Name: ACL Primary Repair Using the InternalBrace™ Technique
Uploaded: 2013-09-02T00:00:00Z
Channel: Arthrex

Gordon Mackay, MD (Glasgow, Scotland), presents an ACL primary repair using the InternalBrace™ technique. Using BioComposite SwiveLock® anchors and FiberTape® suture, the InternalBrace technique allows the surgeon to address certain patterns of ACL ruptures, especially proximal tears with good tissue quality.
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.

Not Hidden

English  - en

video

VID1-0151-en-US | B | ACL Primary Repair Using the InternalBrace™ Technique

Gordon Mackay

Human

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

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Surgical Technique Videos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

ACL Primary Repair Using the InternalBrace™ Technique

I'd like to take the opportunity to talk you through the internal bracing technique for primary repair of the anterior cruciate ligament. Well, I'm just using the new Torpedo shaver here to improve access or and clear some of the soft tissues in the lateral wall. As we can see, this is an injured ACL. If we in the empty lateral wall and as we come round the fibers of the the PCL are clearly in front of us. The idea here is to try and repair these, these soft tissues and bring them back to the lateral wall with the internal brace. So we can position this standard ACL gate here over the footprint of the ACL. Then all we're concerned about here is that we actually align with the middle of the footprint. Excellent. And we tap the drill sleeve into the cortex just to ensure that our track is established until we feel a firm endpoint. Excellent. Advance this now and we need to be suture grasper. You can see this coming through easily and it presents the suture quite nicely. It's easy to identify. And once you hold of the suture itself, bring it out through the medial porthole and the FiberStick can be withdrawn. And we simply remove the tibial femur. Okay. This is a loop in the end of the TigerWire effectively in the FiberLink. And I'd like to show you a little trick with you to allow you to cinch the ACL soft tissue. We pass this through the loop, and then we simply take the end end of the loop itself and feed this into the end of the device. As we push it down, you can leave the jaw open, but you can advance just to make sure that's fully engaged. And then we're ready to enter the joint moving into the joint here. We're going into the substance of our ACL fibers. We're making sure we have a good bite and relatively proximal as well. And as we pass through this, retrieves our suture automatically and comes back out through the joint. And the fiber link then slips easily onto the soft tissue. And you can see here we've now got some control over that soft tissue. I illustrate here with a suture passer. When it passes proximally we'll apply appropriate traction to the ACL bundle itself. And we've now prepared the tibial side as simple as that. And just using a blunt obturator it's apparent the attachment point on the midpoint of the footprint is just at the tip of my probe. But I would like to use the PowerPick just to freshen the lateral wall here to facilitate and enhance healing. Within the joint. We can then gently advance the tip of the PowerPick itself, and you can do this quite generously to make sure there's adequate soft tissue. But in an acute situation, the wall is relatively fresh and needs modest preparation, and that should do nicely. We then turn our attention to preparing the femoral tunnel from the medial port hole, using the spade tipped guide wire, which prepares a 3.5mm tunnel. Fortunately, here we can see the soft tissues coming off from the lateral wall, so it's easy to identify what we regard as the midpoint of the footprint itself. And we have calibrating devices which allow us to do this more specifically to ensure anatomical placement of the midpoint of footprint by gently flexing the knee. It's easy to come around and then we can advance freely through the femoral tunnel. Okay. We now have the trajectory for the internal brace and we have the soft tissues prepared. We are going to tie the cinch down onto the TightRope. This is an advantage in that it gives secure cure fixation to the button, but does not transfer the tension of the InternalBrace to the soft tissues. It is also important to take a knife and just release the tension through the guidewire on the lateral femur, and this has two benefits. One releases the skin edge, but secondly, a nick through the fascia means it's very easy to slide the suture directly down onto the button without getting entrapped. We feed our primary lead suture from the tibia and our cinch through the eyelet of our guidewire, and then it's easy to pull this construct just gently through the knee itself and out through the joint inside the joint itself. We know that we aren't snared within soft tissues because we have the passport, and the cinch gently gathers the ACL tissues, directing them as we would like. And you see the tension through these fibers already with very modest, modest application of force. And the blue suture here also will be where the internal brace will be directed. I now like to just demonstrate the demonstrate the construct that's going to pass through the joint. This will be our internal brace with the TightRope, which allows fine tuning of the length of the internal brace. Even once the distal attachment is secured and we have our FiberTape looped over our TightRope our T, and proximally we have a two lead suture which will allow us to tie, will act as a post and allow us to tie the suture down onto the button. And this can be gently advanced through the joint. And as we come through you can see the lead sutures coming out nicely. There we go. The button coming through the substance of the ACL itself. Excellent. Okay. So we can just see the tip of the internal brace coming through. And using the TightRope allows us to be quite precise positioning the FiberTape. So we should be demonstrated now. Just gently gentle toggles from side to side and you can see that tensioning nicely. And we rest there. So that's fine. So we can fine tune later if we need to. So for our swivel lock we have the standard drill a nice little guide. Protect the soft tissues using the same one centimeter incision and going perpendicular to the tibial cortex just distal to the tibial tunnel. We advanced a fixed depth stop. We then take the tap. Because the tap is important, especially for the cortex, we can identify the soft tissue track. Advance this down to the black laser line. Now it's worth leaving that just so you can remember the direction and position while you prepare the end of the internal brace. We'll now remove our guide. I always like to fix this in full extension so that it's a screw home mechanism. So the soft tissues are established at the natural natural length and they shouldn't require any extra tension to. Through the internal brace itself. Fortunately, if it is left slack, the TightRope will accommodate for any imbalance and with a little bit soft tissue entrapment. Sometimes it's important just to tap home the swivel lock. We're happy internally that the tension has been reestablished, and you can check your anterior drawer if you want, and then you simply advance into cortical bone. We then release the central cord, which in this situation will not be necessary. We have here the lead sutures for the TightRope, and we pass this through our FiberWire cutter. And then release. Once we've released, all we have left is the suture that led the construct or the augment into the joint and the cinch structure, which is a TigerWire, and then we can gently advance this down, just a wee nudge at a time, down until we're flush onto bone. We do a reversing suture, which just simply locks this onto the post like so. And finally, taking this down onto the button cutting flush ensures there's no irritation with the fascia. And what we can see is that cosmetically the ACL we would retain the proprioception and natural fibers. The best graft is actually it's own the ACL itself from stem cell studies. It's the ACL stem cells that are actually the best regenerative tissue. Not surprisingly. And as we come into extension, the ACL is reestablished and the internal brace is protecting the construct, allowing early safe mobilization.

ACL Primary Repair Using the InternalBrace™ Technique

Páginas Relacionadas

Rodilla

Reparación del LCA

Procedimiento