Name: SpeedBridge™ Knotless Double Row Rotator Cuff Repair
Uploaded: 2017-06-12T00:00:00Z
Channel: Arthrex

Peter J. Millett, MD, MSc, (Vail, CO) describes his rationale for using the Knotless SwiveLock® suture anchor with FiberTape® suture to complete a quick and secure double row SpeedBridge™ rotator cuff repair. Dr. Millett explains his preference for using a totally knotless construct. Dr. Millett shares his latest clinical results including 809 knotless SpeedBridge repair patients with a mean of 5-year follow-up. He also shares how well FiberTape suture is incorporated and synovialized.

Not Hidden

English  - en

video

VPT1-00803-EN | A | SpeedBridge™ Knotless Double Row Rotator Cuff Repair

Peter J. Millett

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

SpeedBridge™ Knotless Double Row Rotator Cuff Repair

The goals of rotator cuff repair are to restore the anatomy, achieve healing, and what we need to do is have strong fixation and promote healing. The SpeedBridge technique is a double row knotless linked self reinforcing rotator cuff repair construct that we heard about. It uses SutureTape invented fully threaded anchors, and this has a number of advantages. It minimizes surgical steps with minimal medial row passes. It maximizes the tendon to bone fixation strength. It optimizes tendon to bone healing. It enhances the surgical precision and speed, and it also improves outcomes for our patients. Being from Colorado, I like to think about about it like these bee netting that lines all the race courses. When a skier goes off the course, there's multiple rows of fixation with multiple fixation points and the whole construct is linked. And that's what we're doing with the SpeedBridge. The biomechanics are such that it spreads the force from the tendon across the whole construct. So there's less force per unit area, less risk of a retear or bone, or failure of the bone. The advantages of the SpeedBridge you have this linked self reinforcing construct. The harder you pull, the more compression there is. You have decreased suture cut through with better load distribution. Because of the broad tapes. You have improved vascular inflow to the healing tendon because you don't have any foreign material at the tendon bone interface where the healing is occurring, you don't have over tensioning with the medial knots, the force is dissipated through the whole construct. You have less irritation in the subacromial space, and you have better biology because the tapes will act as a bioscaffold. It's also very adaptable. If you like to tie knots medially, you can. If you have a larger tear, you can do an extended SpeedBridge. If you have dog ears, you can incorporate free sutures into your lateral row. You can incorporate this with a patch as well. So there's just a lot of versatility and adaptability to the specific situation that you encounter. The SpeedBridge is also very economical. We heard about this earlier. It's faster in the O.R.. Time saving. This has been studied by Max Park. There's fewer steps. It's more efficient. The SOS database also shows this. It's also economical for our patients because they have faster recoveries. And they're also having fewer revisions as well. And there's also these convenience kits, which make it easier for your staff in the O.R. that have everything packaged in one kit that allow it to allow you to use the SpeedBridge quite reproducibly in the O.R.. What about the SOS database? This shows that knotless repairs, on average, take about 20 minutes less than knotted repairs. So you can do the math. That's an hour a day if you're doing three cases that you save just by using the SpeedBridge. This is how it's done. This is the circa 2008 case. This was the original SpeedBridge here. It's a crescent shaped tear. The medial anchors have been placed and passed, and then you tension it laterally with the lateral row of anchors in an Xbox configuration. And you can see I can take a complex tear pattern into a nice compressed repair. That's the rotator cuff is on the footprint without any form material between the tendon and the bone. You can also use this for larger tears. This is a 25 year old patient who dislocated his shoulder and had this massive rotator cuff tear as well. You can see it's a large right shoulder viewing from laterally. Eight anchor extended SpeedBridge repair two SpeedBridge kits. We closed the posterior interval with one side to side suture from the eyelet suture, which you'll see in the in the back here, and then repaired the remainder of the cuff with four anchors medially. Four anchors laterally and eight interlocked suture tapes. What about second looks? Well, they definitely heal. I have a couple cases of second looks. This is a this is a woman who was in her 50s, had a double row linked construct. Four months later, she developed adhesive capsulitis and elected to have surgery. Here you can see it at the footprint, the neovascularization that's occurred. And on the on the surface, the tendon is backed down onto the bone. This seems to occur quite early to. This is a second look that we had at six weeks. This is a 52 year old competitive rower who had a full thickness rotator cuff tear. It was repaired. It was a crescent shaped tear. It was It was repaired with a SpeedBridge. He subsequently had a fall. You'll see the repair here, placing the medial anchors at the articular margin where the bone quality is good. Lateral row of anchors. Typical SpeedBridge construct. Six weeks later he fell got an MRI. The MRI was read as a retear, so he wanted it fixed. So we went in. What we learned was that the immature tissue has high signal intensity, and you can see at six weeks there's neovascularization. The tendon is back down in the articular margin. And you'll see here the second look the tissues the tapes are completely covered with new tissue. So they act as a bioscaffold for new tissue to grow onto this. This is at six weeks. So it occurs quite early. So you have to be careful. If you get MRIs post-operatively in the early phases they'll have high signal. And sometimes they can be misinterpreted as a retear surgical pearls with SpeedBridge. Well you can have poor quality tendon. You can use the eyelid sutures for margin convergence. Or if you want to create a complex terrapattern into a simpler terrapattern, you can use load sharing ripstop sutures. If you have poor quality bone, I think the link construct definitely helps. Or you can go to the five five anchors as well. The five five SwiveLock you optimize the biology locally using these vented anchors, and you can also use a PowerPick to prepare the healing surface of the bone so that you get additional access to the bone marrow. For dog ears, we add FiberLink. We plan for these and then just incorporate them in our lateral row, and then always address associated pathology about 80% of the time we're also performing a biceps. Tenodesis. And we're addressing any abnormalities of the acromion. What about SpeedBridge versus SutureBridge? This is my own series 155 cases, minimum two year follow up. This was the transition from SutureBridge going to SpeedBridge. I was worried that maybe if I went to a knotless technique, that we wouldn't have the results that we were having with our knotted technique. And what we found was that there were excellent clinical outcomes for both techniques. The Aces score was actually slightly higher for the SpeedBridge, although not statistically different. But there were lower reshares on the MRI for the SpeedBridge cohort. And in those patients that had second look MRIs, there were seven cases that needed a revision, two of the SutureBridge and five of 113 SpeedBridge cases. So and these were revisions for all causes. So certainly not higher failure rates going to an all knotless technique. If anything, it was better better outcomes. Since 2006, I've done 135 rotator cuff repairs. Since 2008, we've collected all of our clinical outcomes for our SpeedBridge. And you can see that the mean post-operative Aces score is around 88 at one year, and it gets up to about 93 at a mean of 3.3 years. So very good good outcomes and high patient satisfaction. This is similar to what's being shown with the SOS database. Very good Aces scores at two year outcomes with the Soas database, and the average over time, as I mentioned, is less using these knotless techniques compared to the native techniques. Revision rates. We have 809 cases with five year data, 36 revision surgeries for any causes, 4.4% revision rate and less than 3% of these were for recurrent rotator cuff tears. So low revision surgeries. And that's an important outcome factor for your patients. What about older patients? We've looked at the SpeedBridge. Many of the older patients are told just live with their tear. But we deal with a very active patient population where we live. And these patients don't want to just rehab it. They want to get better and they want to get back to their activities. So we looked at 49 patients all over the age of 70. The mean age was 73. They all they all described themselves as recreational athletes. Their scores improved from 57 to 90.3, similar to the overall cohort dash improved and median patient satisfaction was very high, and 77% of the patients at this age were actually able to return to their sport at, at, or at the level that they were at prior to their injury. This is an example here. 74 year old with a crescent shaped rotator cuff tear. You can see good quality tissue. We're able to do a nice repair with the SpeedBridge two anchors medially, interlocking the sutures and compressing it into the lateral row, compressing the tendon back down onto the bone. So age is not a contraindication to rotator cuff repair. What about the strength of SpeedBridge? Well, the strength of the repair for me allows faster recoveries. You can start physical therapy right away and start earlier range of motion. If I have a very secure repair, I'll start passive motion immediately. And I'll start active motion between 3 to 4 weeks. Post-operatively. We looked up 517 of my cases. 87% of the patients were cleared for full activities at three and a half months. So it's more more confidence for the surgeon. Less risk of repairs with secondary trauma. Here's an example. This is 71 year old very active male recreational biker and hiker. He was thrown from his horse, had a massive left shoulder rotator cuff tear. We did an extended six anchor SpeedBridge repair four months postoperatively. He returned to full activities and his subjective shoulder value was rated at 100. 11 months later, after his surgery, he had a bike crash at 40 miles an hour. He had an Ideberg type two transverse glenoid fracture, seven rib fractures, Hemopneumothorax degloving injury to his scalp. He underwent emergent treatment for the scalp, his pneumothorax, and rib injuries. And you can see he came in to see me once he got discharged from the hospital a week later, he was weak in his left shoulder. He was concerned that he may have reinjured his rotator cuff. His examination, as you would expect, was difficult because of his glenoid fracture. But the MRI showed that his SpeedBridge was intact. He underwent operative treatment for his glenoid fracture. And you can see here, after sustaining this massive trauma to his shoulders, rotator cuff tear is completely intact. On the left, you see the intra-articular view. On the right you see the bursal sided view. He underwent arthroscopic reduction of his glenoid fracture, and three months later he was recovered and back to full activities. This is a 51 year old woman who had a rotator cuff tear after falling while skiing. She had a crescent shaped supraspinatus tear. She underwent a typical SpeedBridge repair. This is a four anchor SpeedBridge repair six months post-op. She was doing very well and returned to full activities. A month later she called me and said I fell while skiing. I had a problem. I can't move my arm. So she went to the emergency room, had this valgus impacted proximal humerus fracture. On the MRI, she came in. We couldn't examine her shoulder because it was too painful. But you can see clearly her SpeedBridge is intact. So these these constructs can sustain. Can withstand significant post-surgical force, which gives you a lot of confidence for this with the patients when they call you and they have these types of injuries post-operatively, which we all have it also, the patient has tremendous faith in you. When you have a repair like this, it can withstand injuries. It can break the bones, but the rotator cuff repair stays intact. So in summary, I think the SpeedBridge results in excellent outcomes, not just in my hands, but now with the SOS database, we're seeing it in everyone's hands. We have an optimized, reproducible surgical technique. You do not need to tie knots with this construct. It's very strong. The knots actually will actually reduce the self reinforcement that occurs with the construct. So so in many ways it's probably better biologically and biomechanically not to have these medial knots. It's economical. It's faster for the surgeon. It will save you time. It will save O.R. time. It's faster recoveries for your patients. It's stronger, and it results in better outcomes.

SpeedBridge™ Knotless Double Row Rotator Cuff Repair

Related Pages

Shoulder

FiberTape^® and TigerTape™

Product

Shoulder

SpeedBridge™ Double-Row Technique

Procedure

Shoulder

SpeedBridge™ Implant System

Product

SpeedBridge™ Knotless Double Row Rotator Cuff Repair

Related Pages

Shoulder

FiberTape® and TigerTape™

Product

Shoulder

SpeedBridge™ Double-Row Technique

Procedure

Shoulder

SpeedBridge™ Implant System

Product

FiberTape^® and TigerTape™