Name: Meniscal Repair Options Using the NanoScope™ System Presented by Dr. Michael J. Stuart at TPC
Uploaded: 2020-11-18T00:00:00Z
Channel: Arthrex
Description: Michael J. Stuart, MD (Rochester, MN), presents meniscal repair options using the NanoScope ™ system.

<p>Michael J. Stuart, MD (Rochester, MN), presents meniscal repair options using the NanoScope<sup>™</sup> system.</p>

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VID1-001216-en-US | A | Meniscal Repair Options Using the NanoScope™ System Presented by Dr. Michael J. Stuart at TPC

Michael J. Stuart

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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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Meniscal Repair Options Using the NanoScope™ System Presented by Dr. Michael J. Stuart at TPC

So here we have a right knee. And if I insert the NanoScope turn our water on you can see the field of view. You talked about. So we'll just look around a little bit about the anterior cruciate ligament. We can come into the medial compartment. I want to just show how simple it is to go through the intercondylar notch. And I can make my posteromedial portal as necessary. I can look at the posterior horn, look for a ramp lesion to probe that. And it's so easy to just switch back and forth. We made a couple little portals here. Now I'm in the Inferomedial portal. I can see the lateral side. And again it's very simple to find your way through the intercondylar notch and see that root attachment so nicely. You just got to get in the habit of manipulating the camera a little bit differently, because you can't rotate your scope, but we can really see the patellofemoral joint if we come down. See, this patient has a central groove trochlear lesion. We We can come down into the gutters and you can really appreciate how small it is and how we can get way back down into the popliteus hiatus and look for any loose bodies. So it's pretty exciting to to think about the indications since the optics are so dramatically improved. Now, if we put a little varus stress on the knee, just a gentle one. As you mentioned, there's these nano instruments and I actually have these available for all my scopes now because in a really tight spot, let's give a little more stress the opposite way. There you go. You know, you can see how if it's a really tight knee, that you would be able to take one of these little small instruments and you could maybe do your little partial meniscectomy since they're disposable, single use, they're very, very efficient, very sharp. And I think you'll be surprised how nice this is. So maybe we're going to limit the damage when we start training, especially our residents, with these cool instruments. Now, the other thing I wanted to show, I've taken the liberty here of talking a little bit about this device, which I think most everybody's familiar with. But this ZoneNavigator for me has just been absolutely fantastic because it has three different attachments and they're completely adjustable. You can rotate them so that you can ergonomically use this. So we have a right mid and posterior. We have a left mid and posterior. And then we have an anterior that's used right or left. And just to kind of demonstrate a little bit of this concept. So with the NanoScope in the ipsilateral portal. And now I can put my ZoneNavigator in the contralateral portal. And those of you who know me know that I'm a big fan of, of this technique, because this is a small needle and it's solid. And so with my thumb, I don't know if you can see can see that. I can actually retract or advance this needle. And what I've always liked to do with this technique is advance the needle a little bit, and then you can very accurately skewer where you want to put it. And then we're just going to pull that out through a small portal. And I've been using this for every kind of meniscus tear. And I don't need three assistants anymore. You can almost do it yourself, but it's nice to have somebody pulling the needle out so I don't have to change my position. And let's straighten the knee just a little bit with a little bit of valgus. So now I can advance this second needle. And I'll try to get that tip comes out at one centimeter increments. So now I can very accurately decide for example in this case we'll do a vertical mattress suture. And I'm going to do very little damage to this meniscus here because I've literally only put one hole in it. And it's a small hole. And we And we think that the tape will actually distribute. If you skewer your other suture, it really doesn't matter because you can just pull one end or the other, and that will pull through real nicely. Yeah, that's been something I've noticed. You can just find that. So this is this is going to allow us very accurate tensioning. And quite honestly we all like sometimes to combine both. Inside out and all inside. So this this shouldn't be a lost art. I think that inside out meniscus repair is here to stay. Especially stacked vertical mattress sutures for vertical tears. I use it for radial tears as we talked about with the ripstop. I also use it for horizontal cleavage tears now where I can throw a very tiny little incision, tie these very accurately over the capsule. So now I'm just going to switch the scope to the Inferolateral portal. So here again this is that view we get. So let's just say there's a posterior horn tear. We have this little skid you could use a passport to I guess if you want. But if you put this so that the sharp side is down, it should slide in very easily and we can just take the ramp out. So now I'm inside the joint. We can we can find this. And now we'll give it a nice valgus stress. So the NanoScope is so small that I can get it way back in there. And, and this FiberStitch device actually has a calibration. So you can see 1014 and then 18 here. And you can also put a stop on it. I typically just go by the laser lines, but it's again very ergonomic because once I go through, all I do is I take this wheel back until it clicks and then forward until it clicks again. And now my first implant is deployed so I can pull back carefully because I don't want to skewer my suture loop with my needle. But if I find where I want to put this second throw now. So for example, let's just say we're going to do a vertical mattress. Or we could just for fun, let's say we're doing a circumferential suture, which you could easily do for certain type of tears. And then the same thing, you wheel it back until it clicks and then you wheel it forward again. It didn't really feel it click that time, but it's as far as it goes. And now we've deployed both of these. So here if you just want to grab the scope just for a second, you show. Us up close here. This is an important part. Yeah. You'll you'll notice here that there's a loop. And then there's a free strand a single strand. And the real key is just to identify the loop. And if you grab it with your probe, you want to pull and you're going to see this suture tight. Now you can visually see it get tight. And also a trick I learned. If you see your single strand start to move, that means that you're tight enough. Now that looks like it might be underneath there. So now if I let go of the loop and I pull on a single strand, you'll see this cinch down. So you can do vertical mattress, horizontal mattress. Just for demonstration I did a circumferential suture. But this is an all suture device, so it's all inside. There's no peek implants. There's a cutter. And so we can decrease suture bulk. No intra-articular knots, no extra capsular implants. That could potentially be painful. And so I think this is really going to turn out to be a real appealing way, especially to get at these very difficult areas because this is a hard area to get to with an inside out type technique. So I think going through the intercondylar notch, you can really appreciate how far back we can put these sutures now.

Meniscal Repair Options Using the NanoScope™ System Presented by Dr. Michael J. Stuart at TPC

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