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VCD-1045 | A | Repair of SLAP Lesion with Bio-FASTak® Suture Anchors

Stephen S. Burkhart

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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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Repair of SLAP Lesion with Bio-FASTak® Suture Anchors

I want to show you how I repair a Slap lesion using the BioIB FASTak suture anchor system. This is a left shoulder. We're probing the superior labrum. The head is toward the top. Back here. You see, there is some detachment in the posterior superior quadrant. We'll check the peel back test where the arm is brought into abduction and external rotation. As we watch and you see the whole biceps labral complex peeling back over the edge of the glenoid when it comes into abduction and external rotation, including the root of the biceps. We'll now prepare the bone bed for repair of our slap lesion. You see, the area of greatest attachment is posterior superior. When we lift it up. But it also does extend more anteriorly under the root of the biceps. And you want to prepare this entire area down to a good base of base of bleeding bone. If you need to go around the corner a little anteriorly, you can bring your shaver through an anterior-superior portal to prepare that. Now we're ready to place the anterior anchor. We'll use the spear, guide and punch to make a pilot hole coming through the Anterior-superior portal. Here's the spear guide. We have a trocar punch that we tap down to the shoulder of the punch to create the pilot hole, angling toward the glenoid bone so that we don't enter the interface between cartilage and bone. Then we use a tap to tap the bone for the threads of our bio FASTak. There's a laser mark at the top of the threads of the tap that indicate when you've tapped to the proper depth, and then you simply unscrew the tap from the bone and you'll be ready to insert your anchor. There's our hole for the anchor. Next we bring in our BioIB FASTak, which is a PLA biodegradable anchor that has an eyelet of suture that's molded into the body of the anchor. We'll screw this down until we feel resistance. The laser mark of our inserter is just below the level of the bone. And you see that we have this doubly loaded with two sutures. Now we use a posterolateral portal to place our second anchor. Because of the posterior slope of the glenoid, we get a better angle into the bone by using this particular portal. You'll see that we use the trocar tip for introduction of our spear guide right alongside the needle. And we'll make a pilot hole, just as we did for the anterior anchor. You see, the angle of approach is just perfect for this anchor. We'll use this punch and tap it in up to the shoulder of the punch. Then in that pilot hole, we'll place our tap and tap the threads for our anchor. Once again, you want to be angling your spear guide toward the bone so that you're entering into bone. Next, we'll place our posterior anchor. There you see the hole? You want to be sure that the threads are catching. And because of the taper of the anchor, sometimes it doesn't catch until you reach a point about halfway down the threads. And so you have to be pushing on your inserter as you go to be sure the threads are engaging. You'll see this down to the top of the laser mark. And now remove the inserter. And we have two doubly loaded anchors. I like to pass the posterior sutures first. We use the 45 degree BirdBeak suture passer. And we're going to do a handoff. Once we've passed this through we'll pass through the labrum just at the margin of the articular cartilage. We have two sutures per anchor. These are color coded. And we'll try to have about a centimeter of separation between the two. You see how the 45 degree angle of the BirdBeak is just about the perfect angle for passing these sutures from the posterior anchor. Next, we'll pass our anterior sutures. This one is also doubly loaded. We'll use our 45 degree or 22 degree BirdBeak to pass one to anchor the root of the biceps. We'll pass this through the labrum at the base of the biceps, and the loop of the suture as it's tied, is going to come over the posterior half of the biceps. This is the most critical suture. We can then pass the anterior suture if we feel that's necessary. If we have prepared some bone bed in that area and pass it anterior to the biceps, we use the Penetrator suture passer for passing this suture. This way you have a double loop around the biceps, one anterior and one posterior. Next will tire nuts. I like to use the sixth finger, not pusher, because it holds a tight loop. It provides the maximum loop security as you're tying your knot. Alternatively, you can use a sliding knot and stack half hitches on top of that. The most secure knot is going to be one that has your base knot, with three half hitches stacked on top of that. You want a pass point to get all the slack out, and you also should consider reversing the posts, which you can do simply by flipping the post and tensioning your loop suture a couple of times as you go down. This is the most critical loop here, the one that goes over the posterior half of the biceps. This is the one that's going to negate your peel back forces. The clear cannulas help. They give you those added few millimeters of room to work. Now we'll show our completed repair and we'll take it through a peel back maneuver. Here's the completed repair with four sutures and two suture anchors. You see, this is very snug and firm. Now, we'll test the peel back test and take the arm into abduction and external rotation. You'll see the biceps will move, but the labrum doesn't. Medially, medially displaced at all. Nothing peels over the edge of the glenoid. We've totally negated the peel back. Thank you.

Repair of SLAP Lesion with Bio-FASTak® Suture Anchors

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