Name: FiberTak™ DR Bridge Double Row Rotator Cuff Repair
Uploaded: 2017-03-02T00:00:00Z
Channel: Arthrex

<p>Laurence D. Higgins, MD, MBA, (Boston, MA) demonstrates the use of "all-suture" FiberTak™ DR (double row) anchors that are loaded with LabralTape™ suture for the medial row of a double row supraspinatus repair. He uses knotless BioComposite™ SwiveLock<sup>® </sup>anchors in the lateral row to complete a strong, low profile repair that reconstructs the rotator cuff footprint and maximizes contact between the tendon and bone. Dr. Higgins also demonstrates the use of FiberLink™ sutures to address potential dog-ears.</p>

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VID1-00904-EN | A | FiberTak™ DR Bridge Double Row Rotator Cuff Repair

Laurence D. Higgins

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.

Operationstechnikvideos

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

FiberTak™ DR Bridge Double Row Rotator Cuff Repair

We're here going to show the FiberTak Dr bridge, and we're looking on a right shoulder. We've created a tear here involving the anterior fibers of the supraspinatus extending back to the infraspinatus. This is intra intra-articular there, and specimen had a great cuff, so we were able to create a nice full thickness tear here. And our overall construct is going to be to create three FiberTak Dr anchors medially, one about here, one in the mid aspect and one anterior. And then we're going to put two swivel locks down here laterally to optimize our construct. So we'll start here. We're going to put our first anchor kind of in the back aspect that I'm just sliding the spear down or the drill guide. And we've got that right off the articular margin. So there's our articular surface right there. You can see it. We're going to slide that just adjacent to it. And that's really the optimal bone density right there. We're going to use one of the Dr anchors. And we'll talk about some of the unique aspects of this Dr anchor. Her good. So this is a quick release. Inserter. What's nice? We'll just take off that tab. We can just pull straight back, and we'll set the anchor by giving it a little bit of tug. And it is right. It is in there. We're going to pass with a FiberLink here. And so we'll use this on a Scorpion. You can see that coming in right there. We'll pop that into the joint here. And I'm going to come to the back of the of the tear here. And we'll pass that there. There it is right there. And I want to take too big of a bite. It's not that big of a specimen, but I think that's going to pass well and we'll pull that out. Okay. So this is the TigerTail here that we're going to pull out. We're just going to get rid of that because we're not going to use that stitch for this construct. So this is us passing in one construct. You can see we're going to pull this through here. And so we're pulling back on itself here a little bit. And you'll see the stitches coming through. There we go. And we'll just complete that. And there's our first suture being pulled. And I'm going to actually take those to the back just to get them out of the way. I think just from a suture management standpoint, it's good strategy to keep those safe and out of the way. I don't do these through the canyon. I tend to make a separate percutaneous incision for those. It helps keep our our sutures in a good spot. And I'm going to look where our last anchor was, which was right there. I'm going to march this forward. And you'll see that coming right off the articular margin. So right here we're going to pass this one. Now you can see the anchor coming in very cleanly right here. We'll just tap that in. And once the once the inserter just hits the drills the drill guide or spear we want to stop. And what's nice about this is it's just a straight pullback. It's a really good purchase. We'll pull out our spear. And you can see the TigerTail are a different color here. Again I'm going to pull out our number two because we're not going to use that in this construct. And again I want to show how easy that moves and how easy it is to see Intra-articular or Extracurricularly which one you're pulling. You can see how the suture changes. So these are the TigerTail and these. That's a great advantage for us to manage suture particularly we're going to do a multi multi-angle anchor repair. Okay. So now we're going to pass our fiber link again. And I'm just going to pull the sutures out of the way. We can see where the first group came in. So I'm going to actually just come just about a centimeter or so behind them and we'll pull that out. What we can do here is we can actually pull out the medial end here. So as we pull our sutures through, we will actually be able to not cross them. And they'll probably have less of an issue or less of a likelihood for us to actually have suture management issues. I'm going to pull out our label tapes. So we're going to pull that through here. And you'll see the sutures coming in right there popping through the cuff. And we can take the the slack out of them. Now we have one more anchor to do so we'll set up our spear with our obturator again. And I can come in right to the very front aspect here. And what I'm going to do is just externally rotate just a little bit. You can see where our medial anchor is. You can see how close we are to the articular surface. We're right adjacent to it. And right here we're going to put this anchor right at the very leading edge of our tear. And this is a very important position for us to be in. We're right juxta articular. And this is important biomechanically, because it really serves to anchor the cuff at the very anterior aspect. And Steve Burkhart and Ty Lee have done some really nice work showing the importance of doing that. So again, our tiger tails are going to be different from this anchor. And you can see a different color LabralTape and a different color TigerTail here. We're going to pass another FiberLink. And we'll grab our cuff right here. And now we can see we've kind of spread our cuff out like that. And again, just for simplicity's sake, I will retrieve the end here out through that anterior cannula. And then I'll retrieve our two tails here. Now, if you are so inclined, you could actually pass these through separate passages, if you like, for this tear here, which we created. This is certainly more than adequate. And what we do, probably 85, 90% of the time will deliver the labral tapes through the cuff. Great. Okay. And now it's time for our lateral row repair. Here's the PowerPick. Okay. And you can see it's spinning here. And you can see it retracts. And here it is. We can deploy it now. You can see it. And we can actually create a little bit of a biologic response here. So as I look at the construct here, I would say that if the potential for a dog ear were to exist, it likely will exist on the back part of this tear just from where our sutures are passed. So we use the FiberLink to actually pass all our sutures, and then we can elegantly use the FiberLink now to kind of prevent us from having a dog ear. So I'm just going to put this in right here, pass that through the rotator cuff. And we're And we're going to incorporate that into our lateral row. We're going to pull that in right there on our rotator cuff. And we're going to incorporate that directly into our repair. I'm going to manage our sutures. Now this three two construct works really well because we're going to actually take one limb of each LabralTape. And I, I'm not particular about which one I take, but if I can choose, I'll pick the posterior one. That one looks like I may have picked those were laying right on top of each other from the middle anchor here. We'll take the posterior one and then from the anterior anchor the same. So here we're going to pass our sutures through a swivel lock. And you can pass all four limbs. Or you can do it sequentially. But you can see we just got them all four passed in one pass. And we'll hold those with a little clamp. And now we're going to look and try to optimize our lateral anchor position here. You know we spend a little bit of time thinking about how to optimize this position from a medial anchor position, but we should also be thoughtful about how we actually fix this laterally. And so I can grab all of the limbs of this, and I can pull this down, and I can move my repair or my anchor point laterally in different constructs. So what I can do here is I can actually hold it right there. And that's kind of where I think the optimal position will be. So I'm going to make a little mark on the bone right there. And I can see that. And now I'm going to actually take our all. And I'm going to put it in the exact same spot where I thought we optimized it. So somewhere right around here. And we'll advance that. Okay. Good. So our SwiveLock is down there. So here we are. Now we're about to secure our lateral row. We'll just park the eyelet right here so it's outside of the bone. And then we'll remove the tension of each suture individually. So one thing that's nice about this FiberTak Dr is that this achieves fixation at the articular margin. What I mean is that each LabralTape is fixed as soon as you insert it into the anchor. So we are tensioning the sutures here. They're not the LabralTape are not going to slide like the tiger tails on the FiberWire that we showed earlier. But here's our our construct. It looks very, very good. We have no dog ear. I think it's going to come together nicely. We're going to tap this in. Okay. A lot of compression on that. And that looks great. And now we'll remove our SwiveLock inserter. And we're going to pull this back. And we're going to pull out that stitch. I'm not going to use that stitch or anything. If you wanted to you could. But we're not going to use it because we have a nice FiberLink that's doing our repair ahead. And we're going to slide this down here, and we're going to cut this flush right on the bone. Great. And so we'll take a look at our first anchor repair. And that's going to look great. We have no Dog ear at all. And we have really robust fixation there. So I'm going to retrieve our sutures. Fantastic. There's our first one. There's our second one. And there's our third one. [00:09:42] Great. Okay. Good. Great. Okay. So here, we'll put this right down. We've got our cutter right there. And so really robust repair. I mean, you can see we have great repair. And that FiberLink really did a nice job in the back. And a great utilization of it. You can see here. Here we are back Intra-articular. And one of the things that I really love about these repairs with multiple points of fixation is that you don't even see, I mean, you can just get a sense of where one anchor is. I mean, but if you were to look quickly at this repair, you would see that this person has a normal rotator cuff.