Name: Tensionable Knotless Bankart Repair Using the Knotless 1.8 mm FiberTak® Implant System
Uploaded: 2019-02-07T00:00:00Z
Channel: Arthrex
Description: Peter J. Millett, MD, MSc, (Vail, CO) performs a cadaveric demonstration of a knotless Bankart repair using Knotless 1.8 FiberTak ® suture anchors. Dr. Millett demonstrates how to use the unique adjustability of this knotless suture anchor to achieve an anatomically tensioned soft-tissue glenohumeral repair.

<p>Peter J. Millett, MD, MSc, (Vail, CO) performs a cadaveric demonstration of a knotless Bankart repair using Knotless 1.8 FiberTak<sup>®</sup> suture anchors. Dr. Millett demonstrates how to use the unique adjustability of this knotless suture anchor to achieve an anatomically tensioned soft-tissue glenohumeral repair.</p>

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VID1-000079-en-US | A | Tensionable Knotless Bankart Repair Using the Knotless 1.8 mm FiberTak® Implant System

Peter J. Millett

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Tensionable Knotless Bankart Repair Using the Knotless 1.8 mm FiberTak® Implant System

Welcome. My name is Peter Millet. Today we're going to demonstrate an arthroscopic bankart repair using the new Knotless FiberTak anchor. Here you can see the instruments that we're going to use for the anchor. On the left, you can see the Knotless FiberTak anchor. This is a 1.8mm anchor. It's all suture based. It creates a low profile repair, takes up minimal real estate on the glenoid. So you can you can have multiple fixation points. And today we're going to we're going to demonstrate how it's used for an arthroscopic bankart repair. So here we've. We have a right shoulder. This is a cadaveric model. Obviously there's a bankart lesion in the front. We're going to demonstrate an arthroscopic bankart repair. We create a standard posterior portal parallel with the joint line. So we have good visualization. We've created two anterior portals. We perform a diagnostic arthroscopy. Look at the rotator cuff the superior Abraham. We check in fairly to look for a Hagel lesion. This demonstration does not have any of those. We just have essentially a bankart lesion here. And at this point, the next step then will be to mobilize this lesion so that we can then perform a repair. So we'll take a bankart elevator. So here we're mobilizing the labrum. Sometimes it can be adhesive like an Alps type configuration. So a helpful trick is to use an Apollo radiofrequency devices is the hook tip device which can be very helpful. You can use this in conjunction with your elevator so you can elevate the tissue, put some tension on it, and then you can come in with your RF. And with the Apollo you can really release the capsule and the labrum safely without damaging it. So you can get extra mobilization. Okay. So now we're we're ready for our repair. We've mobilized the tissue. We visualize to make sure we're not dealing with significant bone loss. We've looked for a lesion which isn't present, so we'll perform our repair. So the first step now is going to be to plan where our anchor is going to go. Here you can see the guide for the for the drill and for the Knotless FiberTak anchor. You can see it has teeth on it. There's a blunt obturator that goes through this and this in in this case we're going to use the curved guide. It's approximately a 15 degree curve which really helps you access the lower parts of the glenoid. We'll come in through our lower 8.25mm cannula into the joint and take the obturator out. And now I can sort of plan where I'm going to put that first anchor. And there's also a little marking here that is on the concave side of the curve. So I can just angle that as I, as I see fit to see where, where it goes best. And I get up onto the glenoid a little bit so that I'll pull the labrum up onto the glenoid once I perform the repair. Now I'm going to come in with our 1.8mm drill, And we'll drill. All the way down. So here we have the anchor. I find it's helpful if you grab the anchor more towards the central portion or the front third. And then we'll insert the anchor into the guide and just slide it in. And then at this point I'll usually push it in by hand to get it started. And then just make sure that you tap right in the center portion of the inserter. And then it bottoms out on the drill drill guide. Then there's this little plastic suture retainer that you remove. It's like a rubber grommet. Take that off and then just pull the inserter off. At this point now we can make sure that the the anchor is securely fixed in the bone. We can pull back on it. This allows the anchor to bunch up a little bit and achieve really good cortical fixation. You can see here it's got great fixation. This anchor has three sutures which are in it. You can see there's three different types of sutures here. There's a blue suture which becomes your repair stitch. So I'm going to retrieve that out my superior portal. You have this this suture here, which is actually connected, which is a shuttling suture. One side has tape and one side is round here. It's a in a TigerWire configuration. But at this point, we retrieved the blue repair suture out through our superior portal. At this point we'll come in with our SutureLasso. This is a 25 degree curve. Suturelasso. This is a right. Since it's a right shoulder, which works well for the anterior labrum. I'll come in through my anterior inferior portal. So what I like to do is actually grab the tissue, just like you would use a forceps in open surgery. Pull the tissue up so I so I can tension it. Then I'm going to grab this the the capsule and labrum inferior to where my anchor is. Penetrate through perpendicular to the tissue and then come around all the way through. And then feed the wire and retrieve the wire out through my superior portal. Now we'll just shuttle the suture in standard fashion. So at this point, just as I'm about to pull it through, my assistant is going to grab that repair suture as it's coming out, and he's going to pull it all the way out. So at this point now we've retrieved our repair suture, and we have basically three limbs coming out of our cannula. This is actually just a shuttling stitch. So it's connected. So it's just one stitch with two distinct limbs. It's used for shuttling of the repair stitch. There's a round limb here which has a loop on the end. And then there's a tape tape limb here, which can be which is the one that you're going to retrieve and pull on to shuttle the suture. We'll grab the end of the repair suture and shuttle that through the loop. And there's a little purple mark that tells you the ideal or optimal length to fold back on itself. At this point, then I'll pull the tape end of the shuttling suture and you'll see it will start to pull this into the cannula and inside the joint. You can also see it shuttling through the anchor. Through the the anchor that's in the bone. Now we'll start to pull it through. Good. So now we just have the repair suture and we just keep pulling the end of this. So here we have the the anchor just about just before we're going to do the final tensioning. I've come in with a grasper through my superior portal. And I can pull the soft tissue up and then I can tighten around it. And then I'm just going to tighten this to the to the desired tension. You can see I'm pulling pretty hard on this. The anchor is not budging at all. This is what we're going to use to cut the suture. Now the repair stitch. So once you get it down, it's always important to cut in the center of the cutting device. If you cut it on the on the end or the corner like this, sometimes it will fray the suture. If you cut it right in the center like this, it'll cut it very flush and smooth. So now we'll put our we'll put our second anchor in. We go up about a centimeter. These anchors are very low profile. They're small in diameter. So you can put more points of fixation pretty easily, which I think is an advantage. And at this point then we'll pull back again to set the anchor and to make sure that it's really strongly in the bone. And you can see again it's really strong in there. We've done some biomechanical testing in the in the lab and the anchor, even though it's much smaller than other anchors, is is just as strong, if not stronger in the bone. So we'll retrieve my repair suture. I'll come in again with a curved 25 degree. Right. Lasso again. I'll come in with a grasper so I can grab the grab the tissue and figure out where the appropriate tension is. I can come below my anchor so I get an additional shift, go perpendicular to the tissue, pop through, and then come around the tissue. So I'm coming all the way around the labrum and the capsule. Feed the wire out and then retrieve the wire out the superior cannula. At this point, I'll then shuttle the repair suture back through the labrum in the capsule with the first anchor. We just went ahead and passed the suture so that we were able to pass it right away. As an alternative, if you're concerned at all that you might have some tangles. One extra step that you can take just to avoid any twists or tangles is to retrieve the repair suture out through your superior portal, and then you can see the difference in the two sutures here. This is the shuttling suture. One side has tape on it and one side is round. You'll retrieve the round end here. Round suture end which the round suture end has the the shuttling link on the end. So I'll retrieve that out the same superior portal. So you can see here the the link for shuttling. And now I can shuttle my repair suture back through. And then again I'll fold it till that purple mark. So I know I have the, the appropriate amount of folding on it. And then I'll retrieve my suture. This is the tape side of that shuttling suture. So I'll retrieve that out my inferior portal. And now I can you can see how it's going to tighten up quite nicely. If you get a little twist in it like that. Sometimes it's a good idea to just come in with your CrabClaw grasper and just kind of give it a little bit of a straightening out before you, before you do the final tightening. And also, again, I can grab the tissue and pull it up so I can get some additional tension before I do the final tension. I can get tension on the soft tissue before I apply the final tightening and get great loop security of the anchor. You can see how much that's pulled that up. You can see how you cut it right in the center. So now we're going to come in with our third anchor. It really gives great fixation in the bone. So retrieve our wire. So another method to avoid any tangles is to retrieve the shuttling suture. The round one with the link on the end of it, which is here, which I have, and then grab the repair suture at the same time, which is the blue one here, and you can pull them out together. And that just obviates any issues with twisting. And then we'll shuttle it through. We place the anchor through the anterior inferior portal. So we're retrieving out of it. And then we're also tensioning the final construct through that same portal. So again a small grasper here to grab the grab the tissue. And just before our final tensioning I can pull that tissue up. And then I can apply tension to the anchor. And again it's coming out through the same portal. Most of my bankart repairs I use for anchors because because I can get more fixation points. Since I'm going to be coming in through my superior portal here. I'll have to remember to retrieve the anchor through that. Here you can see we're going to drill it through the superior portal, as that gives me a good trajectory. At this point, since we're going to come in with our lasso through the inferior portal, I'm going to retrieve, instead of retrieving the repair suture, I'm going to retrieve the other two sutures and grab the labrum and the middle glenohumeral ligament. And I'm going to shuttle the wire out superiorly and shuttle the repair suture back through the through the wire. At this point, I'm going to retrieve my other suture out superiorly, because it's always important to remember to retrieve and tension from the portal that you put the anchor in through. So you can see how we've managed that. We went in through a different portal. So whenever you get twists like that, you just make sure you untwist it a little bit before you tension it for its final tensioning. You can see how strong the fixation is. I'm pulling as hard as I can and it's just rock solid. So here you can see the final repair. We have excellent tension on the inferior glenohumeral ligament complex. You can see it pulling up here. We have it on the middle glenmuir ligament complex. We have four really strong anchor points. If the tear goes around the back, you can go in from the back as well. Using similar techniques, you can repair slaps with this. You can do posterior labor repairs. It just really gives a very nice low profile repair of the capsule labral tissue.

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