Name: Knotless Medial and Lateral Row Rotator Cuff Repair
Uploaded: 2019-09-11T00:00:00Z
Channel: Arthrex
Description: Stephen S. Burkhart, MD, (San Antonio, TX) discusses the history of double-row rotator cuff repair and highlights the latest anchor options that incorporate knotless tensionable technologies, including Knotless SutureTak ® , Knotless Corkscrew ® , and Knotless SwiveLock ® suture anchors.

Stephen S. Burkhart, MD, (San Antonio, TX) discusses the history of double-row rotator cuff repair and highlights the latest anchor options that incorporate knotless tensionable technologies, including Knotless SutureTak®, Knotless Corkscrew®, and Knotless SwiveLock® suture anchors.

Not Hidden

English  - en

video

VID1-000239-en-US | A | Knotless Medial and Lateral Row Rotator Cuff Repair

Stephen S. Burkhart

Human

A video of a live presentation reviewing Arthrex products or techniques.

Video einer Live-Präsentation, die Arthrex Produkte oder Techniken überprüft.

Präsentationsvideos

Presentation Videos

Vídeo de apresentação ao vivo analisando produtos ou técnicas da Arthrex.

Apresentação vídeos

Video de presentación en vivo que revisa los productos o técnicas de Arthrex.

Video presentaciones

Knotless Medial and Lateral Row Rotator Cuff Repair

Good morning. I'm Steve Burkhart from San Antonio, Texas. I'm going to talk to you about Nautilus medial and lateral row rotator cuff repair. So in doing this we're going to basically give you a short history of nearly everything about double row cuff repairs. So the double row evolved from being two separate rows medial and lateral to this linked double row configuration. So why would this be superior? There are anatomic, biomechanical and clinical considerations here. Anatomically, the normal footprint is fixed both on the medial and lateral sides of the tuberosity. So it makes sense that we would want to reconstitute that anatomy. Meyer showed that the single row repair reproduced 46% of the footprint, whereas a double row repair reproduced 100%. There are other anatomic considerations as well. The rotator cable crescent complex being one. We looked at this in an anatomic study and found that the cable attachments were the most important, strongest attachments at resisting failure of rotator cuff. This led to this suspension bridge modeling for rotator cuff tears. And I think because of that, I like to reinforce these cable attachments with an extra cinch stitch in all cases. Biomechanically. We know that double row minimizes tendon to bone interface motion. We know that double row improves tendon to bone contact during internal and external rotation. We know that the linked double row seals off the healing zone from synovial fluid, which I think is quite important, and that these double row bridging constructs are self reinforcing systems, much like a Chinese finger trap, where the harder you pull, the tighter the grip becomes. And this happens in the rotator cuff for a couple of reasons. You have increasing compressive and compressive and frictional forces. As the muscle contracts and displacement occurs, and you get a wedge effect of the tendon being wedged between suture and bone. So what if the tendon is poor quality or short or deficient? What do you do then? Well, we've been using the anchor based load sharing ripstop. And what this does, it has a knotless FiberTape that's fixed laterally. And then that acts as a ripstop for sutures that go over that. So it basically converts what would have been a single row repair into a linked double row repair. That's self reinforcing. We've looked at this in the lab, and we found that the load to failure for the load sharing ripstop is 1.7 times higher than with the single row repair. So how does this work? Well, we know that cables are the most efficient way to support a load over a long span. We talked about the suspension bridge modeling as being an example of that. And then how that there is an anatomic basis for that. If you look at the cable if you look at these cable systems, there are two types of cable supported bridges. One is a suspension bridge, but the other one is a cable stayed bridge. And if you look at the modeling of this load sharing ripstop, it's basically the same mechanics as this cable stayed bridge, which is a self reinforcing construct. So if you use these tried and true biomechanical modeling, I think that you're going to be safest staying with things that have worked in other settings. So I think today is gold standard for a pair of crescent shaped cuff tears. Is the SpeedBridge linked double row repair? These are some SOS diagrams that just show that the recovery is basically the same between knotted or knotless, but the knotless saves significant amount of time. There are some enhancements to the SpeedBridge this dog ear reduction cinch loop, which also reinforces the cable attachments. And then if then if your if your tissue is suspect then doing this medial double pulley double mattress it seals off the healing zone and reinforces things medially. So the biomechanics of Nautilus lateral fixation, we're basically we know there's friction between the anchor and the bone. But there's also what we call cable friction around the eyelet of the anchor, which I think is even more important. And as with many things in Texas, there are lessons from the ranch. We know that if you have a lead rope on a horse and you try to restrain it, there's no way you can do it because he's stronger than the man. But the if you're able to get a wrap of that rope around a post, you can significantly decrease the amount of force you have to put the old cowboys near this. They knew that if you get one wrap around a post, it would take about one fifth of the force to restrain that horse. And so the same thing happens. You have a cable friction that develops with the SwiveLock eyelet and FiberTape. So you have that cable friction that's That significantly inhibits lateral failure. What about medial fixation? There's this concept that you heard described earlier from Tom Dooney this cross anchor knotless self-reinforcing tensional loop fixation that you have with knotless SutureTak knotless corkscrews, and now with a knotless SwiveLock where you're taking the working suture of one anchor and shuttling it through the splice of the other anchor, and vice versa. You've seen this diagram, this video, many times just how these anchors work, how the splice works. This is a study that we just published in the Arthroscopy Journal in November, looking at Remplissage, which basically ends up being like a posterior pair using interconnected knotless anchors and the superior biomechanical properties. So basically you have the two anchors, much as you would have with a posterior pair, and you interconnect the splices of one anchor to the other. And we compared that to the standard knotted double pulley technique to the knotless double pulley. We cycle it 100 cycles pull the failure. And what we found was with cyclic loading, there wasn't any failure in either group. But when you look at the single pull to failure, the yield load for the Nautilus was almost twice what the nodded was. And. And if you look at the mean load to to failure, the the Nautilus was about 40% higher than the nodded. So in conclusion, the medial nautilus fixation by interconnected, self-reinforcing tensional loops is significantly stronger than the knotted fixation. And the editorial comment from Doctor Pedowitz on this was in total agreement. So I was pleased by that. Techniques. Here's a Nautilus post repair using Nautilus SutureTak. You see here a significant pasta lesion. And we're going to use a percutaneous insertion kit. We're going to try to puncture that capsule there as well. So we bring the tendinous layer and the on the capsule layer down. I think that's important. You want to get the capsule attached immediately. So this will be a knotless SutureTak going in here. You can punch that hole. So you compress the bone rather than drilling it and taking out. Now that we have the knotless Corkscrew, this is actually if the bone is suspect at all, you'd want to use the threaded anchor here, the Corkscrew rather than the Knotless SutureTak. This just happens to be the Knotless SutureTak here. So we have the two anchors, one at the front and one at the back of the footprint. And then we're going to do cross anchor threading here. We'll take the working suture from the one anchor and thread it through the splice of the other anchor. And then we'll then we'll reverse that. Take the working suture of the second anchor, thread it through the splice of the first anchor. And then you're going to cinch these down by cyclically reciprocally pulling on pulling on them. You see these? You bring them down to where they're close, but not tight. And then you tighten them. Once both splices have been, have been formed. And you see how this brings it down very nicely. And then you can fix this laterally. So then you turn this into a linked double row Nautilus type of configuration. So this is that Nautilus SwiveLock where you can do a nautilus medial and lateral rows. And this just is a the foam bone demonstration of it, where again you're doing the cross threading one anchor through the splice of the other anchor. You get them both down most of the way and then you cyclically tighten them down. And then you can use the tension loop from your lateral anchor to do that dog ear reduction. Now this is using the Nautilus SwiveLock immediately with attentional loops. This is on a cadaver. So we passed all the sutures. We've just shuttled them through two spots in the rotator cuff, again passing the working suture through the splice of one anchor, through the splice of the other anchor, and vice versa. You see how they're not all totally cinched down yet, but then we're going to pull on those reciprocally and we'll indent the tissue there. And you see looking under there through the lateral side, how you have great apposition of the tendon to the bone. Now we'll use that same anchor laterally to take the FiberTape out of it first. But now we have our tensional loop construct here that we can use to reduce the dog ear. And so this is done with for Nautilus SwiveLock anchors. Thank you.

Knotless Medial and Lateral Row Rotator Cuff Repair

Related Pages

Shoulder

Knotless Corkscrew^® Anchor

Product

Shoulder

Knotless SutureTak^® Anchor Technique

Procedure

Shoulder

Knotless SutureTak^® Anchor

Product

Shoulder

Rotator Cuff Grasper

Product

Elbow

Rotator Cuff Grasper

Product

Knotless Medial and Lateral Row Rotator Cuff Repair

Related Pages

Shoulder

Knotless Corkscrew® Anchor

Product

Shoulder

Knotless SutureTak® Anchor Technique

Procedure

Shoulder

Knotless SutureTak® Anchor

Product

Shoulder

Rotator Cuff Grasper

Product

Elbow

Rotator Cuff Grasper

Product

Knotless Corkscrew^® Anchor

Knotless SutureTak^® Anchor Technique

Knotless SutureTak^® Anchor