Name: Patella Tendon Repair Using ACL TightRope® II Implants With InternalBrace™
Uploaded: 2022-03-16T00:00:00Z
Channel: Arthrex

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VID2-003076-en-US | A | Patella Tendon Repair Using ACL TightRope® II Implants With InternalBrace™

Mark Frame

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

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Patella Tendon Repair Using ACL TightRope® II Implants With InternalBrace™

Here we can see with the specimen. We've simulated a patellar tendon tear. Here's the patella. Patellar tendon exposed below. The retinacular split on both sides, which is very typical. It's not just isolated to the tendon itself. Fat pad underneath. And a very small segment of patellar tendon still attached to the distal pole. The first step is that we start distal to proximal using a SutureTape. And we want to do a Krakow suture where we're gripping the patellar tendon. And you can see we take a bite of the patellar tendon passing it through the previous loop. And it forms that very typical grabbing suture. This just gives the tendon repair, security and strength. We continue in the same fashion all the way up the patellar tendon until we get to the open end at the very proximal part of the tendon. We want to exit out through the end of the tendon, because this is where we want the pool to take place. And so that the ends of the patellar tendon and the segment left on the distal pool of the patella to line up with each other. So you can see we take that suture tape through and we're exiting on the very end. We don't want to fold that tendon in or to shorten things. We then take a TightRope to width. You can see that that's got a FiberTape already loaded onto it. And we go through the the loop. And what we're trying to do with this construct is to Is to secure the TightRope and the Censurable device onto the end of the patellar tendon. So we then reenter the tendon in a similar fashion from the very cut end, and then duplicate what we've just done on the way up, all the way back down with a further crack of suture, making sure that we take up the slack of that SutureTape. It's not super important as because it's a sensible device, even if there is some slack of the SutureTape at the end. Once things tension up, that will be shortened along with the TightRope two. So again, a locking suture all the way back down to the distal end coming out where we started. And then we want to tie that off in a secure fashion. This is then repeated. Once we've done this up the other side of the tendon to give us two TightRope twos attached to the patellar tendon in a very, very secure fashion. As you can see, the next step is to create the tunnels through the patella to allow us to bring these buttons up and secure them on the proximal cortex of the patella. So we use two drill pins, and we try and bring them as parallel as we can, but giving enough space between them so that they don't converge with each other. When we drill the 4.5 tunnel, it's important at the top that we do a longitudinal split into the quads tendon. This just allows access for the button. Once we tension things so that it can sit on the patellar cortex, rather than catching or gathering up the quads tendon. We then use a 4.5 drill and drill over that wire. And we repeat that on the other side. So we have 24.5 longitudinal tunnels within our patella. These drill pins have an eyelet. We use that just to bring a passing suture up into both and just loop and secure that. On one side you can see there's a TigerWire used there and a FiberWire just so that we can differentiate between the two tunnels. Although this is visualized and quite easy to tell the difference. Again, with this one, just loop it through to secure it so it doesn't disappear. Using the passing suture, we pull the button up and through. It's important that we just bring the cinching sutures and the passing suture for the button, and leave the FiberTape so that they're down through that tunnel still, and they're used as an internal brace later. And we'll go through how we secure them on. We repeat this again on the opposite side. So you see separating out the FiberTape which doesn't go through the tunnel, and just the pulling suture and the cinching sutures for the TightRope to go into that FiberWire and brought up through the tunnel. And the button deployed and flipped on the proximal cortex of the patella. Now you can see the importance of the splits in the quads tendon. As if we started to shorten these down, it would start to catch and tether the quads tendon, which is not something that we want to do. So separating out you can see the much flatter profile of the TightRope two. It's much easier on your hands when you start to cinch, and you can see that shortening things down. Just reorganize the FiberTape so it doesn't get caught up. And that's down on cortex. And if you just visualize the patellar tendon, you can see that closing that gap and shortening up with tension underneath. Now we're going to repeat the same on the opposite side. Just making sure that button doesn't get caught in the quads tendon. Even with that split pulling the TightRope to watching it cinch making sure that button sitting on cortex. And then again, as we tension watching the patellar tendon and the gap closing up, which is just fantastic. We now have four tales of FiberTape sitting down. You can see, and we're going to use them as an internal brace, as a secondary backup for our reconstruction, which is already fantastically solid. So use the spade tip drill to drill what would be a 4.5 tunnel for a 4.75 swivel lock? Really important in tibial bone where you've got that hard cortex, particularly in young patients, that you tap it so you don't damage the SwiveLock as you try and insert it. Using a peak SwiveLock in this circumstance. And what we're trying to do is to have one crossing over from one side over the patellar tendon and the other one coming down longitudinally. Use the flag to pull the FiberTape ends into the peak eyelet. That's at the end of the SwiveLock. And what we want to do is measure our attention. We do not want to over tension. So you can see the laser line that's there. We want to put the tip of the SwiveLock at the mouth of our tunnel, and then we measure the laser line and mark it onto the FiberTape. And we know that when we bring the eyelet to that level, the tension we've with preset is then the tension that we apply to the FiberTape and to the patient. So we engage that into our socket, give it a tap if we need to, just to engage the first few threads of the SwiveLock holding the paddle and then twisting the end of the screwdriver, that's part of the swivel lock device. And that advances the swivel lock in the sheath, pushing the swivel lock into the tunnel. You can undo that paddle, and just make sure and visualize that your swivel lock is in as far as you want it to. This is the point that you can adjust. Once you remove the screwdriver, we can see the SwiveLock there. There's an accessory suture that's present. That's through the eyelet, but not necessary for this. And then we repeat the same process on the other side using that spade tip drill. I use a bit of diathermy often at this stage just to visualize that hole preventing soft tissue coming in, using the tap again for that hard tibial cortex. Making sure you advance the tap all the way in. Finally, using the flag at the end of the SwiveLock just to pull the waxed ends of the FiberTape in. We've measured again off that laser line. Tap into our hole like that. And then holding the paddle in, advancing the swivel lock in again with the sheath, pushing and helping that SwiveLock into its position. Trim and cut the FiberTape. And you can see that we've got a fantastically secure reconstruction, Both with regards to cortical fixation from our TightRope TOS using the SutureTape that's secured onto the patellar tendon, and also the FiberTape as a secondary backup and an internal brace. And often I can find at the end of these surgeries, we're able to flex the knee right up to 90 degrees almost through a full range of motion, which is very unusual in a patellar tendon reconstruction. Once you've cycled the knee, if there's any gapping at all, we can retension, as you can see with the TightRope tos. Finally, we can trim the tensioning sutures of the TightRope TOS. We would then close the retinaculum with a further SutureTape just to secure that split, and then close in a normal fashion.

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Patella Tendon Repair Using ACL TightRope® II Implants With InternalBrace™

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