Name: Mini-Incision Brostrom Utilizing the Arthrex® Brostrom Repair System
Uploaded: 2015-05-19T00:00:00Z
Channel: Arthrex

Jorge Acevedo, MD, (Jacksonville, FL) presents his technique for a minimally invasive Brostrom repair using the Arthrex® Brostrom Repair system. After inserting two BioComposite™ SutureTak® suture anchors through a small 1.5 cm incision at the distal tip of the fibula, Dr. Acevedo shuttles the four sutures through the anterior talofibular ligament (ATFL) and extensor retinaculum using a curved Micro SutureLasso™. The Arthrex Brostrom Repair system contains all the necessary products to perform this repair through a small incision.

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video

VID1-00449-EN | A | Mini-Incision Brostrom Utilizing the Arthrex® Brostrom Repair System

Jorge I. Acevedo

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

Mini-Incision Brostrom Utilizing the Arthrex® Brostrom Repair System

We're here filming the mini incision modified ArthroBrostrom technique. You can do this procedure through about a 1.5cm incision, as is shown here. And the concept is that you don't have to do it arthroscopically necessarily, but you can pass the sutures using the arthroscopic technique. Okay. So now we'll make a small incision. You can feel the distal fibula right there. And as it curves and we're going to make an incision and take the ligament right off of the fibula. Okay. So here's the tip of the fibula. Here's your ligament underneath here. Okay. And so the next step is we're going to drill. So the nice thing is we have this drill system that we use Arthroscopically. And I'm going to put an anchor right in the distal fibula there. The drill fits right over the cannula, and you can just drill it down to the hard stop. Okay. So now we're putting the anchor through the cannula and it goes down to the laser line. You can see proximally the line is buried right on the handle. Then you can take these sutures out. Okay. That's your first set of sutures. We're going to drill the next anchor about a centimeter apart on the footprint here of the atfl. And you can tap it once again to the laser line. Okay. That's good. And you can bring the sutures out. And now we're going to pass the sutures like we would in the arthroscopic technique. So here we have the safe zone, which is the intermediate branch of the superficial peroneal nerve and the superior margin of the peroneal tendons. And then the inferior extensor retinaculum is about a centimeter and a half distal to the fibula that I've drawn here. And the goal is to come out with your sutures, grasping the retinaculum at these points that we've drawn here. Okay. So if you look in here, we can grab our ligament and you're going to come in the joint. And with this SutureLasso. And the idea is to come out right at this point distally. And you can feel it come out. And you can bring your SutureLasso out. Bring your first suture through. Got it. And then we shuttle the sutures as shown here. Now we can use the SutureLasso once again. And the idea again is to come in intra-articular early, grasping your ligament. And we're going to use again this curved SutureLasso. We're coming into the joint. And I like to feel it with my hand here so I know exactly where I'm coming out. And you can just puncture right through as shown. So if you come out a little bit more distal that's okay too. And we're going to pass the next suture through. Okay. All right. Very good. We'll do the same process again for the two limbs of the second anchor as shown there. And same technique. The wire loop is used to pass the first limb of the second anchor. Okay. And then we'll do the same again. Okay. And now you've passed all your sutures through. Then you can come subcutaneously through your same incision, and you can pass your sutures using your arthroscopic probe. Okay. And you can see how simple this is. Okay. So we got our sutures have been passed, and now we can tie our sutures, holding the foot in neutral and slight eversion. And you can just tie your regular knots. You don't have to do any fancy arthroscopic knot. And this will bring the retinaculum up to the fibula. I've shown there. Okay. And then you can tie These. And while you're tying them, he's holding the foot in slight eversion and neutral dorsiflexion with a posterior stress that's being applied. And again, this the idea is you bring the retinaculum up to the fibula like you do in the arthroscopic technique, and the ligaments are being imbricated as shown. Okay. Okay. So here you can see how the tissue has been pulled up. And this is good evidence that shows that the retinaculum is actually being pulled up in the process. But you really want to kind of release this. So there's no puckering of the skin as is shown there. And I'm doing this just subcutaneously like this. And then you can just cut your sutures. You can test it first. And good stability. Cut your sutures in the same fashion as you would with a regular open technique. And if you want, you can close some of this periosteum with just an absorbable stitch, and then close your incision, and you're left with a relatively small about a centimeter and a half incision, as you see there. So here we're showing the retinaculum as it's been pulled up by your two sutures right here. Nicely imbricated up to the distal fibula right here. Okay.

Mini-Incision Brostrom Utilizing the Arthrex® Brostrom Repair System

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