Shoulder

<p>Asheesh Bedi, MD (Ann Arbor, MI), demonstrates the use of the Knotless 1.8 FiberTak® implant system to address multidirectional glenohumeral instability. The technique highlights reproducible joint access and precise anchor placement using the system's low-profile cannula and curved drill guide, along with enhanced suture management enabled by differentiated repair suture colors. The repair is completed with final retensioning to achieve a balanced, circumferential construct.</p>

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VID1-010054-en-US | A | Arthroscopic Multidirectional Shoulder Instability Repair With the Knotless 1.8 FiberTak® Implant System

Asheesh Bedi

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Arthroscopic Multidirectional Shoulder Instability Repair With the Knotless 1.8 FiberTak® Implant System

Speaker  Hi, I'm Asheesh Bedi from Ann Arbor, Michigan, a shoulder and sports medicine surgeon, and I have the opportunity to share with you today the Knotless 1.8mm FiberTak implant delivery system for MDI. As you can see here, you have your traditional needle with an associated guide wire. These link with this nice low profile five millimeter cannula that allows you to place that seamlessly, directly wherever you would like, aligned with that wire and needle system. Here you have your 1.8mm drill guide. It's a curved drill guide with this disposable operator, and then the associated drill that goes with that. And what's really nice now is having the associated anchors that go along with this system. For those that have used knotless instability anchors and the FiberTak anchors, these have been improved even more by having sutures that allow for real ease in recognition of the repair stitch and the shuttle stitch. So as you can see here, we've placed our standard anterior cannula. This is just above the rolled border of the subscapularis. This can get you access as you can see nicely here all the way to the 6:00 position on the glenoid. But certainly the kit is compatible with percutaneous. So you can certainly place your anchors percutaneous using the guidewire and and drill guide through the Subscapularis. This is a great location to use that percutaneous kit. Here we place that spinal needle just in front of the supraspinatus. So we're not violating the rotator cuff and just posterior here to the biceps tendon. You can withdraw your guidewire back. It's important to keep this cannula localized in that location relative to the biceps tendon, so that you don't have your sutures inadvertently wrapping around the biceps tendon during the repair. Speaker  And now you have nice dual placed cannulas to work anteriorly. So now we'll bring in our drill guide. As you know, this comes in our implant delivery system kit. This is a curved guide just featuring a couple of things here. You can see this disposable white obturator. I like this so that it doesn't catch tissue on the way in. Also you can see here with the curved system you have this nice black mark here. This helps to orient you. That's the concave side of the curve, so that if you're working to make sure that you're keeping your drill hole contained within the glenoid, you're going to keep that curve towards bone. The guide allows us to gently lever the humerus. And then we have a nicely positioned drill guide for for placement. Our flexible drill bit now gets introduced. And now we're ready for anchor placement. So this is a great look at those sutures coming here right out of the diaphragm of the cannula. What we featured on the back table you can see the blue repair stitch. And then you have your pulley stitch. But your pulley stitch has both the flat component, which will be your pull side, and the round component, which will be your shuttle side containing the enlarged loop for the link. So now with our anchor in place, we can introduce our SutureLasso. And remember with MDI we want to both inferior to superior shift in the anterior band of the inferior glenohumeral ligament, but also a pinch tuck technique where we're pretensioning this anterior band. Speaker  So here I'm going to poke through this anterior band of the I, g, H, l and then tuck. And we want to tuck this to get this purchase right through the capsule. You may titrate that based on your preoperative examination and degree of tightness you're looking to restore here. We're going to now come back and then capture around our labrum. This is an advantage of these new anchors. You can see here my ability to easily distinguish the round stitch. That's the blue black stitch. The other more flat stitch. As you can see, there will be our pull side. This is our shuttle side. So we'll grab these together and we'll run them out the cannula so that there's no twists. You can see here the advantage of the larger loop. This makes it easier for us to pass that repair stitch through. And we're going to watch that shuttle right through. And you'll see there it's seated. It shuttles nicely. You can see it's going to start to bring that around the labrum. But notice here now our ability to even tension that anterior band of the inferior glenohumeral ligament, directly under visualization. We'll keep moving forward here, up along the glenoid. Here we bring our drill guide in again. We're going to come slightly higher up on the glenoid. And advantage of these 1.8mm anchors is they're small. So you can place them closer together and minimize any risk of postage stamp lesions or fractures. Speaker  As we know, load sharing is a principle here, and a minimum of 3 or 4 anchors is very appropriate. We've now placed anchor number two. This is again a feature of our implant system. Here. The repair stitch here is the white and blue configuration with the blue and black being our pulley stitch, allowing us to distinguish sutures. Our second anchor has now been placed. We're going to tension that anchor. But now the benefit here we can go back to our first anter inferior anchor and do balance tensioning between these two to assure that we've maximized the benefit if we want to continue work posteriorly, we make this a little bit of a portal here. Percutaneously working right along the edge of the humerus. But this trajectory is a beautiful trajectory to assure that we're placing anchors relatively perpendicular to the face of the glenoid into bone. But we can work all the way down from 7:00 all the way along the posterosuperior glenoid to continue that tensioning and now capture the posterior band of the inferior glenohumeral ligament. We've completed that two anterior inferior and two posterior inferior balanced repair, which we can continue posterosuperiorly and anterosuperiorly. But this is really nicely retention and eliminated that patulous pouch and capsule from the posterior band of the eye. Here the anterior band of the IGHL. Here we do a final tension and retention of that and then simply cut. And that results in our nice balanced repair for MDI recentering the humeral head on the glenoid.

Arthroscopic Multidirectional Shoulder Instability Repair With the Knotless 1.8 FiberTak® Implant System

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