Name: Acute Superficial Deltoid Repair Using DX Knotless FiberTak® Anchors
Uploaded: 2026-06-22T00:00:00Z
Channel: Arthrex
Description: Ryan B. Rigby, DPM (Logan, UT), demonstrates his repair of acute superficial deltoid injuries using DX Knotless FiberTak® anchors.

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Ryan B. Rigby, DPM (Logan, UT), demonstrates his repair of acute superficial deltoid injuries using DX Knotless FiberTak® anchors.

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video

VID1-009803-en-US | A | Acute Superficial Deltoid Repair Using DX Knotless FiberTak® Anchors

Ryan B. Rigby

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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Acute Superficial Deltoid Repair Using DX Knotless FiberTak® Anchors

Speaker  So after inspecting Arthroscopically and finding that the deltoid is incompetent, we have a positive drive through test and we've made our decision to move forward and repair it. Basically take the distractor off. I like to make an anterior medial incision and right along the anterior border of the tibia just offset from the portal here. I usually don't have to sweep this back. I can just come from right across this as a utility incision. It gives you great access to basically what you're looking for is that anterior superficial cuff of the deltoid. So we'll make our incision. We do watch out for the saphenous nerve and vein. So at this point we've reached the outer layer of the superficial deltoid ligament. And we've moved the saphenous nerve and vein out of the way. This is the tibia. We're looking at the fibers that now run down to the from the tibia to the navicular tibia to the spring ligament. They fan across this area. So we will now make a medial arthrotomy right across the anterior face of the distal tibia here. I'm not going to swing back underneath the tibia much. I stop at the anterior colliculus and basically just just make an arthrotomy through the superficial anterior cuff. Those fibers that hold the talus back in the ankle mortise. So a deep sweep right across this anterior portion of the tibia all the way down into the joint, allows you to release that anterior cuff of the deltoid. So now we'll be able to see the medial wall of the talus right there. Speaker  And we have a periosteal flap of tissue we can use in our repair. So we've made our medial arthrotomy giving us exposure to the anterior face of the tibia. This is a perfect location to use two bone anchors. I prefer the knotless fiber tacks. It's a simple, very minimal k-wire. The impact upon the bone is very small, but they have an incredible hold. So we'll place two of those here. We've pulled back our anterior superficial cuff of the deltoid, but I do want to show the instability. So come out with the retractor there. You can see the lateral side is obviously unstable. But the medial side you basically see the the talus sublux completely out of the mortise here. So we'll repair the medial side and then we'll move to the lateral side and plan for an internal brace augmentation with knotless knotless fiber tacks on the lateral side as well. So let's place our anchors. I use the guide. I like to place one a little more superior. And there's the k-wire. You can see the minimal impact this has on the bone. Once you see it, you want. You do want to hold position with the guide a single pass through and then the anchor is all suture very minimal, but the incredible hold and this is knotless, which is fantastic technology. Little taps will seat this down just until it stops and bottoms out. So we'll pull this out of the way. The guide is slotted so that removes. And we'll set our sutures off to the side. Speaker  And we'll place a second one. Maintaining a little bit of a bone bridge in between. We'll place a second anchor. Again don't angle into the joint and breach the gutter angle directly anterior to posterior single pass. Again our all suture Rd knotless fiber tack. I love that the drill for these is a simple K wire just preserving as much bone around the anchor as possible. We're now ready to repair the ligament. So these needles come attached to the fiber tack. And I like to do my inferior pass. Doesn't have to be too deep. And I'll do a mattress stitch. So we'll reverse this for the first one and we'll come back. We're grabbing the whole ligament complex here. We'll set this off to the side and we'll do the same thing with the other anchor. Again, this is the anterior superficial portion of the deltoid. So we'll bring this back. Now once we're ready to pull this we will remove the needles. And there are two purple lines you can see on the suture. And so we'll cut it off right at the purple line. So we've made our two horizontal passes corresponding to each bone anchor. Now what we'll do this Knotless technology is amazing and allows us to advance the tissue back to bone without having to tie any knots, which is super slick. So as I'm passing this, I bring this down to the second purple line on the suture, and I grab the other side. And the key here is to pull in line with the direction that we place the anchor. Speaker  So I'm going to pull this. This is our shuttle or our passing suture. And I'll start to feel some resistance. And at this point I just give it little short tugs. And then I hold this. Keep doing little tugs and we'll bring this right down. I'll slip this underneath so you can see it. But we're bringing this right down. And before I see all the tension I'm going to stop. We'll set this off to the side and we'll do the same thing with the other one. Okay. This is the superior anchor. I'll again pass this one again, slide it back to the to the purple line. And the suture is tapered to pass through the bone. Much better if you pass it at that purple line. So again, staying in line with the direction that we seeded the anchor a little short tugs will keep pulling that through. As you see here, and I just hold one loop, it tends to slide through nicely. Now we're getting ready to start our tensioning. So let me just show you again. We're going to we'll pull this direction and the horizontal mattress will pull that tissue back to the medial malleolus. Just go a little lighter on the retraction here. And to position this, we have not repaired our lateral side yet. So I like to do everything neutral. I make sure that the heel is off the table. So it's not influencing the position of the talus out of the mortise. Speaker  If you'll just hold this at 90 degrees, I don't do any inversion or eversion. I hold everything straight neutral. So we will tension our inferior one first. And you can just pull, pull, pull. And you can start to watch this. Just pull down nice and snug to the bone right there. And then I like to lay this over the top to the periosteum. So the superior anchor we're about to see and pull this back with tension. You can see how it's lax. And then as I pull, you can see how that just tightens down very nicely. I'll pull again with a little bit more tension. And now we've reapproximated it back to the medial malleolus. Now at this point, our talus is secure. You can see it's right underneath this. It's no longer subluxing out medially. And the tissue through those horizontal mattress sutures have been secured back to the medial malleolus. So we'll cut these. And being knotless, we can just cut these flush. Okay. There's our deltoid repair. It's very simple. Anterior superficial deltoid. We have our two horizontal mattress sutures. Inferior and superior that have pulled and tensioned the deltoid back to the medial malleolus. This is just the periosteal portion over the top. You can suture this closed if you like. I think it lays a little nicer if you do, but the stability has been restored by these two Rd knotless fiber tacks in a very nice fashion. You cannot sublux the the talus any longer. The anterior drawer is now negative on the medial side.

DX Knotless FiberTak®

Acute Superficial Deltoid Repair Using DX Knotless FiberTak® Anchors

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