Name: Acetabular Labral Repair
Uploaded: 2019-02-05T00:00:00Z
Channel: Arthrex
Description: Brian D. Giordano, MD, (Rochester, NY) demonstrates an acetabular labral repair using a variety of suture anchors. In this video, Dr. Giordano passes multiple suture configurations using a 2.0 mm Mini Hip SutureTak ® anchor, a 2.4 mm Mini Hip PushLock ® anchor, and a 3.0 mm Knotless SutureTak anchor.

Brian D. Giordano, MD, (Rochester, NY) demonstrates an acetabular labral repair using a variety of suture anchors. In this video, Dr. Giordano passes multiple suture configurations using a 2.0 mm Mini Hip SutureTak® anchor, a 2.4 mm Mini Hip PushLock® anchor, and a 3.0 mm Knotless SutureTak anchor.

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VID1-000029-en-US | B | Acetabular Labral Repair

Brian D. Giordano

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.

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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

Acetabular Labral Repair

So this is Brian Giordano. I'm going to be performing arthroscopic acetabular labrum repair. What you're seeing here is total working length of the SwiftStitch. My thumb is going to depress the thumb piece. There's a nice ergonomic feel to the device. Suture can then be grasped or secured at the tip of the SwiftStitch pressure is applied to the thumb piece. Thumb piece is then slid back into position. The suture is nice and secure, and once the suture is is passed, the thumb piece can be depressed, advanced, and the suture will be released for later retrieval using a distal accessory portal. This facilitates a very anatomic perpendicular positioning to the acetabular rim to avoid iatrogenic intra-articular anchor placement or drilling. After I place the 14 gauge needle, I'm going to place a nitinol wire. Through the cannulated portion of the needle, I'm going to withdraw the needle, leaving the nitinol wire in place. Now the Now the nitinol wire is positioned in the joint, and we're going to be introducing a plastic cannulated obturator over the nitinol wire with Drill Guide. So you can see the plastic cannulated obturator advancing into the joint over the nitinol wire. The nitinol wire is then withdrawn. Plastic obturator is then withdrawn. So there are two really nice points of orientation on this guide. One that there's a laser line which corresponds to the the angulation of the curved guide. Secondly, the handpiece of the guide has a flattened portion that corresponds to both the laser line and the upswept portion of the guide. So this allows the guide to be placed in very tight proximity to the labral control interface, so that you can technically be as perpendicular as possible to the acetabular rim resection I'm going to be viewing in the joint as we as we drill, ensuring that there's no accidental intra-articular penetration of the drill. So we're using a two PowerPick SutureTak anchor with a positive stop. This has number one FiberWire SutureTak, which is a nice low profile suture configuration. So you can see that the anchor countersink so that it's deep to the drill tunnel. The guide is then withdrawn. So once the anchor has been placed, one thing that's important is to actually toggle the suture through the eyelet of the anchor to make sure the the suture slides easily. And that will help to facilitate suture passage and retrieval. Next the SwiftStitch is introduced into the joint. And in this case the suture is retrieved a little bit higher up. And what that allows is, is a relatively tension free passage so that there's enough redundant suture material. And I and I assess that both from the intra-articular and intra-articular side that's passing very nice atraumatic manner with as minimal a footprint as possible. The suture is then is then released. Swiftstitch is then passed either around or through the labrum, depending on surgeon preference. Suture is grasped and withdrawn from the joint. I'm going to retrieve the other suture limb with a CrabClaw suture grasper. And then I'm going to tie on the extra articular portion of the joint. At the end of our repair we have a nice knotted construct. It's perpendicular to the orientation of the labrum. It's far anterior toward the psoas notch and very, very thin low margin of error bone not as low profile and with very minimal trauma to the to the labral interface. For our next two anchor configurations, we're going to be using two four mini hip PushLock through a mid anterior portal. I'm going to change my position slightly, about one centimeter away from my initial anchor And with the guide in place, we're going to be introducing the drill. We're going to drill both both of our tunnels right away. And visualizing both intra and extracellular positions. Again I'm spacing myself approximately one one centimeter apart. Next I'm loading my SutureTape using my SwiftStitch. I'm going to be passing the limb of the suture first through the transitional zone at the RetroDrill interface. I'm then going to retrieve the suture in a mattress configuration through the labrum. Next. We're going to load our suture strands through the anchor. The anchor is going to be placed in our first tunnel. If you're slightly loose initially, the anchor should be placed adjacent to the bone. The orange outer protective cap will be removed. The inserter handle handle is withdrawn. The suture limbs are then cut using an open ended suture cutter. And as you can see, using the SwiftStitch, which has a 1.5mm tip, very minimal. There's very minimal trauma to the surface of the labrum. Next we're going to be passing a third suture. Again with the attempt to be perpendicular to the drilled tunnel. The stitch is again passed through the drill interface using the SwiftStitch with minimal trauma to the tissues to promote a tension free and anatomic repair. Once again, we're going to use a horizontal mattress configuration using the benefit of the 1.5mm tip of the SwiftStitch to penetrate the labrum and facilitate this technique for repair. So once again, you can see the two four mini hip PushLock anchor tip being advanced with the sutures slightly loose. The anchor is then advanced over the insertion handle. Orange protection cap is removed and the anchor is is tapped into place. It's. In a certain handle is removed and once again, an open ended suture cutter is passed over the over the sutures to cut them flush to bone. All right. So what you can see now in adjacent to the the initial looped anchor, we have 22. four millimeter mini hip PushLock anchors using a labral base or a mattress configuration. So now in this case, our our far superior posterior superior anchor has been placed through a distal accessory anterolateral portal. I've switched the scope over to my modified mini anterior portal, and I've switched my TRIM-IT cannula to my anterolateral trochanteric portal. So we're going to start out by grabbing the looped or shuttle suture portion of the knotless SutureTak. And that is the stitch that we're going to pass through our lateral control interface using our SwiftStitch. So the looped end, the shuttle suture of the knotless SutureTak is grasped with the SwiftStitch. And that is the initial suture that's going to be passed through the labral interface. Suture is then docked and it's retrieved. And secondarily a CrabClaw suture grasper is going to be used. To then retrieve the repair stitch. And of note, the repair stitch is visibly a different color, helping to differentiate the suture types. What you can see is the repair stitch being passed through the loop. I generally like to use an average distance where the color of the repair stitch transitions from from a white to a blue. That's ensures that adequate suture material will be retained once the suture is is passed and docked, but also ensures that the thinness of the suture is retained as it passes through the tip of the anchor. One of the advantages of using a knotless SutureTak anchor of this variety for this type of repair is that it is. It actually inverts rather than inverts the labral tissue, facilitating a more anatomic style of repair. One of the concerns during repair is that the that the labrum everts and is placed into a non anatomic position. In this case the labrum is actually inverted and the amount of tension can be varied. Using this technology to facilitate more or less tension or compression on the labor repair. At this portion, the tensioning suture still remains out the distal accessory portal. I'm going to retrieve that through the anterolateral portal, so that we can cut this flush to bone using the percutaneous tensioning cutting device. So now in terms of our final construct we have our our far anterior tool SutureTak far anterior with a looped and tied configuration. We then have 22.4 PushLock anchors in a horizontal mattress or a base configuration. And finally Posterosuperior. We once again have A30 knotless SutureTak in a looped configuration.

Acetabular Labral Repair

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