Name: Achilles Midsubstance Tendon Repair With PARS Using the Knotless Midsubstance SpeedBridge™ Technique
Uploaded: 2019-10-25T00:00:00Z
Channel: Arthrex
Description: Thomas O. Clanton, MD (Vail, CO), highlights a clinical case treating acute midsubstance Achilles tendon tears with the PARS (Percutaneous Achilles Repair System) using 1.3 mm SutureTape and the Knotless Achilles Midsubstance SpeedBridge™ technique.

<p>Thomas O. Clanton, MD (Vail, CO), highlights a clinical case treating acute midsubstance Achilles tendon tears with the PARS (Percutaneous Achilles Repair System) using 1.3 mm SutureTape and the Knotless Achilles Midsubstance SpeedBridge™ technique.</p>

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VID1-000383-en-US | A | Achilles Midsubstance Tendon Repair With PARS Using the Knotless Midsubstance SpeedBridge™ Technique

Thomas O. Clanton

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.

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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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Achilles Midsubstance Tendon Repair With PARS Using the Knotless Midsubstance SpeedBridge™ Technique

We make a transverse incision. Blunt dissection is used so that you avoid injury to the nerve laterally. And then once you've done that, you can grasp the proximal stump of the Achilles tendon with two Kocher clamps, as you see here. That allows you to then place the two inner arms of the pars jig inside the tenon and pass it up so that you hub the pars jig proximally so that you can place the guide wires through the jig. The number one hole is filled with a guidewire that's left in place with no suture originally, so that it holds the jig to the Achilles tendon, and then you can pass the blue and white SutureTape through the number two hole. Two green and white sutures are then placed through the three and four hole. Each one has a loop on it. And the loop is left on opposite sides. And then you place a black and white SutureTape through the number five hole. A white suture is then placed in the number one nitinol loop hole and passed through the jig. Then you can carefully pull the sutures out through the transverse incision, managing the sutures on each side. Once you've done that, then you can pass the blue and white suture into the loop on each side. That's done by first taking the blue and white suture underneath, and wrapping it around the green and white sutures two times. And then place it through the loop. So you've got a loop on the lateral side and a loop on the medial side. And once you have the blue and white suture through the loop then you play. Then you can pull on the non looped end of the green and white sutures on each side, and pull the blue and white suture through the Achilles tendon so that it is locked in the Achilles tendon at that point. Now you have three sutures. The number one suture. That's white. The number two suture that's blue and white. And the number three suture is through the number five hole, and it's black and white. Then you want to cycle the sutures to be sure that you take out the elongation and then move to the distal stump. So as you see here, we make stab wounds on each side. And then use the 3.5 drill and the drill guide to create a bone tunnel within the calcaneus on each side. Then once the the drill hole is tapped with the 4.75 tap, you put a guide pin in the hole to hold your angles and know exactly where the Where the holes are while you place the banana suture, lasso through the stab wound and then up into the transverse incision to grasp your sutures and pull them down and through the lower stump of the Achilles tendon on each side. Once you've done that, you want to pull some tension through the Achilles tendon. Make sure you've got good tension on each side. Typically, we'll pull the foot down into plantar flexion of 10 to 15 degrees more than you have for the contralateral uninjured side. And then with it tensioned, you can insert the SwiveLock. After placing the sutures through the SwiveLock and hold the tendon in place with the swivel lock inserted into the bone so that it does not leave the SwiveLock proud, which can be a source of pain at the Achilles tendon. Postoperatively. So just be certain that you get the angle correct. Get the SwiveLock into the bone tunnel. Make sure you maintain the tension on the Achilles tendon, and then once you have the SwiveLock against the sutures, then you can simply insert the SwiveLock and make sure that it goes underneath the cortex of the calcaneus at that point with both SwiveLock in the Thompson test should be negative. You can repair the peritoneum to provide some additional strength to your repair. I use three monocryl to do that, and then close the incision with three monocryl and four monocryl plus steri strips.

Achilles Midsubstance Tendon Repair With PARS Using the Knotless Midsubstance SpeedBridge™ Technique

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