Name: Broad Compression Knotless Instability Repair Using the PushLock® Anchor and FiberLink™ SutureTape
Uploaded: 2019-09-24T00:00:00Z
Channel: Arthrex
Description: Matthew Provencher, MD (Vail, CO), repairs an inferior glenoid labrum tear with 2.9 mm Short PushLock ® suture anchors and FiberLink™ SutureTape in a knotless configuration. Dr. Provencher discusses optimal anchor placement using a percutaneous instrument kit. He uses the ReelPass SutureLasso™ suture passer for suture passing.

<p>Matthew Provencher, MD (Vail, CO), repairs an inferior glenoid labrum tear with 2.9 mm Short PushLock<sup>®</sup> suture anchors and FiberLink™ SutureTape in a knotless configuration. Dr. Provencher discusses optimal anchor placement using a percutaneous instrument kit. He uses the ReelPass SutureLasso™ suture passer for suture passing.</p>

Not Hidden

English  - en

video

VID1-000237-en-US | C | Broad Compression Knotless Instability Repair Using the PushLock® Anchor and FiberLink™ SutureTape

Matthew T. Provencher

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

Broad Compression Knotless Instability Repair Using the PushLock® Anchor and FiberLink™ SutureTape

Welcome everyone. We're going to focus here on an anterior, inferior and posterior labral repair using knotless technology and SutureTape links. So now we're going to start the label repair. Our tear here is almost 180 degree repair from posterior at 8:00, right here down to 6:00 and then anteriorly up to 3:00. So what I'm going to do here right at the 6:00 position is take a bite of tissue. We're then able to just gently translate and rotate again about 30 to 40 degrees. I use two fingers on these wheels to help facilitate the suture passage. And when I see it balling up in here, I know I have enough suture that will facilitate changing this over to a SutureTape link. And what you want to do is turn this so that the needle is not going to compromise the suture, but that it's coming straight out. So I'll turn this device so that it's coming straight out. You have a hemostat feed, additional suture. So we have one limb of suture out the cannula. We have to get the other limb out to be able to shuttle this. Once we get this out, it depends on the tissue and tissue quality. But a lot of times I'll make just one dilation stitch, especially if I'm using just a standard SutureTape. And then just after that you throw another single overhand loop and we drop in the link portion of the suture. This is another key point. In order to take advantage of the luggage tag principle of this link suture, we're going to pass the link portion a little bit of ways into this passing suture. The reason is we want the link to stay on the tissue side. And so as we pass this through. You can do a staccato move to help pass it a little a little bit easier, which is a little bit of a pulsed pulling, if you will, a gentle pulse pulling of the suture. And are you able to pass that suture through. So what we're left with is the suture outside the cannula and the link portion. If I pull this here this is the link portion. So now we'll leave that there while we do our percutaneous insertion. I want to show you the reason why percutaneous insertion is so important. So here's our standard posterior portal. We've got our suture through it. But I'm just simulating a repair trajectory with the fish mouth with the anchor. And you can see it's very shallow and very superficial. You can skive. You may not be able to get good bony fixation. So we really want to have this trajectory to be much more perpendicular to the glenoid surface. In order to accomplish that we utilize the percutaneous kit. We're going to utilize our posterior lateral portal which again is about four centimeters straight lateral from the posterior lateral edge of the acromion. We're then going to look inside the shoulder and marry up the tip of this with the tip of our cannula. So here we have our spinal needle that's coming in. And what we like to see is that's really up nice and high against the capsule right there, which is really adjacent to the capsule at the humeral attachment. And that's a perfect trajectory for putting this in place. So this is a needle. We just want to be a little bit careful as we enter down to the glenoid and cartilage surface. But we take out the center trocar and we place in our nitinol pin. Once we place our nitinol pin, the spinal needle comes out. We have an assistant grab the pin so that it does not come out of place. And then what I do is make a small incision with an 11 blade knife. I generally use a depth of about half the length of the 11 blade. So we're going to put this outer dilation cannula on. And this is also going to facilitate passage of our metal cannula which will allow us to do the repair and pass our instruments. And so now we've got this cannula here and we're able to able to get in very nicely at a good trajectory to be able to put our anchors in place. So we put the cannula and the fishmouth construct together and then this passes over the dilation pin. So now we have the fish mouth and cannula in place. We're now going to place this at the 6:00 position. And we're going to bring that just a little bit forward right around the 6:00 position. But it's also predicated on where you pass the suture. We're going to just gently tap. And I always do a gentle tap here on my fish mouth because it just allows me to ability to lever a little bit more. You can see I can lever that very nicely to get a really nice trajectory. Okay. So we're going to start the drill. We have a short push lock that we already know we're using. It's opened up on the back table. We're going to stop right at the black line right there. So once we've drilled that we make sure the metal outer cannula is still in place. And now we can facilitate passage of the suture. This is the mini suture retriever. And generally what I do is pass one limb at a time. You can back up the metal cannula and I pass one limb at a time. But sometimes you can get to. In general, I try to grab the one on the tissue side first. And now I have both limbs of suture out of the cannula. We're going to make sure that we haven't captured any additional tissue. And we can almost simulate the repair here that we're going to achieve through this metal cannula. So once we know the luggage tags synch is ready, we pass it through and gently pull it down depending on the tissue. You can also use a pusher to help push this down. So once we've loaded this up, we're then going to come down the same trajectory down through this cannula. And here you can see how that principle of the SutureTape link works with the luggage tag principle. That link is able to pull down further and hold in very securely the labrum in tissue repair. We're then going to gently tap this in position after we find our drill tunnel. What we're doing is watching for engagement of the anchor, so I'm going to hold that there as we pull the orange tab off. And now we're able to put the anchor in position. Good. At this point we now do six counterclockwise turns in that collinear fashion the same way that you inserted it. Once you do six turns, it will just easily pop off. You'll feel it. We test it. We have a really nice repair construct. So now we're going to put the mini cutter in. What I like to do with the mini cutter is making sure that the teeth are away from your repair construct. We just gently put it into the cortical hole and squeeze the trigger. So now we're going to continue the repair around the front. We're going to put this anchor in right about 5:00 position. So we poke capsule rotate. Pass a sufficient amount of the nylon suture feed as we go. Grab, cut. So here's our tape. Suture. We're going to pass it through. Pass. I pass it through just to the isthmus, or the end of the luggage tag and shuttle that through easily. And then even it up again. The tissue side is always the link side. And then we're going to take this link, push it down and deliver it. So it's remains nice and flat. And that we also get a good configuration. And so in general I'll bring it maybe 1 to 2mm from where the tape exits the labrum. Tap this in place. We again check the trajectory of the overall drill and anchor construct, which we like to make sure that we're not too superficial and not too shallow. And we're going to going to use a short 2.9mm PushLock. Engage the anchor. Take our orange tab off. So now we want to keep that same trajectory. So I'll just keep my finger here so it doesn't drop down. We unscrew it six times counterclockwise and it just gently pops off. And there's our construct. Test it before we make our final cut. So this is your final repair. You can see that the SutureTape link has excellent fit and hold of the tissue, both through the capsule and also through the labrum. And you can see how it really nicely and anatomically restores the glenoid labrum concavity and restores the labrum to its anatomic position.

Broad Compression Knotless Instability Repair Using the PushLock® Anchor and FiberLink™ SutureTape

Related Pages

Shoulder

FiberLink™ and TigerLink™ Sutures

Product

Shoulder

PushLock^® Anchor Instability Technique

Procedure

Shoulder

PushLock^® Anchor

Product

Shoulder

SutureTape

Product

Broad Compression Knotless Instability Repair Using the PushLock® Anchor and FiberLink™ SutureTape

Related Pages

Shoulder

FiberLink™ and TigerLink™ Sutures

Product

Shoulder

PushLock® Anchor Instability Technique

Procedure

Shoulder

PushLock® Anchor

Product

Shoulder

SutureTape

Product

PushLock^® Anchor Instability Technique

PushLock^® Anchor