Name: SutureBridge™ Rotator Cuff Repair Using the 2.6 mm FiberTak® Soft Anchor
Uploaded: 2018-01-09T00:00:00Z
Channel: Arthrex
Description: Jeffrey R. Dugas, MD, (Birmingham, AL) performs a SutureBridge™ double-row rotator cuff repair in this cadaveric demonstration. The 2.6 mm FiberTak ® anchors are preloaded with 2 strands of SutureTape and are passed, tied and secured laterally with 5.5 mm PEEK SwiveLock ® C anchors to complete the repair.

Jeffrey R. Dugas, MD, (Birmingham, AL) performs a SutureBridge™ double-row rotator cuff repair in this cadaveric demonstration. The 2.6 mm FiberTak® anchors are preloaded with 2 strands of SutureTape and are passed, tied and secured laterally with 5.5 mm PEEK SwiveLock® C anchors to complete the repair.

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VPT1-00986-EN | B | SutureBridge™ Rotator Cuff Repair Using the 2.6 mm FiberTak® Soft Anchor

Jeffrey Dugas

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

SutureBridge™ Rotator Cuff Repair Using the 2.6 mm FiberTak® Soft Anchor

Today, I'm going to go through a rotator cuff repair on a pretty standard sized tear using two double loaded FiberTak RC. These are rotator cuff anchors that go in through a 2.6mm drill or punch hole. They have two different colored suture tapes. And we're going to put two of these medially, followed by two swivel locks laterally to create a dual layer repair of a standard rotator cuff tear which is supraspinatus and some of the infraspinatus. First thing is we've created this tear right off of the bone. Kind of typical pattern rotator cuff tear. We can see the biceps up here in the front. And we're going to be very careful to avoid that as we pass our sutures. As we look down inside the tear, we can see the articular surface right here. First order of business is to create a surface for healing. So we're just going to abrade a little bit of the bone here. We're not going to decorticate it. We just want to just want to take off the soft tissue. So once we've got it, just the soft tissue removed like that and we're down to bone, you can see there's no soft tissue on there. Now we're ready to put our anchors in. So we do this through an accessory portal. So this anchor this this portal is going to come right off the acromion. We're just going to find a good spot where we get a good angle to the greater tuberosity here. And we're going to be able to see that this is going to be a good angle for insertion. I also like to use this this portal for tying through, because that way I'm tying the knots and pulling on the sutures in line with the anchor, rather than at an acute angle, which will put a little more stress on the anchor. So this is a cannula with a these come with a sharp or a dull trocar. This is the cannula we're going to drill and place the anchor through. So I like to start anterior. It gives me the best view of the biceps. So I can see the biceps right there. I do not want to incarcerate the The biceps. When I'm doing this. I can also see the articular surface down here. So I know that this is right about where I want to put my anchor. The first anchor. So we're going to drill a pilot hole. This can also be done with a punch. So this has a positive stop on it. Drill a pilot hole. Next the anchor is placed through the cannula and just impacted into the bone. And we're going to tap that in. Once it's in, we remove the rubber stop after we pull back gently on the anchor. So that sets the anchor in the bone. So we're just a little tug on it. Remove the rubber. Stop. That allows the sutures to be free, and we can just pull the driver out and remove the cannula. And so I'll test that by pulling on the anchor a little bit just to make sure it doesn't pull back. So I'm going to make sure I can see the articular surface here. So I've got the scope in the in the lateral portal. I want to make sure that I don't violate the articular surface, and I couldn't see it from the backside. So now I've got my first anchor in up here. I'm going to put my second anchor in back here. And I'm being careful not to affect the articular surface. So now I've got two anchors in there. They're separated by about a centimeter and a half. And that'll be the medial row. So now we're going to go back up into the subacromial space to pass our sutures. So I like to pass through the cannula. It helps with suture organization. You can see our two sets of sutures there. I'm going to use a device called a KingFisher, which is going to help me grab the sutures without piercing them. I like to pass from back to front. That way I can know that I've got the cuff pulled anteriorly enough, since the tendons come from the posterior side of the shoulder. So I'm going to remove one of those and we're going to start from back to front. So we load the the Scorpion parser by placing the tapered end of the suture through it. So we're going to make sure we don't have any tissue in the way besides the cuff. We've done a really thorough bursectomy here, which is important if you're going to do these procedures arthroscopically, you can really cause yourself some problems by not being able to see. So I'm going to get back here into good healthy tissue, and I'm going to advance the suture and pull it out of the cannula. And what that's done is pass this suture through the cuff. So I'm going to retrieve these through the accessory portal. And I'm going to use that portal as kind of a repository for sutures as I'm passing these from back to front. So now we've got eight sutures passed at pretty evenly spaced intervals from back to front in pairs. This tissue is grabbed with the Scorpion parser at approximately the depth of the elbow of the Scorpion parser. So it's it's a centimeter and a half, approximately. Which is about the thickness of the cuff attachment on the greater tuberosity. So we're going to start tying these I like to tie from back to front. So I like to tie through this. The portal that I put the anchors in through gives me a direct line of pull to the anchor. So I'm going to pull the first two sutures out. I've passed the rest of them out through my cannula, and I want to space the knots out. So I'm going to choose my post wisely. So in this case I want to put the post posteriorly. So I'm going to shorten the post. And that way I'm putting the knot stack as far back as I can, and I'm going to push as much as I pull. I think it's important not to just yank on the anchors. These are really strong anchors, but every anchor has its limits. And so bone quality is important. And I've tried to get in the habit of pushing as much as I pull as I'm tying these anchors down. So I want to get a good compression. I think it's also okay to pull on the other sutures while we're doing this. That takes pressure off the anchor as you're tying it down. So I also like to switch posts compared to suture. The tape is much easier to use. You don't go home with cuts on your fingers and going through three pairs of gloves, or having to wear finger cots, if you're so inclined. I've found that the tape is considerably easier to use from a trauma to my finger standpoint than the than the standard rounded suture. So I'm going to pull these out one by one. I put I normally put five suture or five knots in each suture. In this case I only did four just for demonstration purposes, but I normally will put five. So I'm going to pull these out laterally and I'm going to go get the next pair. Now I've got our medial row accomplished. I've got all got all the sutures tied. And if I look down in here, you can see that the medial row is down on the bone. So we've re approximated the medial row back. And now we've got all this exposed bone that we're going to cover over bringing those sutures over the top to create compression over our our healing surface here on the greater tuberosity. This is a SwiveLock anchor. What we'll do is we're going to put four sutures through here. The way I like to do it is I like to put the two anterior ones, and then one from each of the middle two into the front anchor and the posterior ones, and one from each of the middle anchors into the back anchor. That creates kind of a crisscross pattern and compression across the cuff. Instead of just having four double strands going straight out it, it creates compression from different directions. So the first thing we're going to do is we're going to pull our for that, we're going to put in the first anchor. And it doesn't matter if you go anterior your first or posterior first, but I'm going to pull those two anterior ones and one suture from each of the tied middle two. Next I'm going to make a pilot hole for the for the SwiveLock. So this is our anterior of the two lateral row anchors. So I'm going to take the punch. This is just a standard punch. And we're going to go to the second line on this. Sometimes you don't even need a mallet for this and some bone because the bone out here can be pretty poor quality. So I'm going to start right about here. I want to be at least a centimeter off the greater tuberosity. And I'm going to impact this into the bone. Go into the second line. Right. Then while that's in place, I've got my KingFisher through the loop. I'm just going to grab my four sutures, pull those through there, and then these will easily shuttle through the eyelet of the of the swivel SwiveLock. So now I've got my four sutures. I want to make sure as I do this, that I hold the sutures this way, which is putting a little tension on them. So my assistant is going to hold that as I retrieve the all that I've made the pilot hole with. And then I'm just going to advance this down. So we're going to tension the sutures individually. So I've got my assistant individually tensioning each of those. And then I'm going to advance the anchor. And I'm going to have her release the tension now. And I'm going to impact the anchor down into the bone. That's it. Then I'll advance the anchor. I loosen the stay sutures. I remove the driver. This stays. Suture can then be removed. That was through the eyelet. And I'm going to cut My sutures. So same thing here. I'm going to pass the sutures through the parser, through the hole in the cutter. This slides down this and then cut it right at the bone. So next we're going to do the same thing. We're just going to take the other four sutures the ones that we didn't pass. So we're going to make a second hole. So our first hole is up there. We're going to rotate the humerus a little bit and get a little further back. So now we're going to go back here I'm going to make my hole. And that's our completed repair. So I think it's important in each of these to check the repair from multiple angles. So I'm going to check it from the lateral side. So this is really what I want to see I want to know that I've got a got a good spread, that my anchors are down. There's no prominence of the anchors. I want to know that I've brought the cuff back to its anatomic origin without over tensioning it. So I want to know that I haven't advanced the cuff past its normal position. I want to know that my knots are tied and they're not prominent, and that I've got a pretty good spread on my sutures. You can see how nicely the tape lays down on the tissue without creating, you know, any kind of a over tension. It distributes the force very nicely and is ultra strong. So that's my top side view. And then I'm going to look inside to make sure I got it back on the articular margin. I also got to make sure I didn't snare the biceps. And you can see that that is nicely tight. Back to the native attachment for anatomic insertion of the cuff. But no over advancement. We didn't realize it and we definitely did not catch the biceps.

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