Name: Acetabular Labral Repair Using the Knotless 1.8 Hip FiberTak® Soft Anchor
Uploaded: 2019-12-19T00:00:00Z
Channel: Arthrex
Description: Asheesh Bedi, MD (Ann Arbor, MI), demonstrates a tensionable knotless acetabular repair technique using the Knotless 1.8 Hip FiberTak ® soft anchor and SwiftStitch™ suture passer. In this cadaveric demonstration, he showcases this soft anchor's ability to appropriately tension the labrum against the acetabulum for an anatomic labral repair.

<p>Asheesh Bedi, MD (Ann Arbor, MI), demonstrates a tensionable knotless acetabular repair technique using the Knotless 1.8 Hip FiberTak<sup>®</sup> soft anchor and SwiftStitch™ suture passer. In this cadaveric demonstration, he showcases this soft anchor's ability to appropriately tension the labrum against the acetabulum for an anatomic labral repair.</p>

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VID1-000547-en-US | A | Acetabular Labral Repair Using the Knotless 1.8 Hip FiberTak® Soft Anchor

Asheesh Bedi

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Acetabular Labral Repair Using the Knotless 1.8 Hip FiberTak® Soft Anchor

This is a right hip that we have set up for arthroscopy. As you can see here, we've really done nothing more than create our inner portal, cut and expose the extracapsular rim here. As you can see here, I'm viewing from a proximal anterolateral portal. There's your ligamentum teres. There's the labrum. You can see some area of delamination. And all we've done there is just expose the extracapsular rim. That's the area of the sub spine and anterior inferior iliac spine. And as we look medially you can see the tendinous fibers of the psoas crossing anteromedially we're viewing, as you can see here right now from a proximal anterolateral portal. And then we've just set up on the outside here a mid anterior portal in our distal anterolateral portal. These are the typical workhorse portals that we can use for pretty much anything we want to do in the central and peripheral compartment, both in terms of drilling and placing anchors for labral and chondrolabral fixation, but also later for for treatment of the cam and closure of the capsule. So in this case, we'll take our straight guide for our FiberTak here from the distal anterolateral portal, which can give you a nice trajectory here. The advantage of the distal anterolateral portal is it does give you this working trajectory that's more distal to proximal and increases your margin of safety from penetrating into the joint. And as you can see here, in this case we'll start perhaps relatively anterior on the socket. And we can place our guide quite close to the rim again for two reasons. One, these are small anchors. And two, we have this nice trajectory working from distal to proximal, which makes us comfortable that we're nicely seated into bone and aiming away from the joint. So we'll go ahead and seat that there. You can see the drill and the window there which is nice. And this is a positive stop drill. So we'll drill right down to the bottom there and then come on back. You can view always with the camera to make sure you see no undulation of the cartilage or any concern that you've penetrated into the joint. Then as you introduce these FiberTaks here, because they have this flexible shaft, you want to slide it down and gently seat it there like that before you push in. Much of that you can even do just by hand. And here we'll just bring that right down to a positive stop. You pull the black tab, which allows you to withdraw the sutures, and you can see here we can just gently pull back on that to make sure that the anchor seats and sits just deep to that subchondral bone. So right there in the deep to the cortex, your anchor is seated. At this point, you can either leave your drill guide in or for the sake of the video, we'll pull it out so you can see those sutures nicely. And then depending on your choice here, we can either go ahead and instrument here from the mid anterior portal or work all from the distal anterolateral portal. In this case we're going to go ahead and work from the mid anterior portal here. So we're going to retrieve out our passing stitch. In this case, the passing stitch for us should be the blue stripe stitch. You can see here they actually have two other stitches there, one that's round and one that's more flat, like tape. You'll see momentarily that will actually help us to distinguish which one is our shuttle stitch and which one is our pull stitch. Now we're going to go ahead and load on our passing stitch here on the SwiftStitch. You want to load it a little bit towards the end, so that you don't damage the stitch later. For passing through and shuttling, we're going to slide in through from our mid anterior portal again I think, as you can see here nicely, we can really look and feel with the Swift stitch that we're working at the Chondrolabral junction. I'm wanting to feel there. I'm feeling rim, feeling rim. I want to capture just the labrum and work in that interface between the labrum and the bone. In this case, we've not done any formal detachment at that chondrolabral junction. So here, as I feel that I work my way through that Through that interface, we pass through and then release the stitch. Here we'll come down through, grab the stitch and retrieve it back. That stitch is now retrieved and passed around the labrum. And now we can go and retrieve our shuttle stitch to facilitate that shuttle. So as you can see here, here we are through the Dalla portal. This was our pass stitch. So we'll go ahead and retrieve this one through. As you can see they're distinguishing the two. It's easy to see the flat stitch and the round stitch here. The round stitch will end up being our our shuttle. So if you see there there we have both the passing stitch and the shuttle stitch looped together to make sure they're in a clean plane. And we'll retrieve those back out through the Dalla portal to shuttle together. Now, as you might be able to see on the outside here, there's a suture mark here on the stitch. That mark helps you to know how much you want to fold through your shuttle stitch, to allow it to it to easily seat and load inside the anchor. Here, we'll pass that through. Again, fold it around that mark. It's not critical that it be at the exact location, but that tends to be a helpful guide. And now remember, because we retrieved those two sutures together, we know that line of pull is clear. I'll now take the flatter back stitch, which is the tape portion of that, and start to shuttle that stitch through. And so as we kind of get close here to where that stitch is about to load, this is kind of done as a little bit of a sequential pulling motion here to pull it through the anchor. And if you can appreciate that it was a series of small pulls. That stitch is now loaded into the anchor. And as you can see here, I can now take the free end of that stitch and bring it through and around. And you'll start to see that come down right around the labrum like that. Now what's nice here, as you can see, is I don't need to fully tension. I can even leave that partially tension this way. And we can subtly adjust as we continue the labor repair around here, working towards the lateral and posterior aspect of the socket. Again, the key idea here is you don't want to pull too much. Unlike a shoulder. This is maintaining a seal. Not not trying to Evert the labrum. So now you can just slide down right along the margin here. Again, once you're at the point where you're happy with the tension, sometimes in labor reconstructions, you can even leave those and then continue to differentially tension as you continue the repair. And as you can see, that's your nice loop around stitch there. Even in this cadaver with relatively diminutive labrum a nice repair. Next we're going to demonstrate this curved anchor guide. In this case the advantage of the curve as you can see is we get the benefit of a distal anterolateral portal trajectory but working from the mid anterior portal. So I just want to show on the guide here you see this line. This line is on the concave side of the guide. So here when we place this you want to want to angle that usually away from the socket. That's going to give you that favorable trajectory from the mid anterior portal, the trajectory that's going to keep you aiming outside of the socket. So again here I'm going to sit at that chondrolabral junction the guides in place. Generally speaking, if you just put a couple of little taps on the guide you can appreciate that will get the crown tips to seat to make sure the guy doesn't walk for you. Now, if you notice here, I'm not really levering on my hand at all. The curve gives you that favorable trajectory to work away from the joint. You can even look inside the window there. See, when you're fully seated, there's a positive stop and then the drill will come back out. Now the anchor slides down because the shaft is flexible, it will follow the curve. It is important, though, that you line up the flat aspect of the anchor handle with the flat aspect of the guide, as you can see here. That will help it follow the curve nicely. So here again you just want to seat that initially. And then after that seat is in you in you can just gently, either with your hand or with a mallet. Just impact that down again to a positive stop. Now the tab comes off there, we can gently withdraw. You can even lift the handle up at this point to start to see and make sure that you're seated at the interface there. Perfect. And then once we're set there now the drill guide can come out and your anchor is ready for passing. Now it's an important step with any of these, in a perfect world, to have your passing stitch separate from your ultimate anchor stitches. And so in this case, from the Dala portal, it's going to make sense to pull away all of the sutures except for the passing suture. So I separate them here and then here. I'm going to grab both the shuttle stitch and the tape stitch and pull those out this way. So we've truly just isolated our passing stitch from the mid anterior portal here. And now we're set to load that either to your SwiftStitch or to your labral Scorpion. Again try to grab towards the tip of your passing stitch so that you minimize the fraying of the important portion of the suture that's ultimately going to self load. So here again we come in from our mid anterior portal. Our other stitches are clear. I'm just going to feel for that chondrolabral junction. So we're maximizing our labral pass. Pass through here even in this hypoplastic labrum we'll deliver the stitch there. Leave it there. Come back around the labrum here. So we'll grab that bring that back through. Now it's important that you generally speaking pass your your passing stitch through the vector, the same vector through which you place the anchor. So in this case we we drilled from the mid anterior portal with a curved guide. So we want to grab that stitch around stitch and bring it back out the mid anterior portal. This way. Again grab it with your passing stitch. That will make sure there's no bridge between the two. And now we're set to go ahead and load and shuttle there again. We're folding right to about the marking line. And once that's set in place, we're now in a good position to go ahead and pull here. Again, that same motion we're gliding that down. Once it's about ready to go ahead and load through the anchor again those short tugging motions. We're there. And then now this just turns into your critical tensioning step here. So loop will come down through here and there. Now we're ready to go ahead and cut. In this case from our our Dalla portal. Again you can leave these tails as you sequentially go in a situation where you want to variably tension. But in this case again we don't want to invert the labrum. So we just go down and cut it flush. In this process as you can see can continue working lateral and posterolateral. Or anterior or anteromedial as needed.

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