of Tissue Elevators, Rasps, Curettes and Chondro Picks all in one convenient tray. Dr. Provencher also shares some of his pearls for improving glenoid and labral preparation.

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Tissue Elevator and Bone Preparation Set

My name is Matthew Provencher, and I'm here to talk to you about the tissue elevator and bone preparation set. So one of the things that I wanted to do when I helped design this set was to use some additional tools to help prepare the glenoid labrum, save for the rotator cuff, safer, and make it more efficient while protecting the tissue. What we also wanted to do was make a more robust handle that had a really good, solid interface so that there was no wiggle and that you had opportunities to do many different types of tissue preparation and elevation. Here's one of the elevators that we have here, which is really my workhorse. And it's a spoon elevator for glenoid labrum preparation. This has really helped me prepare the labrum anteriorly, inferiorly and posteriorly really well. You can see that the spoon is sharp, but after the spoon portion it's really dull. So that really helps protect the rest of the tissue. And you won't get any other tears in the tissue if you just put this in right at the interface. Another thing we wanted to do was help address how to get to the posterior labrum better. And one of the nice ways to repair the posterior labrum is using an elevator device from the front. And by bringing it in from the front, if you had it a little bit steeper, you can come in the back and prepare the posterior labrum really nicely. So this is the steep spoon elevator, which is really good for preparing posterior labrum tissue. When we're talking about cartilage injuries, we wanted to have several options for you. And here's a microfracture all. And here's a couple different curettes both of them ring type of curettes to help deal with cartilage injuries, prepare vertical walls, scrape down cartilage, or prepare a microfracture site. Whatever you want to do with a couple different configurations of ring Curettes. We also have a couple different spoon elevators, which have a variety of angles, and these are really nice to get around the 5:00 or 7:00 area posteriorly or anteriorly inferiorly in the glenoid, for example, which we know is a very important area to treat to get instability treated correctly. In addition, we have the prior elevators. The 15 and 30 degree also on this handle, which are actually really good to help prepare a bony injury that has healed immediately down the glenoid or a posterior bone fragment, because these are really sharp and get in the interface really nicely. And then lastly, from a tissue standpoint, if you're preparing a tissue and you want to get a bleeding response or incite an area of bleeding, we have a really nice tissue rasp which can be used for a multidirectional shoulder instability type of patient, or to prepare your capsule before doing any capsule label repair. And then finally, one of my favorite instruments, which is this double sided angled rasp, which is really nice to get in the interface between the glenoid labrum and the glenoid or other areas of the body where you need an interface to prepare the bone for eventual healing. I think the last thing is my staff really likes it as well. And the operating room, because everything's in one small contained set and I bring it up for all my shoulder and knee knee cases. And it's really easy, efficient and well packaged.

Matthew Provencher, MD, (Boston, MA) uses the 2.9 mm PushLock® Percutaneous Insertion Kit to place PushLocks and LabralTape™ all around the glenoid through a small metal cannula with a 4.7 mm inner diameter and only a 5.4 mm outer diameter. He demonstrates the following anchor positions:
<ul>
 <li>Portal of Wilmington for posterior SLAP repair</li>
 <li>7:00 portal for posterior instability</li>
 <li>5:00 portal for placement of a low Bankart anchor</li>
</ul>
All instruments required to facilitate the percutaneous PushLock insertion are included in the convenient and sterile kit.

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

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Percutaneous and Knotless Glenoid Labral Fixation Using the 2.9 mm PushLock® Percutaneous Insertion Kit

Hello, my name is Matthew Provencher. I'm from Boston, Massachusetts, and we're here to demonstrate percutaneous glenoid labral fixation. You can see that this kit is utilized to perform glenoid labral fixation basically anywhere around the glenoid. And the percutaneous ability is key to help you get to some of those positions that may be a little bit more tricky to reach. And one of the anchors that could be utilized for this is a 2.9mm short biocomposite PushLock with LabralTape fixation. So what we'll do first is we'll make a mid glenoid portal. This will help facilitate passage of our sutures. What I want to show here now is your standard switching stick. It's got the standard tip on it. But what it now has is a switching stick handle giving you additional control without having to hold the stick. You can see how nice this is to put in hold. And now we're going to take out the switching stick handle. So now we'll load this in place and we and we just gently put this in place, always keeping in mind you want to minimize any trauma to the articular cartilage. And so this is the elevator set here which comes with a handle. And then multiple different options for inside the shoulder from rafts to curettes to different types of elevators, depending on what type of work you want to do for the glenoid. What I'm going to choose here is just a straight spoon elevator. We put this in place. Come into the triple. Damn. The reason I like this is because it's smooth around the edges and is pretty atraumatic to the rest of the glenoid, except sharp where we're doing the work. This is a hook to the left, 45 degrees and has a built in nylon suture. It's nice about this real pass device is that the suture is integrated into the system, and believe me, there's plenty of it here to feed. And when we get out here, what we'll do is we'll just pull this straight. You can pull a little bit more. We'll cut. So now we'll pass the LabralTape. We'll just make one little dilator stitch and then we'll follow it with the stitch. Just an overhand. And this is the one we pass. I just pass enough of this. Maybe 4 to 6in. Tighten it down. And now what we're gonna do is we're going to pull this in place. And there we go. We've got the suture. That's through. And so that's a pretty nice position of that I like where that is. So now we start with the spinal needle. And the key to this spinal needle is trying to get this in the right place. And here you can see I've got it through that area which is probably near the muscle tendon junction. It's right on the lateral edge of the acromion, probably anterior one quarter of the acromion. To get this in place now, what we'll do is we'll take out the needle trocar and then we'll put in the nitinol pin. And so this will allow us to get the needle out. Now we'll use the dilator. So here's the skin incision. You just do one third depth at most, maybe one quarter depth of the 11 blade knives. You can just see just a tiny percutaneous incision. Now we're going to load this in place I'm just bending it here I normally would but I'm just showing you for the camera. We'll get this in place so you can see that nitinol fits very nicely over this cannulated switching stick. And so now we're going to just gently introduce this. So now what we do is here's the disposable metal cannula. It has a plastic mouth to prevent fluid leak. And this fits directly over the 2.9mm drill guide. And so you can see this goes in position like this. And so now we're going to load this up out here outside the stick. So now we'll gently put this in place. And now we have the whole system in place. Now at this time we can take out the cannulated stick. And so I like that position right there. We already tested that position with the Cannulated guide. You get a very nice steep trajectory to really drill deep into the glenoid bone without skiving or injuring the cartilage and allowing for a very nice percutaneous fixation technique. And so we and so we bottom this out. And now we're going to go back and retrieve our sutures with a suture retriever. By the way this is the only retriever that does fit down the metal guide. I'm going to do these one at a time just to take down some of the friction in the system, because this is a pretty tight percutaneous system. But that's exactly what you want here. And you can see that went very easily. And passing them one at a time is a very nice technique. Now we can load up our short 2.9mm biocomposite PushLock. This anchor is actually 12.5mm. So it provides the same excellent fixation techniques but a little bit less depth if you're concerned about going deep into the glenoid. And so now what we're going to do is come down. You can see how easily and gently this goes in the Cannulas help guide this in place. We back up the cannulas just a little bit so we can see what we're doing. And now we're easily coming in and we're going to stop right there. That's right. As the anchor starts hitting the glenoid cortex, we're going to go ahead, complete the fixation, making sure that the depth of this is correct. I want to get that black line all the way to the cortex. So I want to see that that goes down. Now we're going to do six counterclockwise turns. So this is a suture cutter. We've preloaded a suture on that. This mini suture cutter actually fits down this cannula which accommodates this whole percutaneous technique. So we'll pull both tapes in these. It can accommodate two tapes at a time. We'll put this down through the cannula. And so this fits down very nicely to get these sutures very close to the glenoid cortex. So there's our completed fixation. We still have the percutaneous portal. We can take this out at this point. And now just test our fixation. You can see a very nice final repair. So now what we'll do is we'll switch our attention to the posterior inferior or inferior labrum. One of the nice things here is you can work on the posterior labrum actually much easier from the front. And you can also bring in a shaver to do some additional work. The Torpedo here is nice because it's very atraumatic to the rest of the tissues. You want to make sure you're deep enough and not getting any cartilage. We'll do a little bit of labral preparation here. You can also use this to roughen up a little bit of the capsule, which is really nice to incite a healing response. So what we're going to do is actually do our inflow through this stopcock here. And so all we need is just the camera, which is actually nice because it's a very thin diameter and the triple dam will work even better. So this is a nice way to get your inflow, provide a nice sealed circuit. And so here you can see there's the there's the tear posteriorly. And you know this is a little bit of a shallow trajectory to get this type of anchor in place. So what I want to do is I'm going to reestablish this, I'm going to actually take out the switching stick and come in a position right here. And so now I have a very nice Ease. I'm simulating hook repair techniques. We're now going to dilate it. Now we'll load up another triple cannula in place. And so here's the real pass hook. It's got still plenty of suture left from our first approach. So we're going to do is we're going to start our repair right here. Now when you're doing hooks back here you still have to be careful about the nerve. But you're also doing a capsule labral repair. So you always poke 90 degrees to the capsule. Once you poke 90 degrees. Now you're free to rotate and bring this up into position. And there we have this underneath the labrum. We'll now start passing the suture. And you can see we've got plenty of suture on this reel. We'll come out. Now you can see the that's the type of repair you're going to get. And I like that because we're now going to if you look where the two ends of that are, you can see how it's going to shift from inferior to superior. We'll cut the suture now. Grab the Grab the FiberWire pull this out. And so what we'll do now is do a dilator stitch followed by the next stitch. Feed about 5 or 6in of LabralTape in, and now we'll pass this. So the dilator already went. Now there's the LabralTape. So now we're going to do the posterolateral portal. So here's the posterior lateral edge of the acromion. And what we're going to basically do is come about four centimeters from that posterolateral edge of the acromion. And it's directly lateral. So I've got that marked in my mind. And now we're going to find out where this comes. The key is where this comes into the shoulder. What it's going to do is bounce off the humerus. You can see how I'm coming right up against the humerus, right in the posterior aspect of the cuff. And you can see how nice that trajectory is. We'll take this out. Now insert the nitinol pin. So we have our nitinol pin in place. Now we'll put our dilated cannulated stick. You can bend this nitinol pins very flexible. You can see it easily goes on. Once I get I get this down now, I'm going to make a percutaneous stab wound. And so this is literally about one third of the depth of the 11 blade. And now we're going to gently put this down and start dilating. And now we'll take out the nitinol. There's also a tight tolerance as it goes over the cannulated switching stick. And so you can see very nicely how that system all fits together. So here's our system I'm going to bring this down. So I'm away from the cartilage. And our system comes in like this. And we just gently massage this in gently back and forth. And I'm staying away from the cartilage. So now we've got the fish mouth in place. And we can now slide over the cannula. And so now we have the fish mouth and the cannula in place. Now we can put our fish mouth exactly where we want it. We're going to back this right up against the tape. Pull the cannula back a little bit so we can see making sure that our tape is protected. We'll do a mallet first Just on the rim of the glenoid. That's good. And you can see the tape behind us is protected. And we'll put the two nine drill in for the short PushLock, which is a 14 millimeter depth of the drill. 12.5mm for the depth of the anchor. So now what we'll do is we'll retrieve the labral tapes with the CrabClaw suture retriever. So this fits down very nicely. What we'll do is we'll grab one at a time here. Now we'll pull the other one. So we'll pull that out. Enough. And there we go. So now we've got both of our sutures out. We'll even these up again. I'm just kind of massaging these sutures so that they're both even. We'll put a hemostat on just to look at the initial tension. And so now what we'll do is we'll bring this down through the cannula and we'll try to find that hole, which is very easy because we've got the cannula to help with our With our trajectory. Before we commit, we're going to pull each of these individually. And so what we're going to do now is put this in place right there. And you can see the capsule hold. Let's go ahead I'm going to hold those while those the anchor goes in. And there's the anchor coming in place. Now we'll go ahead and complete the fixation. We make sure that that black line is well down to the cortex. Now unscrew it six counterclockwise turns, and then we'll load it through this suture loop that's been pre fed into this mini FiberTape FiberWire cutter which fits down this percutaneous metal cannula. Avoiding the other tape that you've fixed. Cut both. You can see that this is just super strong very nicely annealed down. You can see just repaired that hole. Here's the posterior band of the inferior glenohumeral ligament which has been nicely retensioned. We'll put another one here at the 6:00 position and continue to come around for the overall repair. And what we're going to do with the with the percutaneous kit is just come inferior by about a centimeter to centimeter in half, which anatomically obviously brings you more inferior down into the subscapular. And so you can see here we are right in the top one third of the top half of the sub GAP. But the key is we're just on top of the middle glenohumeral ligament. And so now you can see how this trajectory can come in and get you very nicely down inferiorly, which may be difficult with this portal. This portal here. The trajectory of this mid glenoid portal, you can tend to skive and drill out of the glenoid very easily. As I'm showing with the nitinol stick here. It's a little bit hard to do that. And. I really like that position there. I'm going to come backwards and you can see how that really nicely is going to come into the glenoid. You can see not sky with a really good position. So the insertion is the same as for the other two anchors. We'll put in the nitinol pin. Take out the spinal needle. Put in the cannulated dilator switching stick. So now we have the cannulated in. We'll take this out and we'll pass both of these together. They're already married up. It's a little bit more of a push than you're used to, because you are going through a SpeedScap and just spreading apart some pretty thick SpeedScap fibers. I want to do this inferior to superior shift. We'll find a good placement for this anchor, which I like right there. And you can see that nice trajectory, but we're very low. There's the 6:00 position right in the center of the screen on the glenoid. And we'll go ahead and mount this in place. Good. Once we hit the cortex with the anchor, we take the orange piece off and now put in the anchor, making sure that black goes all the way down. As you can see, actually, there's our both of our repair stitches. There's one there. There's one there. I would have done one more at the 6:00 position from the posterior percutaneous approach. But you can see this is a very nice way to put that in. You can see how the capsule is repaired with the labrum. And so what this system shows you is that you can very easily, with a percutaneous technique, get to all areas of the glenoid labrum and provide very good predictable knotless fixation.

ELEVADOR TISSULAR, 15° BAIXO (236.2MM X Ø4.95MM)

Tissue Elevator, 15° Down, 30° Left

Elevatorium, 15° abwärts, 30° links gebogen

Elevador de tejido, 15° abajo, 30° izquierda

ELEVADOR TISSULAR, 15° BAIXO – 30° ESQUERDA (236.2MM X Ø4.95MM)

ELEVADOR TISSULAR, 15° BAIXO – 30° ESQUE

Tissue Elevator, 15° Dow, 30° Right

Elevatorium, 15° abwärts, 30° rechts gebogen

Elevador de tejido, 15° abajo, 30° derecha

ELEVADOR TISSULAR, 15° BAIXO - 30° DIREITA (236.2MM X Ø4.95MM)

ELEVADOR TISSULAR, 15° BAIXO - 30° DIREI

Tissue Elevator, 15° Down, Square End

Elevador de tejido, 15° arriba, estándar

Elevador de tecidos, 15° para cima, padrão

Tissue Elevator, 30° Down, Square End

Elevador de tejido, 30° arriba, estándar

Elevador de tecidos, 30° para cima, padrão

RASPADOR PARA PONTA, 40° (236.2MM X Ø4.75MM)

RASPADOR PARA PONTA, 40° (236.2MM X Ø4.7

Curette, 5.4 mm, Round, Double Sided

Elevatoren- und Knochenpräparationsset

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Epaule & Coude

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

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Tissue Elevator and Bone Preparation Set

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Percutaneous and Knotless Glenoid Labral Fixation Using the 2.9 mm PushLock® Percutaneous Insertion Kit

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