Name: Transosseous Patellar Tendon Repair Using Double Knotless Knee FiberTak® Anchors
Uploaded: 2024-12-23T00:00:00Z
Channel: Arthrex
Description: Chad M. Hanson, MD (Las Vegas, NV), demonstrates a retensionable, transosseous patellar tendon repair using Double Knotless Knee FiberTak® anchors. In this demonstration, Dr. Hanson removes the FiberTak anchors from their inserters for easy passage through the patella.

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Chad M. Hanson, MD (Las Vegas, NV), demonstrates a retensionable, transosseous patellar tendon repair using Double Knotless Knee FiberTak® anchors. In this demonstration, Dr. Hanson removes the FiberTak anchors from their inserters for easy passage through the patella.

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VID1-007026-en-US | A | Transosseous Patellar Tendon Repair Using Double Knotless Knee FiberTak® Anchors

Chad M. Hanson, MD (Las Vegas, NV)

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Transosseous Patellar Tendon Repair Using Double Knotless Knee FiberTak® Anchors

Hi, my name is Chad Hansen. I'm an orthopedic surgeon practicing in Las Vegas, Nevada. And today I'd like to show you a patellar tendon repair technique using a double knotless knee FiberTak. Here we are at the back table. We have our patellar clamp, our zebra pin with the grommet, our Cannulated two four pin nitinol wire FiberSnare for shuttling our one seven SutureTape. And we have our two six double knotless knee FiberTaks. And then at the end we have a passing needle for final tensioning. For this technique, we actually take the FiberTak off of the guide for easy passage through the patella. One thing that's important is that we lengthen the loops so that once you've passed this through the patella, you still have some working length for your repair. So here we're identifying our injury. This is a left knee specimen. You can see here we've created our patellar tendon tear off the distal pole of the patella. We've extended our incision proximal and distal just for purposes of demonstration. And you can see here we've developed a pair of tendon which in most cases you should be able to preserve. So here we have our patellar clamp. We have this proximal spike obviously can be switched for a quad tear. You want to set that spike onto bone. And notice this specimen has a very pointed distal pole. This is very common. And when you're drilling freehand your drill is very prone to slippage. With this guide we can really prevent that. So now we have our two four cannulated drill we're going to use to create our low profile tunnel. I'm drilling. Drilling fast, but pushing slow just to make sure that we don't slip off the bone. And we're just pushing through there. So now we'll pull this guide off just a little bit, and we'll just deliver the pin through the tissue here. And once that's through, we can cut down slightly just for passage of our FiberTak. And this step is important. You don't want your anchor sitting proud on the tendon or on top of the bone here at the proximal aspect of the patella. So you can do the same technique with the cannulated drill bit for both sides, medial and lateral. As an alternate technique, you can use a solid two for zebra pin. I like to keep both pins in place just to make sure that we're staying parallel. So we're just finishing this pass and delivering it through the proximal aspect of the bone and just piercing through the tendon. Here we'll cut down like we did for our other side. And again this is just big enough to pass our FiberTak. So that our construct is not proud. An important factor when drilling. You want to make sure that this is tight. If this starts to back out because it's not fully tightened while you're drilling, then you'll fill the cannulated drill bit with bone and it'll be very hard to pass. So once you've done that, once you've finished drilling, you're going to loosen here. Pull out the inner portion, leaving the cannulation where we can then easily pass. All the way through the bone and you can see it passing proximal. So here you can see our loop. You want to make sure and pull this all the way through so that there's no wire showing. So now your assistant has the wire held steady. And we're just going to very carefully back this out. So the alternative is with your standard Pin, you're just going to pass your suture through the eyelet. And then we'll take. And your assistant will pull it through as you start to pass it. So here we're just converting with a FiberSnare to get our loop proximal. This will help us to pull our anchors distal. Go ahead and pull that through. So now we have both loops proximal and our free tails our distal. Here we have our double loaded NE FiberTak. You can see we have a safety stitch on our two loops distal. And this is just going to help us as we pass these sutures from proximal to distal through the loop. Here. So we've now passed these through our loop proximally. And we're going to pull the whole construct through the patella. And again, as a reminder, these loops, you want to lengthen these loops from the FiberTak so that you have enough working length distal. So now that the loops are through and again we still have our safety stitch in place, we want to set our FiberTak with counter tension. And you can see I'm pulling as hard as I can. And we're set nicely. Now we're working with our lateral anchor. And again we're going to pass all the sutures, including the safety stitch through the loop. We're going to hold tension on all of the sutures. And then we again very carefully pull through. We've lengthened those loops. And again, once we see the loops distally, we can put our fingers through the loops and the free sutures. And then with counter tension, we'll set that anchor. Now we can clamp all of our sutures away from the tendon while we prepare the patellar tendon. Now we're ready for preparation of the patellar tendon. We have the peritoneum out of the way. We want to start our repair distal, and we're going to do locking sutures. So when you're preparing the tendon and again we're starting distal with this repair. We want to leave enough tendon for tying at the end. You can see here we've left suture enough to tie at the end of our repair. We're working our way proximal and we're just going to lock these. So normally with a patellar tendon repair you're starting at the tendon and working down and then coming back up and tying at the level of the tear. This is reverse. So we're starting away from the tear. Working our way up to the tear site. And when we reach the tear site, this suture is going to pass through both of our loops of that medial anchor. So now we're passing the suture through the loop. We've left enough excursion of suture so that we can work our way all the way back down. And then we're going to do our locking stitches back down the tendon. At this point, you want to do. So when you reach this point we are going to take some of the tension out of these loops. We want to make sure that we have a nice tight junction at the repair site. And so we will take some slack out of both of these loops. Remember to pull in line with your anchor. So now we will complete this repair suture. So we're locking on our way down as well. And now our medial side is complete. So we will repeat the same technique for our lateral anchor in the lateral aspect of the patellar tendon. You can see here we've finished passing all of our suture. We have Krakow up and down the patellar tendon. So we have four strands distal. You can see the remnants of our FiberTak for our tightening sutures here coming out of the distal patella. And then proximal you can see the FiberTaks set. So our next step will be to tie our distal knots. Then we'll tension at the FiberTak the patellar tendon and patellar junction. I'm just going to hold our first loop. Here. So same technique on the medial side. Cut these with a short tag. Now we're ready to tension our FiberTaks. So you can see here approximately these are the safety stitches that were just in place for passage. These are no longer necessary and those will just slide out. I like to tension evenly. And so you'll take one end. Your system will take the other. End your knee between 30 to 45 degrees of flexion. And then we're going to slowly tension medial and lateral at the same time until we have our final repair. You can see the defect in the gap is completely closed down. And we have a nice repair of the patellar tendon back to its attachment. So now we've cycled the knee. We added a little bit of tension to each of our anchors. And when we take it to 60 degrees, we have no gap formation. The last thing that I like to do is I like to take these free ends of our suture from the FiberTak, and we're going to repair those over the defect just to get a little bit of extra fixation. I'll pass each of these strands across the tear, and then we'll tie them in a mattress fashion. So here we have our final construct. You can see a nicely repaired defect. Low profile sutures. We repaired over the top proximally. These are flat, very low profile. And then you can see peritoneum. You would close that over your repair. And if you have any retinacular tears as well. It is a very important that you close those with a absorbable suture. I love this technique for multiple reasons. One it's very low profile. You can see these soft tissue anchors are completely flat proximally. But the most exciting thing is the lack of gap formation at the repair site. You can cycle the knee after your repair and then it's retention able, so that you can add more tension to the construct and help close down the defect even better.

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Transosseous Patellar Tendon Repair Using Double Knotless Knee FiberTak® Anchors

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