Name: Endoscopic SpeedBridge™ Abductor Tendon Repair With ArthroFLEX® Allograft Augmentation
Uploaded: 2018-11-13T00:00:00Z
Channel: Arthrex

Carlos A. Guanche, MD, (Van Nuys, CA) demonstrates an endoscopic double‐row knotless repair using a SpeedBridge™ repair technique with ArthroFLEX®* allograft augmentation for a full‐thickness abductor tendon tear. In this cadaveric demonstration, he outlines his technique for repairing tears off the superolateral facet of the greater trochanter.
*ArthroFLEX is a registered trademark of LifeNet Health.

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VID1-01427-EN | A | Endoscopic SpeedBridge™ Abductor Tendon Repair With ArthroFLEX® Allograft Augmentation

Carlos Guanche

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

Endoscopic SpeedBridge™ Abductor Tendon Repair With ArthroFLEX® Allograft Augmentation

Today we're going to do an endoscopic abductor repair. And specifically we're going to do a knotless SpeedBridge double row repair with an ArthroFLEX augmentation. And you can see here that I've already set up. And we've obviously done some prep work. And so the idea here is to establish really essentially as many portals as we need to. Most of the time I end up using at least three portals, if not four portals. And in this case, we've sort of prepped it so that we do have those four portals. We've got our clear cannulas here in place. And the beauty of these is that they really don't interfere with our visualization. In fact, we really have a hard time seeing the cannulas a lot of times, which is sort of the ideal situation. Yet with the the thread that they have, they tend to stay very, very nicely. So we can we can establish essentially any portal, This line. Here is a line along the anterior superior iliac spine. And so essentially any, any point between this point and posteriorly where the sciatic nerve sits, we can create any portal that we need to. There's no acromion unlike the shoulder. So it makes it really simple to establish portals and really get the right angle. So we've established what is going to be probably the most the most efficient way to do this is I do a slightly distal portal about at the level of the at the edge of the greater trochanter. So basically if we if we look intra-articular here, my visualization portal is essentially collinear with the beginning of the vastus lateralis. So I'm at the vastus ridge and I'm looking up approximately towards the gluteus medius. My second portal that I establish is roughly at the very top of the trochanter and slightly anterior. We have the leg slightly internally rotated also. And that also kind of brings that trochanter up and really allows us to see the footprint and essentially where the abductor mechanism is going to go back onto. Typically we have a couple of other accessory portals. The more anterior portal, which I usually find it under direct visualization with the needle, is the one that we're going to use to shuttle our sutures. So to get our sutures out of the way so that we can place the sutures in from this, our working portal. When we do the final crossover with the sutures, we use the more posterior anchor point here. So I'm going to be doing drilling from more posterior and more distal so that we can get a really good, essentially double row repair of this abductor. And the indications for this type of procedure are the most common type of tears that we see with these are not, unfortunately, young healthy people. They are typically what is an is an attritional tear, and somebody who has had some chronic pain that's been going on for for several years and has now become dramatically worse. So I find the need for an augmentation device is really great for this type of pathology. Obviously this is a cadaver tissue and the tissue is going to be better. But the reality is that when we get in a live situation, sometimes the tissue doesn't look this good. So it's nice to have a backup plan, and it's nice to be able to augment it through a, an endoscopic procedure rather than having to open it. So the first step after preparation of the footprint. And we can see that there's a big area here. Big surface area for re approximation. The first thing we do is we use the punch. And this is for the 4.75mm SwiveLock. And in cases where the bone is a little bit softer, sometimes I will minimally punch. I won't actually do the full thickness punch. In this case we have reasonable bone and then we'll insert the anchor. So we'll screw in the anchor. And we can hear some good bite here. So we've got really good reasonable tissue. And then we'll pull back the sutures. There's a suspending suture that we'll pull out. And that's the number two. So we'll grab these two sutures and pull them out of these out of this cannula. And then we're going to establish the the shuttling here. So we're going to use a FiberLink. And we're going to try to grab as big a bite as we can. And then now we'll simply go and retrieve our tapes. And this is the beauty of having this extra portal. You can do it all through one portal, but it gets really confusing and the sutures are liable to get twisted even though you think you've got them untwisted. And now all we'll do is we'll shuttle through, which makes it really simple. And we always want to visualize the shuttling mechanism so that if there's any surprises in terms of any kind of hang ups. So now we've got a really good solid bite here with the first anchor, and then we'll switch back. And now we'll pull these out, get them out of the way in anticipation of our second anchor being placed. So essentially we're going to repeat our steps. Now we're going to go with our punch. And one of the nice things that we can do here is to actually use a little bit different color tape. So this will be the white. So then it won't be a mystery as to whether we're getting the right sutures later. Good solid bone. And you can see as, as we inserted these that these are vented swivel locks. So we get some good blood supply going and we'll actually do some bone vents also before we, before we close the defect down. So same thing. We'll pull the retaining suture out. And now I'll use my inferior portal to grab these guys. Get them out of the way. We'll pass the FiberLink and same thing. You can't take a big enough bite in my opinion. With these. You really want to kind of dig in there because invariably the bite is smaller than you probably think. And then same thing. We'll come grab it, pull it out the other suture point here, the other cannula, and we'll run it through. And we're halfway through with the procedure, which is really pretty dramatic when you consider how quick you can get these done. A lot of times the preparation is half the battle. So now that we've established our two, our two sutures, we want to want to see how big our graft is going to be. So now we'll use our arthroscopic measurement probe. So we'll put it on top where the entry points are in the suture. And we can see that it's roughly about 17mm is the the point. And now we'll prepare our graft on the back table. So now we'll use the punch from the prior anchor that we used. So we've measured 17mm. And so now we're going to make our other punch at that 17 millimeter mark. So that'll be our starting point. And we'll do the same thing. And it's really thick stuff. So you need to really hit it. So we've got a nice little punch biopsy now. And then the next step is to cut it. And what I like to do here is to use a couple of clamps on either side of our, our position. We'll cut right next to this coker clamp that I've attached. And then the final consideration that we want to have is sort of how big do you really want this thing over the lateral aspect. And what I find that is usually about a centimeter and a half or so is, is plenty of tissue. Because you don't you don't want it to bunch up. You don't want it to be too much tissue, because then it almost seems like a bit of overkill. And also the tissue will bunch up. And so that's the final. The final cut that we'll do here is we'll get our graft ready to go. So now we've got our final graft prepared. And so it's 17 to 18mm from side to side. This is going to be the more distal aspect. This is going to be the more proximal aspect. And then this is medial. This is lateral. This is the one punch hole that we drilled first and then the second punch hole. So now our graft is ready to go. So now we've got the graft prepared. I'm going to use a little suture grasper. We're going to go through that more distal hole. And then we're going to run our two sutures that we've placed through the graft. And then we can basically just run the graft into the joint. And sometimes to position the graft and to get a really clear shot, we need to kind of play around with where, where our sutures end up in anticipation. So I'm going to reposition the sutures through this more distal more posterior portal. So now we've poked through the second more proximal penetration in our graft. And then I'll reach underneath and grab the blue sutures. And then we'll shuttle them through as well. So now we'll grab one of these to get it out of the way. So now we've got our sutures are nicely positioned. And then what we'll do is we'll pull. We have both of the ones. Both of the white ones are through this distal portal that we're going to actually use for our first lateral suture. So now we're going to grab one of these sutures and get it out of the way. And then we're going to take one of the blue sutures and bring it down here so that they're crossed. So we have one now. We'll pull that out. So now we're going to have the two sutures crossing over the side. So this will be the second part. And now we'll load our anchor after punching. And it's a matter of fine tuning your position. Sometimes we'll use this more distal portal. Some occasions it makes sense to use a slightly different portal. And it's absolutely fine to create as many small portals as you need to. So here we can see this is going to be right at the posterior margin of the distal aspect of our repair. So we'll go ahead and punch it through. Perfect. Now we always take a big sort of wide perspective here to make sure that the graft is going to sit flush, that there's no tangled sutures because it's really hard to retrieve them and save them. And then now we take most of the slack out of the system and then insert our anchor. And then we'll cut that suture, because otherwise it'll become a problem with the with the second one coming in. So we're going to switch gears. And we're actually going to switch our sutures to this portal, the more proximal portal which is simple enough to do. And now we're going to have a much better. Angle of approach. And so we've got good solid bone right here. We've got good clear sailing. We can see the tunnel. And then we can see that the graft is really a nice solid piece of tissue. That's going to sit there and actually do something biologically. So this is our final construct. And we're visualizing from that same portal. So here's the center of the graph. We can see the white sutures very nicely crossed over with the blue suture sort of bunched up the graph slightly. But it really looks like a very solid area here where we've got a nice little footprint reconstruction with a double row.

Endoscopic SpeedBridge™ Abductor Tendon Repair With ArthroFLEX® Allograft Augmentation

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