Ombro

Multidirectional Instability

The Knotless 1.8 FiberTak® soft anchor and PushLock®&nbsp;anchor are designed for arthroscopic glenohumeral joint instability repair. The Knotless 1.8 FiberTak soft anchor is inserted through a guide, with the suture passed through the labrum and then through the anchor’s locking mechanism. Sequential tensioning creates low-profile knotless repair. The PushLock anchor provides the ability to independently pass the suture through a desired amount of tissue before anchor implantation, allowing for proper visualization and adjustment of tissue tension prior to final implant insertion.
Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA.

Shoulder

Procedure

The tensionable Knotless FiberTak soft anchor combines the benefits of soft anchors with knotless soft-tissue fixation. Curved- and straight-guide delivery systems are available with 1.8 mm drills, making this the smallest knotless anchor on the market.

Grant H. Garcia, MD (Seattle, WA), presents a case of multidirectional instability in which he used a tensionable, knotless technique to stabilize the injury. Dr. Garcia explains a suture-passing technique to add extra capsule tension with the rotation lasso suture passer. The repair is completed using Knotless 1.8 FiberTak® soft anchors placed in the anterior and posterior glenoid.

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Human

Multidirectional Glenohumeral Stabilization Using Tensionable Knotless Anchor Technology

Hi. Grant Garcia from Seattle, Washington. Today we're going to do a case presentation. This is a multidirectional stabilization using all knotless fixation. So this patient is 22 year old female over 100 subluxations continued hyper laxity continued pain instability and failure of physical therapy for over two years. The examination here was range of motion was normal rotator cuff intact neurovascular intact positive sulcus sign and two plus anterior and two plus posterior load and shift. So the MRI findings demonstrated a large labral tear with capsular redundancy and a normal cuff and normal cartilage. So my surgical reasoning for this patient was inability to return to sports, continued pain and instability, and three directions of instability, also known as multidirectional instability. So the data here is Gretzky et al. Ajsm 49 shoulders over five year follow up. These were all MDI patients. They had a minimum of three anchors anterior and three anchors posterior. And you can see the results 88% survivorship at five years 82% at eight years. This is excellent for this patient population. It's important. Here is the operative plan. So lateral positioning I do unique setup here with the TRIMANO and the lateral jack I like this for ease of setup but I also like it for especially with more difficult standard labral pairs. It's hard to get access and I have excellent access with this, so it saves me time in the operating room. Three portals are used here, so an anterior 8.25. I have a posterior Gemini cannula as well as an anterior superior viewing portal. All of my anchors are going to be 1.8. Nautilus FiberTaks. I'll use between 6 or 7, and I'll do a pinch and roll technique here. For the MDI patients, this is different from my standard labral repairs. So here we're going to start our posterior plication again I always start posteriorly. You can see we just have the Gemini in the back. There's no accessory portal needed for this type of situation. We're going to place the FiberTak low down. And again it's important here after you fire it, to load it, to make sure that it's intact. We're going to use a rotation lasso here. And this is the pinch and roll technique. So we maximize capsule maximize surface area so that we compress it down. It will heal back down. And after we pass this you'll see there's a coating on it that allows it to not get tangled or damaged. And then you can easily just pass it through. You don't have to pull it all the way out the shoulder. And here we've already completed our pass. You can see how quick that is. And then we're going to lock down the Knotless FiberTak. And then we're going to repeat this three times. So you see our third anchor going in. And this completes our posterior plication. Now we're going to work anteriorly. So again no accessory portal needed for these. So rotation lasso pinch and roll really tighten up that inferior glenohumeral ligament. You can see here that we have an excellent pass again very quick. And we're going to repeat this three more times. And now you can see we're going to cut each one individually after final tensioning. And we're shifting even further that capsule. And now you see we've completed this entire repair. Finally we're going to do our posterior capsular closure. So we're going to use a SutureTape. We use the rotation lasso for the first pass. And then the second pass. We're going to grab it with the BirdBeak. And then we'll tie this outside the shoulder to complete our capsular closure and prevent recurrence. So postoperative rehab on these patients. We have a gunslinger at 15 degrees for six weeks. And then we have passive motion starting at week four. Active motion starting at week six and return to sport is 6 to 7 months. Final comments. Rotation Lasso for me. Game changer. Faster passing. You can use it bidirectionally which is excellent. The anchor based application is more robust for MDI patients, and I will use this even without labral tears in these patients. Finally, Knotless FiberTak is a workhorse for me in all labral pairs, but especially in these more complex repairs, it's got low footprint. You don't need accessory portals, no notch stacks, and you can retention. Thank you.

Paul C. Brady, MD (Knoxville, TN), presents a challenging case in which he repairs a pan labral tear in the setting of multidirectional instability and decompression of a paralabral cyst. He uses an elevator instrument to prepare the soft tissue, then decompress the paralabral cyst. For anchor placement, Dr. Brady describes his strategy for repairing the 270° labral tear with tensionable Knotless 1.8 FiberTak® soft anchors.&nbsp;

Addressing Complex Multidirectional Instability With the Knotless FiberTak® Anchor

Hi, my name is Doctor Paul Brady, and today I'd like to discuss a patient with a labral tear as well as a large labral cyst. So this is a 45 year old female. She's had a 15 month history of shoulder pain with progressive weakness. On physical exam, while she maintains full range of motion, she has pretty dramatic weakness with external rotation against resistance. First we'll look at the coronal views. And on these views you can see that while her rotator cuff is still intact, she does have this large labral cyst in the spinal glenoid notch. If we transition to the axial views, we see a better view of the septation of this labral cyst, along with a large posterior labral tear. So for this case, I chose to use the 1.8mm knotless FiberTak anchor. I like this anchor because it uses very small drill holes so that you can get more points of fixation in the limited real estate that you have on the glenoid. If we take a look at the case, we'll start out with the diagnostic arthroscopy portion of the case. We can see the large posterior and posterior inferior labral tear with maceration of the labrum. So now I'm visualizing from the anterior superior and I'm looking at the back of the glenoid. I like to place a six millimeter cannula in the low posterior portal. And that's going to be my working portal for really doing the bone bed preparation. And then the elevators allow you to prepare the labrum and in this case decompress that large labral cyst. I like to decompress the cyst as much as possible, utilizing these elevators and just a small twisting motion while you're elevating the labrum off of the bone. We'll start the repair by placing my superior glenoid anchors, and I'll utilize the rotation lasso to pass the repair suture through the tissue. Next, we'll place the repair suture back within the locking splice of the anchor with the shuttle suture. You can notice that I haven't completely tensioned that first anchor. I've left it somewhat loose because I don't want to tighten up the shoulder to decrease my visualization. After we've placed three superior glenoid anchors, I'll take my repair sutures out an alternate portal for later tensioning, and then I'll move on to my anterior portion of the labral repair. Next, we'll turn our attention to the anterior inferior quadrant. I'll place a knotless FiberTak anchor at the inferior portion of my prepared bone bed. Again, we'll load the repair suture into the anchor locking splice. And these anchors I do fully tension at the time of deployment. Then I'll work my way superior along the glenoid, placing an anchor approximately every centimeter or so on the glenoid rim. You can see here the excellent extravasation of of bone marrow and blood that you get from these anchor sites. I call it the lava flow. And you see this with these anchors. And I think that bodes well for healing of this tissue against the bone after the anterior labral repair is completed. I'll turn attention to the posterior labral repair. And again, I'll place these anchors from my low posterior lateral portal. We'll secure each anchor and then just continue to work our way superiorly. After the completion of the anterior and posterior labral repair, I'll finish off the case by tightening my superior labral sutures. And as a final step, we'll take a final view from the posterior portal circumferentially to examine the repair, and we see an see an excellent repair of this pan labral tear. So my post-operative protocol for this patient will be very similar to all labor repair surgeries between weeks one and four. I like to go slow. Shoulder shrugs elbow. Wrist hand range of motion and gentle active assisted external rotation. Between weeks four and eight will progress her to a full range of motion program with physical therapy between weeks eight and 16 will progress to a strengthening program, but we won't do a full release on this patient until 24 weeks. Postoperatively. Thankfully, she's back to full range of motion, almost normal strength. She's playing tennis and pickleball and she has no pain. Thank you so much for your time.

This animation provides an overview of the features and benefits of the Knotless 1.8 FiberTak® soft anchor for the treatment of shoulder instability.

Knotless 1.8 FiberTak® Soft Anchor for Shoulder Instability Repair

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Knotless 1.8 FiberTak® Soft Anchor for Glenoid Labrum Repair

Knotless FiberTak® Soft Anchor Technique - MDI

Child (D)

A âncora PushLock foi projetada para reparo artroscópico simples e seguro da instabilidade da articulação glenoumeral. A técnica sem nós economiza um tempo valioso e elimina a possibilidade de pinçamento dos nós. Essa técnica de sutura prévia permite que os cirurgiões passem a sutura de forma independente através da quantidade desejada de tecido antes da implantação da âncora. Várias configurações de suturas, incluindo sutura simples, ponto simples e suturas em colchoeiro, podem ser realizadas com suturas FiberWire®, FiberLink® SutureTape, FiberStick™, SutureTape ou LabralTape™ usando os passadores de sutura Labral Scorpion™ ou QuickPass™ SutureLasso™. A tensão dos tecidos pode ser visualizada e ajustada, se necessário, antes da implantação final da âncora.&nbsp;

PushLock® Suture Anchor for Knotless Instability Repair

Elbow

The PushLock® is designed for simple and secure arthroscopic glenohumeral joint instability repair. The knotless technique saves valuable time and eliminates the possibility of knot impingement. The “Suture First” technique allows the surgeon to independently pass the suture through a desired amount of tissue prior to anchor implantation. Multiple suture configurations, including simple, cinch and mattress stitches, can be accomplished with FiberWire, FiberLink®, FiberStick or new <a href="http://www.arthrex.com/shoulder/labraltape" data-new-window="true" target="_blank" rel="noopener noreferrer">LabralTape</a> suture options using the Labral Scorpion™ or QuickPass SutureLasso™. Tissue tension can be visualized and adjusted, if necessary, prior to final anchor implantation.

PushLock® Knotless Instability Repair

The Arthrex PushLock is a knotless suture anchor designed for quick and secure shoulder instability repair. The PushLock utilizes a suture first technique that allows the surgeon to capture the proper amount of labrum and capsule prior to anchor insertion. The fiber wires are delivered into the bone socket. Tension is clearly visualized, adjusted, and then locked into position with the PushLock anchor body, creating a strong and low profile construct without knots. The suture first technique also allows the freedom for multiple stitch configurations like cinch stitch and mattress stitches. The Knotless PushLock saves steps and valuable time while providing a secure repair that eliminates issues with knot impingement.

Multidirectional Instability

Knotless FiberTak® Soft Anchor Technique - MDI

Técnica com âncora PushLock® — MDI