Name: SpeedBridge™ Rotator Cuff Repair Using the SpeedBridge™ Implant System
Uploaded: 2011-08-05T00:00:00Z
Channel: Arthrex

Peter Millett, MD, (Vail, CO) performs a live surgery using knotless BioComposite™ SwiveLock® suture anchors with FiberTape® to complete a quick and secure double-row rotator cuff repair that restores the rotator cuff footprint and maximizes contact between the tendon and bone. Dr. Millett prefers a totally knotless construct to help evenly spread the load across the entire construct. He also highlights use of the SutureLasso™ for retrograde suture passage and uses a PowerPick™ to prepare a bleeding bone bed in the rotator cuff footprint.

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VID1-00219-EN | B | SpeedBridge™ Rotator Cuff Repair Using the SpeedBridge™ Implant System

Peter J. Millett

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

SpeedBridge™ Rotator Cuff Repair Using the SpeedBridge™ Implant System

My name is Peter Millett. We're here at the Vail Valley Medical Center, and we're going to demonstrate a case of rotator cuff repair using a SpeedBridge kit. This is a 58 year old gentleman with a left shoulder injury. He had an acute on chronic injury to his left shoulder. And he is a medium sized supraspinatus tear extending into the leading edge of the infraspinatus. It looks like it's a crescent shaped tear based on his MRI. So we hope to demonstrate the principles of achieving a very good biomechanically strong and also a biologically friendly rotator cuff repair to enhance healing and optimize your results. You can see how that elevator is retracting the tear up so I can see inside of it. Clean off the footprint and try and remove all the soft tissue so that we get healing from the bone up to the tendon. So we're going to use the SpeedBridge kit, which has four anchors in it and one punch. Two anchors are loaded preloaded with sutures and two are for the lateral row. So in this case the tendon is hanging down. So I'm just going to put this elevator in again here posteriorly. And just try and adduct the arm as much as we can. And my assistance is going to pull a little bit of lateral traction. The TRIMANO really helps a lot to get this angle. He has a fairly lateral acromion. So we want to make sure we get a good angle with the anchor going in perpendicular to the bone. So this is our posterior medial anchor 4.75mm SwiveLock. It's a biocomposite anchor. So the anchor has to be flush with the bone before you start advancing it. It's getting a good purchase. And this anchor is vented. You can see some of the vents there that allows for access to the marrow. Now there's sutures on this which you can use if you like and incorporate into your repair if you like to tie knots. In this case, we're going to do an all knotless type repair. And that anchors designed it's fully threaded. It's designed to sit flush on the cortex. So use a 90 degree straight lasso. Here, I'll come in from my posterior portal. And then with a grasper through the posterior lateral portal. Here, figure out exactly where the tissue needs to go and penetrate through. And I can look underneath. See the tip of this come through so we can see exactly where it's going to enter the joint here. And just grab the wire. And then we will retrieve the sutures. The sutures are come together to win. Just a one suture facilitates passage either with the lasso or with a Scorpion passer. And we'll just pull the sutures really tight this point to get all the slack out. And now we're going to do our anteromedial. So we'll switch the scope and place that in the posterior lateral viewing portal. So we'll come in with a punch through here. There's the articular margin. So we use that as a landmark. I also want it to be about a centimeter from this other Our anchor. So we can get it fairly perpendicular. I can put an elevator in too, just as an additional retractor. I'll come in with our anchor. Sink it down. The anchor is flush with the bone. Here. It's squeaking. It's making a good contact with the bone. And the anchor, as I mentioned, is designed to be just flush with the cortex. That's some of the best bone. So the anchor is fully threaded to take advantage of that. So it has very good initial fixation strength. If you want you can pack the cannula up just a little bit and make sure it's flush which it is. And then we'll pull out the suture that's on the eyelet. Now to pass through the rotator cuff I'll abduct it again with the TRIMANO and all these little moves. Really just help with your visualization. I'll come with the lasso and a grasper. Right. So I'll just grab the tissue first, and then I'll come in percutaneously through the anterior cannula. There's my lasso. So now what I can do is I can actually lift up on it. And you can see the smooth synovial tissue right there that tells you you're right at the articular margin. So you're not over reducing this tendon. You're just repairing it right back to its anatomic footprint. It's a good landmark to use. And we'll pass the suture. Now we'll just cut these two tapes so they're separate. And we'll cut the one on the back too. And now what I like to do just before I put my lateral row in, is take a grasper and just reduce the tissue, figure out where everything is going to go based on where the sutures are. This is a 45 degree PowerPick here to create some additional channels for healing. So the tendon is going to go to go over this, so hopefully they'll act as little anchor points and healing places for the rotator cuff tendon. And a larger tear will tend to start with the lateral side that has the least tension and work towards the more tension. So we gradually reduce the tear. But with a smaller tear like this, I don't think it's as critical. This is a SutureTape retriever. It has a little roller on it that acts like a pulley, because there's so much friction with the tape that regular grasper, it's a little bit difficult to retrieve, but that's what gives it such good fixation laterally with the knotless technique with the tape. So we grab that. You can see the roller device there and then we'll retrieve it. And then what I do is I use this cannula actually to help me reduce and figure out where I want to put my lateral anchor. It's provisional reduction here. And then I'll take the opus device and we will remove the periosteum here laterally. The best bone is first at the articular margin. Then second is out here laterally. We're working now so we'll have really good fixation. And then I'll take a punch. And the arm is abducted now, so we have good access for our lateral row. Second line is the SwiveLock line. The first line is for a fully threaded Corkscrew. And then I'm going to just grab the suture with a hemostat and pull it through the threader. And then I'm going to just pull the threader. And now the anchor is loaded. And I'll align it so that the sutures are coming from medial. And then the tag ends are coming out laterally so that when we get in there it doesn't have any twists in it. I like to put about eight millimeters of slack into the system. And then what we'll do is we'll kind of hover it and then we'll compress it down. And I think what we can do now is we can just take a little mallet and I can tap this down. In place. And now I can just double check my tension, which looks good now. So I'm happy with that. If I wasn't happy with it, I could back the whole construct out and start over. But I'm happy with it. So now I'll just advance my lateral anchor in place and then we'll take a FiberTape cutter next and cut the tag ends. It looks like it's flushed. So we'll we can pull the whole construct out. And you have these little sutures here. If you wanted to, you could use those to repair a dog ear if there was one. In this case, we don't really have anything. But if you wanted to, you could use those just like you'd use it from a regular anchor. I'm going to pull them out, but they're available as an option. And then Holly's going to come in again with the Grasper now and feed it through. And we've put that threader onto the FiberTape cutter. So now we can just easily. Cut it. And what I'll do now is retrieve the sutures again. Here's the first suture. And. Here's the second suture. Good. Okay. Now, like I was saying, I can use this to help my provisional reduction. And at this point, you can see it seems like we're running out of out of a little bit of real estate, but if we take the TRIMANO and we just internally rotate the arm a little bit, now we have plenty of room to put our posterolateral anchor in. We can look at it, figure out exactly where we want to go and repair it. So again we'll clear off the periosteum. That's about where we want our anchor to go. Just make a little spot where we want our anchor to go. We can look at our other anchor before just to make sure we like it. Maybe I'll go just a tiny bit posterior. Okay, great. Okay, so now we'll come in with our punch and we will punch for our posterior. Lateral. Past the SwiveLock line the second line. And then we'll put fourth anchor in. Very nice. And we're just threading that through. So again we have to get the right tension. So we will go past the hole a little bit by about 8 to 10mm. Millimeters. Drop it in. I think that's pretty good. So I'll just tap that in place now. And now what I can do is I can check everything before it looks like it's pretty solid. And now I'll just secure it in place. And it's nice and flush with the tuberosity. So we'll take that extra suture out. And then the final step, we'll just cut it. Okay. Great. Perfect. You can see all the blood coming out of the anchor. And that's our final repair. That's it. Speedbridge. Thank you.

SpeedBridge™ Rotator Cuff Repair Using the SpeedBridge™ Implant System

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