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VID1-00662-EN | A | SpeedBridge™ Gluteus Medius Repair

John Urse

Human

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

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SpeedBridge™ Gluteus Medius Repair

We have a left hip and this is a gluteus medius repair that will be done endoscopically with a double row SpeedBridge repair. This patient is on their side, so they'll be on a beanbag rest. This surgery doesn't require a central compartment arthroscopy. You don't need traction. You don't need X-ray or imaging. This patient is on a beanbag and the left side is facing up with anterior here. Posterior. We've marked the greater trochanter. And we'll use two portals an antro inferior portal and a posterior inferior portal. We'll be viewing from the posterior portal as we'll be watching for the gluteus medius and minimus tendons coming in from above. This will be a working portal in the front, and we will then position a superior central portal for anchor insertion into the lateral facet. Once we localize where our abductor tear is. So we're in the trochanteric space. We're aiming toward the bear area of the trochanter. We're in the lateral decubitus position. The scope is coming in posteriorly, and this shaver is coming in from an anterior inferior portal to about two centimeters from the tip of the left trochanter. This is the fascia Lata. And we're going to make a window in the fascia Lata, aiming for the bear area of the trochanter. And this will allow us exposure of the trochanteric space. We'll look for the vastus lateralis below, and our gluteal cuff will be up to the right, with the minimus coming in anteriorly into the anterior facet and the gluteus medius coming in from the top, entering into the lateral facet here and attaching to the far posterosuperior facet. Now this this is our gluteal cuff to the right. We're going to create a tear that we can repair. So I'm coming right off the lateral facet. The lateral facet is about 35mm wide. And it extends on the broad area here of the trochanter. So we're going to create a full thickness tear. I'm going to complete this tear. Again the front here is the minimus coming into the anterior facet. The anterior facet is much steeper than the more broad lateral facet which I'm outlining horizontally here. And this gluteal tendon will attach all the way up here to the posterosuperior facet. And what we'll do is we'll bring the spinal needle in from above. And this will be coming in from a superior portal midline to the other portals. And we want to bring those in at an angle that we like. So again we're looking from the posterior portal. This probe is in the anterior portal. And we've created a tear in this gluteal tendon. Here's our bare area of the trochanter. And the lateral facet is this horizontal area here that we want to position our needle. So we want to be able to bring one proximal anchor hole here and a second one more posterior. So these are spaced adequately so our holes don't converge. So this looks like a good place for our our third portal which is a superior central portal. And we're going to put this anchor in percutaneously without a cannula that will keep us separated from our sutures getting tangled. And let's go ahead and we'll go to our second laser line. Yep. Good. And there's our second line. Don't get rid of the mallet. So I'll make my second hole right now I just won't put the second anchor in. So we want to get all our foundation work done first. So there's the first hole. I think we see it see it clearly. We'll take our mallet. And I think the surgeon, as long as he's feeling good bone here. Go ahead. He can control the punch, and his able bodied assistant can do the hammering. In this case, we're not going to get any bleeding. But I will show you. This lateral facet is nice and broad. You would want to freshen this if you believe in decorticating the footprint for the insertion. This would be the time to do that. So at this point, what we're going to do is we're going to take our first anchor and we're going to put this percutaneously through the superior portal. Let's hold the paddle and twist clockwise. Okay. We're going to undo the top. So our anchors in IV coming in from the anterior portal with a FiberTape grasper. I'm going to take one of these. We're going to take the Scorpion next. And we're going to pass these two sutures before we get into any potential for tangling. We'll take a little slack out of our sutures lightly. Great. And now we want to think about how we're going to come in and repair our gluteal tendon. So we're going to bring our Scorpion in. Get a good bite. Pass the suture. Hold the cannula in, please. Deploy this. So we have our first suture in. At this point we want to keep sutures separated. So I'll bring that suture back out the portal. We placed it because it's through the gluteal cuff. And let's put that over there. I'm going to now grab the second suture in the anchor. One thing that's different about the hip is that the gluteal tendons are not as, not as long and well developed as they are in the shoulder. So the closer to the bone that you get with your sutures, you'll get in better tendon and less muscular tissue. So I've deployed my second suture. So we're going to take the second suture. And it's now in. We can make sure it's it looks good. We're in. So now that this is out of the way, we want to take a second cannula superiorly. And what this will do, it will keep our second set of sutures away from the other. You can put the anchor right through that. This will be a different color that helps later with criss crossing. Tap tap tap. Good. Hold the paddle. Twist clockwise. Got some Arrow coming out. Now I've got another colored strand here to deploy. So we'll take that with our FiberTape grasp. Hold the cannula in below and I'm going to take one. So we're going to head a little more anterior here. And a FiberTape grasper. And that one hold over there. So you don't give me that one unless I. You can let me have the second one. There you go. We'll load that. So this is our fourth suture. We're heading anterior to the the minimus tendon. So we'll take a FiberTape grasper, please. So we have a blue that we just passed, we want to take. So that would be the number four suture. We're now going to come up here and take number two in the white. And these are then going to be passed into a distal row anchor. So we're off the vastus ridge here. I'm going to look and make sure I'm far enough from those other anchor holes I am. Let's go ahead and tap that. We'll go to the second line and I'm going to bring this in. Just give me a little slack. So we're now taking the eyelet of the distal row anchor into the first distal row anchor hole. This is just distal to the vastus ridge. Yep. And we're just going to hold the paddle and twist in on the knot cutter. We cut right on the bone. And that's our first distal row anchor to turn the leg forward. Just a real slow bend. Okay. Let's hit that. So the sequence is the same for every anchor insertion for the distal row. The assistant is going to hold the sutures away from the gluteal cuff toward the knee with his other hand. He's going to pull the punch out while the surgeon looks at the anchor hole and holds the suture anchor. The suture anchor eyelet goes into the fourth and final distal hole. Let's tap until we see the actual anchor hit the bone. And there it is. Good. Let's hold the paddle and twist clockwise. So here here we have a double row repair. Is this a SpeedBridge repair? It's a knotless repair. One of each suture will go into the distal row anchor of each color, a blue and white in the distal anterior and in the distal posterior. As we rotate the hip we can see we have a nice gluteal tendon repair with a water seal closure.

Procedure

Rekonstruktion des Gluteus medius

SpeedBridge™ Gluteus Medius Repair

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