Name: Distal Biceps Repair Using the FiberTak® Biceps Implant System
Uploaded: 2020-10-09T00:00:00Z
Channel: Arthrex
Description: Kelechi R. Okoroha, MD (Detroit, MI), demonstrates distal biceps repair using two FiberTak ® biceps anchors. Dr. Okoroha places the anchors near the native tendon insertion through 1.9 mm unicortical drill holes to help recreate the footprint. The anchors are double-loaded with SutureTape with needles to allow for various whipstitching techniques.

<p>Kelechi R. Okoroha, MD (Detroit, MI), demonstrates distal biceps repair using two FiberTak<sup>®</sup> biceps anchors. Dr. Okoroha places the anchors near the native tendon insertion through 1.9 mm unicortical drill holes to help recreate the footprint. The anchors are double-loaded with SutureTape with needles to allow for various whipstitching techniques.</p>

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VID1-001387-en-US | A | Distal Biceps Repair Using the FiberTak® Biceps Implant System

Kelechi R. Okoroha

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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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Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

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Distal Biceps Repair Using the FiberTak® Biceps Implant System

This is Colette from Detroit, Michigan, and we're going to be demonstrating an anatomic distal biceps repair using a 1.9mm FiberTak suture anchor. This is the FiberTak biceps kit. It comes with a 1.9mm anchor. It comes with two suture tapes with needles wedged on the end. It also comes with a 1.9mm drill and a slotted cannula, which allows those sutures to come through. We start by using a two by one small L-shaped incision. We prefer this incision as it allows greater exposure and really allows you to identify that posterior medial footprint. And we will make this a little bit bigger where I mark is where I usually make it. But we'll make it a little bit bigger for this demonstration here. Then you're going to dissect through the subcutaneous tissue using the Metzenbaum scissors here. You want to be careful of the lateral antebrachial cutaneous nerve to avoid any nerve related complications. So then usually the biceps tendon is more superficial. And you can just use your finger to kind of pull that out there. So you're going to grab the tendon with a clamp, and then you're going to free the tendon from any devitalized structures and trim the ends a little bit here. Then we're going to place a traction stitch through the tendon. I'm just going to allow you to free any adhesions from the biceps tendon. Circumferentially. So after we identify our biceps tendon, we're going to proceed with dissection to the radial tuberosity. We're putting two Bennett retractors on either side of the radial tuberosity. And you want to note that you want to have minimal retraction on the Bennett's to decrease any chance of nerve related issues. Postoperatively. Once we've identified the radial tuberosity, we want to clear it from any soft tissue. We usually do this with a bovie electrocautery. So once we identify our radial tuberosity we have Bennett retractors on each side. You want to remove any soft tissue from the tuberosity. And you can gently supinate and pronate. And you see that radial tuberosity. And that insertion is more posterior. Traditionally when we do our button and screw fixation we put our insertion point anteriorly. But as you see, the tendon inserts more posteriorly. And if we recreate that anatomical repair we get increased supination. So after you after you identify your tuberosity, you're going to want to use a small bur or a rasp to decorticate that surface to give you a nice bleeding, bony bed for your repair. So traditionally, we placed two suture anchors, one at the more proximal footprint and then one at the distal footprint. And we want to try to get as posterior as we can on that radial tuberosity to recreate that natural footprint. So I'm going to try to cheat it back a little bit here. And see about this procedure is it allows you to do uni cortical drill. When you're not going through that second cortex. You don't have to worry about any nerve related issues with piercing the cortices. Mount. That in and remove our tab here. And switch this out. And slide a guide allows you to bring your sutures out. And then you want to tension it with your tension. Just not pulling out. Don't place one more. So we're going to put our second anchor distally. Again uni cortical drilling don't violate that second cortex. You don't have to worry about the nerve Posteriorly. We're going to tension it here. Great. So we have pretty two strong. Fixation points. So again these suture anchors are going to allow you to get that more. Posterior footprint on the radial tuberosity. That's going to help with your supination as you see. Put them in pretty posterior here. All right. So next we're going to go to passing the needles through the tendon. So if you look at the tendon the tendon kind of inserts in a vertical fashion on the posterior radial tuberosity. So what you want your first anchor to do is come from the back side to lay it. So lay flat proximally. And then our distal anchor will do on this side to give us that flat configuration. We'll do a crack out here. So we just have one set pass. And then we're going to use the distal anchor to pass our second set. So you can cut your suture ends off with the extra suture depending on the patient. Their muscular anatomy, their activity level. You can pull that suture, or you can pass that second suture for some increased strength. In this case, we'll just pull them. Now we're going to cut any bulbous tissue from the tendon. We'll remove our tack stitch here. So you have your two sets of sutures passed. And you're going to pull on the free end. And that's going to bring the tendon down to the bone and tension slide technique. I have the free end right here that was passed through the tendon. When I pull that it's going to slide that tendon back down. We'll do the same thing with the blue side here. Pull that free tendon. It's going to pull that right down the bone. When you're doing this you want to flex the arm. It's going to allow that nice insertion. Now what I like to do is have somebody hold one of the sutures and I'll tie the other side. So, as you see, I'm going to turn the arm a little bit. That allows it to get real posterior instead of anterior on that cortex. And do your knot tying. I. Just want to make sure you switch your post here just so you have a nice knot. And cut this with a fresh knife. Tie your second set here. And that's your distal biceps repair using a 1.9mm FiberTak we see that rotation, we're getting real superior instead of more anterior. And that's going to give them some great supination postoperatively. So then we'll close the skin incision. Post-operatively. He'll be put in a posterior mold splint which will be at 90 degrees of flexion. He'll then follow up at two weeks. We'll do a dressing change. And we'll be put in a hinge brace which will block extension at 90 degrees. He'll then start physical therapy. And brace is usually discontinued at 6 to 8 weeks.

Distal Biceps Repair Using the FiberTak® Biceps Implant System

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