Name: FiberStitch™ Implant All-Inside Meniscus Repair
Uploaded: 2020-03-12T00:00:00Z
Channel: Arthrex
Description: Asheesh Bedi, MD (Ann Arbor, MI), demonstrates a stacked vertical mattress all-inside meniscus repair using the revolutionary FiberStitch™ implant, which deploys soft suture sheaths behind the meniscus and replaces traditional hard plastic PEEK implants.

<p>Asheesh Bedi, MD (Ann Arbor, MI), demonstrates a stacked vertical mattress all-inside meniscus repair using the revolutionary FiberStitch™ implant, which deploys soft suture sheaths behind the meniscus and replaces traditional hard plastic PEEK implants.</p>

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VID1-000830-en-US | C | FiberStitch™ Implant All-Inside Meniscus Repair

Asheesh Bedi

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A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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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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FiberStitch™ Implant All-Inside Meniscus Repair

Today, we're going to have the opportunity to show and talk a little bit about the FiberStitch, which is a very nice, all inside meniscal repair device. I just want to show the key instruments that you need here to do a nice all inside meniscus repair. And as you can see, it's really quite simple. You'll have your device itself, a sled, which I like to use to introduce the device. You can slide along it to avoid dragging in the fat pad, and even in a tight meniscus, you can use the sled a little bit, like a retractor, to invert or invert the meniscus to access the capsule and deploy the implants for a nice vertical mattress stitches. And then you're not pusher cutter that is here. That comes with this device to allow you to load it easily outside the knee, just to focus a little bit on the device itself. If you look here, it's a nice single kind of handle device. Here is the means of controlling the depth stop. The depth stop is set at a baseline default of 18mm, which is actually a pretty safe and comfortable depth, particularly when you're working from the opposite or contralateral portal to work away from the vessels in the back of the knee. But as you can see here, you can just push down on this and slide forward. Here are the markings where you can go anywhere between 10 to 18. And just simply adjust that in line with the depth that you want in twos. So for the purposes of this demo on the cadaver, we're just going to leave it at 18 to show you here. The way this works with your handle is this wheel which is your self-deployment wheel. I'll show you here when we do this in the patient, but you'll pass into the meniscus. You pull the wheel back to deploy the implant, then simply slide it forward to engage the next implant, and then do the same steps again to deploy the second implant. What's very nice is that these implants are in fact all suture. They're not rigid anchors. And as all of us know with all-inside devices, one of our biggest fears is that that implant can pull through. And if it's a rigid solid implant, of course, can create some iatrogenic arthritis like a loose body in the knee. So as you'll see, these are soft tissue that engage on the other side of the capsule. And those soft implants stay there but don't pose that risk even if you have one. Pull through the capsule. All right. So we've now brought the camera into this knee joint. It's a left knee just to show you if you can see on the screen here this knee has certainly seen better days, but it clearly has either a tremendous amount of chondrocalcinosis or pseudogout or crystalline steroid deposit or both. But in some ways, maybe it's a good example to show this all-inside meniscus repair, because if you can do it in a rigid arthritic knee and get decent access without a lot of iatrogenic injury, you can certainly do it in a typical knee for a meniscus repair. So here just to show you, there's our ACL there. We're focusing kind of on the posterolateral root. And then the posterior horn of the lateral meniscus. I'm going to first as I mentioned bring the sled in. I think the sled is a nice device because it allows you to protect the knee, but also introduce the device and the tip without dragging in fat pad. As you can see here, if you want to put the implant on the underside of the meniscus, it's also nice to do that where I can lift up the meniscus and just gently turn the sled, and it allows you to see the capsule so you can get undecided. Vertical mattress stitches. So as you can see here now I have the sled introduced. We're going to slide the FiberStitch in with the sharp tip along the sled. As you can see, that allows you to bring the device in without dragging in any fat pad. Then it allows us to just sort of retract and look. You can see where the capsule is. Here we have the depth stop set to 18. But I'm going to introduce this above the meniscus into the capsule. Here. Again a lot of this is by feel. But that depth stop is there to also protect us. Once I'm there I'm now going to take the self-deployment wheel and roll it backwards to a hard stop, but also to a click. I don't know if you heard that click, but I'm also feeling that hard. Stop. I can't go further back than that. And then at this point, I'm going to roll the wheel back forward to another hard stop and click that you hear and feel there. At that point, we'll gently come back and that should have deployed our first implant. As you can see there, now we can adjust our hand to get a vertical mattress stitch. As you can see there, I'm angling down into that meniscal tissue to give us a vertical mattress. Here again, down to the depth stop. We're going to roll that wheel back again. Hard stop and a click. Same thing. Rolling the wheel forward. Hard stop and a click and then we'll gently withdraw. And that should have deployed our vertical mattress stitch here into the meniscus. So as you can see now after passing both and pulling the FiberStitch out of the knee, what you have come out of the knee is the loop which I've placed the probe in, and this free stitch that is inside, almost passing through the loop that looks tangled and like it's going to create a problematic knot or tangle at the end of the case. That's actually normal. So what you want to first start with here is your probe inside the loop. And as you're looking inside the knee, you appreciate that first loop of our vertical mattress stitch there. As I gently pull with the probe on these stitches, that's going to start to allow for that first loop to reduce. So it's just a gentle pull as I sort of bring that down. See how that nicely tightens our first loop of that mattress stitch there? And that's kind of where we want to have that first loop to pass there. Now we come out of the loop here and this becomes easy. Just like our routine All-inside devices will now pull the other stitch, but this will bring two full loops down right on top of that. So you effectively get the benefit of almost two vertical mattress stitches. There you can see on the superior surface between the capsule and the meniscus. That's everting that meniscus a little bit, just like we would like it, which would then allow us to put an equivalent vertical mattress stitch on the under surface to give us a balanced repair. And now we're ready to simply slide down our knot, push RetroCutter right on top of that stitch. Now remember, there is no knot on the top of this repair, which is another advantage. The knot is on the back side. It's just those two loops that are on the superior surface of the meniscus. So now as you can see, we've slid the knot pusher cutter down right onto the super surface next to our dual loops there. A vertical mattress stitch. And we'll just go right to the base there and cut the stitch. And now we have a double limbed vertical mattress stitch. And as we mentioned that's gently everted. That meniscus, which is actually what I expect to see with these kind of repairs. I like to see it that allows us to do a balanced repair where we're working on the superior and inferior surface of the meniscus. So now, after placing the nice superior surface vertical mattress stitches, we can use the sled and take advantage of the eversion of the meniscus to place them on the under surface as well. I like this sled because it allows you to slide underneath and hold the meniscus up. You can see the meniscus capsular junction there nicely, so I'm going to just leave that there. We'll slide right along that so that we don't drag in any fat pad. And then once we're there you can now gently retract that sled. That's perfect. You can even leave the sled in. I've certainly done it both ways. But in this case I think you can see here nicely. Here I'm going to try to grab as best I can in this cadaver. Some robust tissue of some capsule and meniscus here for our first pass. And again, we're gently advancing. They're not all the way to the depth stop, but close to where we know we're clearly on the other side of the capsule. Here, I'm going to take the Self-deployment wheel, which you can see here. And now we roll this wheel back and keep rolling it till you feel both the hard stop and a click here. At that point, we can now roll it back forward till we feel a hard stop and a click the opposite direction. Gently come back. And now we're in a position to define our pass. For our second pass here to make a vertical mattress stitch, I'm angling my hand down and taking advantage of the curve of the needle to go up and into the meniscus. And here I'm just going to rotate into the meniscus there again close to the depth. Stop here again we'll rotate the wheel back. That brings it back for the hard stop and click. Then we'll go forward and do the same. And now we should be ready to come back and have deployed our mattress. Again, remember that leaves that loop. It initially looks like it's tangled sutures, but you're okay there and here. We'll bring this probe right into the loop. As you can see on the outside. And then gently pulling on that loop starts to reduce that first pass. And you can see it's a nice pass on the underside of the meniscus there. And it's actually inverting our meniscus from our first stitch. And now once we're down to that point, very gently we'll pull on the free stitch to bring down our second loop here. As it comes through. And now you'll have that second pass for your dual limb repair on the underside. And I think you can see how that's nicely brought that meniscus to sit down. And now the next step is simply to pass our knot pusher cutter, and that we can work back and forth in this fashion and create a balanced repair of vertical mattress stitches on the superior surface, followed by the inferior surface, skipping the popliteal hiatus here and continuing to work on this side of the body of the meniscus as needed. So here, slide down again tension and then simply cut. If you now look here to inspect, you can nicely see it's tucked in nicely. Your under surface vertical mattress stitch here it's tight holding there. You can see that underneath. And here on the superior surface our prior vertical mattress stitch sitting here and here, we've worked on the left side of the popliteal hiatus staying away from the tendon. If we wanted to continue this repair, I would pass a vertical mattress stitch here and then work underneath it and pass a reverse a reversed undecided vertical mattress stitch here.