Name: Achilles Midsubstance SpeedBridge™ - Knotless Achilles Repair
Uploaded: 2013-09-12T00:00:00Z
Channel: Arthrex
Description: Gordon Mackay, MD, (Glasgow, Scotland) demonstrates midsubstance achilles repair using the Knotless SpeedBridge technique. Professor MacKay performs the repair via a minimal incision approach combining the PARS and SpeedBridge techniques, allowing for less dissection, faster technique, less wound issues, and possible earlier return to normal activities.* *Reference supporting literature

<p>Gordon Mackay, MD, (Glasgow, Scotland) demonstrates midsubstance achilles repair using the Knotless SpeedBridge technique. Professor MacKay performs the repair via a minimal incision approach combining the PARS and SpeedBridge techniques, allowing for less dissection, faster technique, less wound issues, and possible earlier return to normal activities.*<br><br>*Reference supporting literature</p>

Not Hidden

English  - en

video

VID1-0462-EN | A | Achilles Midsubstance SpeedBridge™ - Knotless Achilles Repair

Gordon Mackay

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

Achilles Midsubstance SpeedBridge™ - Knotless Achilles Repair

We're using the parse jig here. Through this minimally invasive incision, we can still move proximally. We make sure that it's parallel with the tendon itself, which under some modest tension and then the pin can be inserted. This ensures an excellent proximal locking fixation. Care is taken as this is passed, but you can see how this can easily be inserted. And the guide itself then ensures that pin position is accurate and it's soft tissue fixation is optimal. This is just another level of sophistication. If you feel that the more distal Achilles tendon is not sufficiently robust when you put in your modified Kessler suture, we're crossing over here as the system allows this to lock easily, but it adds very little in terms of time to the overall procedure. And it's a jigsaw correctly positioned here parallel with the tendon itself. There should be minimal risk of pseudo nerve irritation or injury. It's always good to have an experienced team with you. Simplifies it enormously. And with this technique, the risks of any complication can be minimized. We can now gently withdraw the pars jig itself, and you can see the sutures passing easily through the soft tissues and then out. And it's all enclosed within the peritoneum to minimize any risk of scarring or irritation. What we're doing now is we're just ensuring that the calcaneal insertion is deep within the calcaneus itself. It's parallel to the fibers so it can run comfortably within the Achilles substance itself. We make a nick to bone approximately 15mm apart. And it's just really a stab incision that allows us to prepare the bone itself for the SwiveLock fixation. We will drill at this stage perpendicular. Excellent. And then we repeat the process. Once we're happy with the fixation, we can tap and usually find, except in the very elderly patients and occasional cadavers, that tapping is essential and we just take it to an appropriate depth. The beauty of the SwiveLock once it is inserted is it doesn't add any extra tension to the Achilles itself. The heel has been prepared and this doesn't need to be screened. You can palpate your landmarks, and it's just as the tendon blends with the periosteum at the back of the calcaneum we then take the banana lasso. What we found is that the distal stump is evident here, and it's very easy then, to pass the banana lasso through the substance of the Achilles. Once you can see it coming out and you're happy that it's position, we can then simply feed this through and it's easy to retrieve through the loop itself. We retrieve all three sutures at the same time, gently pulling them through the banana lasso. And as it comes through, that's easy. And we can gently just take all the structural tissues back through. To repeat the process again, identifying the distal achilles so that you're comfortable, that you're in the substance of the Achilles itself. Advancing the loop, allowing the loop to open sutures, then grasped and pulled back through. And once it's all slipped through, simply retrieve the banana lasso. Gently bring the sutures distally, it is possible to take the suture material just slightly within the distal portion of the Achilles itself, so it's within the substance, so the points actually match directly. And that would be a worthwhile additional step. We're then establishing the correct musculotendinous length which should match the acuteness of the unaffected side. Once we're happy that this has been approximated, we know there's not going to be any suture irritation or slippage or mechanical weakness at that site, and we can close the peritoneum comfortably once more, just over the remaining suture, so we can close the peritoneum there. And we effectively have a normal looking repaired Achilles tendon. The next stage is to keep the position of the foot in the appropriate Aquinas, and load the SwiveLock anchor. You want all three sutures to be equally tensioned. When you're inserting, you make a modest allowance for the depth of the anchor itself before this is fixed. Usually you can push this into the pre-prepared hole, but a gentle tap with a mallet can facilitate. Again, we're checking that we're not adding Added excessive tension, the resting position when it's unsupported. If it's unsupported, we should find that it rests at its natural length. You then know that you can safely advance by holding the blade with your left hand, and clockwise with your right. You can advance and there's no further tension added to the construct. The idea is not to over tension the repair. This extra anchoring suture can then be removed. Swivelock taken and then the FiberWire scissors. Allow us to cut this as flush as we can to the surface itself. We then repeat the process. The length is set. It's easier to insert the second anchor. That's great. Again, all the tension is even. This is slipping nice and easily. We find our entry point just a gentle tap. Check it once more just to make sure you're happy with the repair and approximation. Advance gently and retrieve the anchor suture once more. Take the FiberWire scissors or scalpel blade and minimize the remaining suture. It's possible to steady strip the repair at the end. However, if we have a final look at our repair, sometimes there's some soft tissue strands that you want to approximate around the site of rupture, and you can use a small vicryl suture. But otherwise the peritoneum can be closed directly. And as this comes down, you can see how smoothly the tendon moves in between. We close the skin with an absorbable suture, and we have restored normal anatomy. But not only that, it will be sufficiently strong to allow early mobilization without attenuation and loss of power during our accelerated rehabilitation program.

Achilles Midsubstance SpeedBridge™ - Knotless Achilles Repair

Related Pages

Foot and Ankle

PARS Achilles Midsubstance SpeedBridge™ Implant System

Product

Foot and Ankle

Achilles Midsubstance SpeedBridge™ Repair

Procedure

Foot and Ankle

PARS Achilles Jig System

Product

Foot and Ankle

Tendon Fixation for Achilles Insertional Tendinopathy

Procedure

Achilles Midsubstance SpeedBridge™ - Knotless Achilles Repair

Related Pages

Foot and Ankle

PARS Achilles Midsubstance SpeedBridge™ Implant System

Product

Foot and Ankle

Achilles Midsubstance SpeedBridge™ Repair

Procedure

Foot and Ankle

PARS Achilles Jig System

Product

Foot and Ankle

Tendon Fixation for Achilles Insertional Tendinopathy

Procedure

Achilles Midsubstance SpeedBridge™ - Knotless Achilles Repair