The knotless SutureTak®, PushLock® and SwiveLock® anchors are knotless suture anchors designed for arthroscopic glenohumeral joint instability and SLAP repair. The knotless SutureTak anchor is inserted through a guide. The suture is passed through the labrum and then it is passed through the locking mechanism and sequentially tensioned to create a low-profile knotless repair. The PushLock and SwiveLock anchors provide the ability to independently pass the suture through a desired amount of tissue prior to anchor implantation allowing for proper visualization and adjustment of tissue tension prior to final implant insertion.
Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA.

Shoulder

Procedure

The tensionable Knotless FiberTak soft anchor combines the benefits of soft anchors with knotless soft-tissue fixation. Curved- and straight-guide delivery systems are available with 1.8 mm drills, making this the smallest knotless anchor on the market.

E. Lyle Cain Jr, MD (Birmingham, AL), demonstrates surgical steps, during a live surgical case, using tensionable Knotless FiberTak® soft anchors to repair a posterior glenohumeral labral tear. Dr. Cain describes the technique using the Rotation Lasso suture passer to create simple and mattress repair stitches. The final repair shows an anatomic, low-profile knotless repair.

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Re-Live Surgical Technique: Posterior Labral Tear Repair With Tensionable Knotless 1.8 FiberTak® Soft Anchors

This case represents a posterior labral repair in the left shoulder. The patient had tried conservative treatment with rehab, was diagnosed with a posterolateral tear by MRI. This procedure was a posterior labor repair arthroscopically using 1.8 Nautilus FiberTak anchors. The arthroscope is in the anterior portal, viewing posteriorly. You can see a spinal needle that's been placed for an accessory posterior portal that will be used for anchor placement, as well as suture passage. The FiberTak drill guide has been placed through the accessory portal. As you can see, there's a black line which indicates the maximum concavity of the drill guide. And this drill guide can be turned in order to allow aiming towards the center of the glenoid, which is critical for the best bone purchase for these anchors. We then elevate the hand and push down against the deltoid to get a nice vertical passage of the drill into the inferior glenoid bone. This prevents skiving off the inferior bone. I like to cycle this drill in and out a couple of times to clear the bone debris. We then use hand pressure to apply the anchor into place. And it's impacted with the back of our hand until it's fully seated. The centering sleeve keeps you from being off center and allows excellent placement of the anchor. Once the anchor is applied, we use a rotation lasso to pass the anchor suture and the repair suture through the labrum. As you can see, the rotation lasso allows you to move the lasso and rotate it perpendicular to glenoid face. We'll try to go a little bit inferior to do a little bit of a superior capsular shift. So we'll grab about a centimeter of capsule and labrum, come out on the glenoid bone junction and then pass the rotation lasso into the shoulder. We then spin the lasso to make it perpendicular to allow easier passage. And we reach through our straight posterior portal with a loop grasper to grab the sutures and do an all-inside shuttling of the repair stitch. In most cases, I like to do a mattress suture on the lowest part of the labral tear. I think this gives you better labral biomechanics, as shown by millet and others, and also brings the labrum up against the neck of the glenoid, where healing should be better. Repair stitch is pulled through the SutureLasso, then the lasso is converted to pull the repair stitch through the labrum and capsule. At this point, we want to convert the anchor. I'll grab the repair stitch and the round conversion stitch, which has a loop through the accessory portal, will then load the repair stitch to the purple mark in the loop, which gives you proper length for passage. And then we pull the opposite end of the suture passage stitch until the anchor is converted and the repair stitch goes through the soft anchor. At this point, I'll cycle the repair stitch. Several times I'll pull it down tense until we get a good approximation. I'll leave this repair stitch intact so I can tension even further after I get the second anchor. In the second anchor is in place with the drill guide again in the accessory portal. The turn of the curve posterior at this point. So I'm more vertical into the bone and have a better angle, and the drill is cycled several times in and out to get the bone debris out of the tunnel. The anchor is then placed by hand, centered using the centering sleeve, and then impacted by hand into the bone to set the anchor in place. This repair stitches then shuttled through the labrum out the capsular attachment and is ready for conversion of the anchor. The anchor is converted through the anchor placement portal, which is the posterior accessory portal, and then as this anchor is tensioned, I like to grab through the posterior cannula, the labrum, and advance it so that I get a nice good tension in the labrum. I will then grab the original mattress suture again and tension it one last time before I cut the sutures. We then sequentially apply up the posterior glenoid. Simple sutures using the knotless device. And for most cases, on the opposite side of the shoulder, this time being the anterior portion of the shoulder. I'll put a simple anchor in order to act as a ripstop anti propagation stitch, and also tension the anterior band of the inferior gluteal ligament. If this were an anterior labrum, I would typically put another anchor on the posterior inferior portion. Again, tensioning the axillary pouch, the hammock effect, and promoting a ripstop effect to keep the labrum from propagating the opposite direction.

Patrick J. Denard, MD (Medford, OR), performs a live surgery using Knotless FiberTak® soft anchors for instability.

Live Surgery: Instability Repair With Remplissage Using Knotless FiberTak® Soft Anchors

I'm Patrick Denard from Medford, Oregon. I'm going to demonstrate a bank card of Remplissage. Our defect is completely prepped. My next step is to place an accessory posterior cannula. I like to use a spinal needle first. This cannula is typically directly lateral to my posterior inferior cannula. Usually it's going to be 2 to 3cm. And I want to get an angle of approach that's going to aim toward the middle of the Hill-Sachs defect. So this is pretty good here because I'm right in the center of the defect. Next I'll take a switching stick and I'll go down to just above the posterior capsule to confirm that I'm at the right location. So we can see the switching stick. We are clearly just above the posterior tissue. I'll insert another seven millimeter threaded cannula. So the goal of the cannula is to go below the deltoid and just above the posterior soft tissue. And at this point I take the cannula and move it in a circular motion to clear out all the posterior soft tissue, which is the Bursa. And I can clearly see that I'm just above the posterior capsule and rotator cuff. Once we've established this space, it's really important that your assistant holds the cannula so it does not back out. I'm first going to insert my inferior anchor. You want to insert the inferior anchor first. Because once you insert the inferior anchor, it becomes difficult to see the superior anchor. So I use a 1.8mm knotless FiberTak anchor. I'll insert with a sharp guide to penetrate through the posterior tissue. I'll typically try to be right in line with the Hill-Sachs defect. I can just see the tip of the insertion guide here. That's going to provide a good angle of approach because I don't want to over or under tension the posterior capsule. Once I establish that location, sometimes I will move inferior so that I'm directed Where I have the most space just below the head. I'll remove the trocar of the guide, and I'll be just up against the cartilage of the humeral head. If I have a really large defect, sometimes I won't go all the way over to the medial edge of the defect. I typically find that A18 anchor works very well in this location. Now, prior to removing the guide, it's important to push the cannula back down to confirm that you have it just above the posterior capsule. And I'll remove the guide. Next I'm going to place my superior anchor. Now I will insert the guide first without the trocar in place. So both anchors are going to go through this same cannula. Once I get down to just above the tissue which I can see here, now I'll insert the trocar into place. And I think that's important so that I just do not catch the other sutures on my way down. So here we can see the spike just reaching the soft tissue. Once I go through, barely, I'll direct away so as to not damage the cartilage and just use a subtle twisting motion. Again, you can see my anchor placement is in line with the posterior capsule, so I'll tag both sets of sutures. I'll typically tag one shorter so that I can distinguish which anchor is which. So again we can see both sets of sutures are coming out the posterior cannula. And I'll set these to the side. At this point I'll move on to do my bankart repair. So I need to prep the labrum first. Typically I'll place anywhere from 3 to 4 anchors from inferior to superior. You can use a variety of suture configurations. With these anchors, you can use simple configurations or mattress configurations. I often use a hybrid approach where I will place a mattress suture configuration inferiorly. A simple configuration in the middle and then mattress again up top. So here is our completed bankart repair. You see, we nicely brought the labrum and the capsule up against the glenoid. The humeral head is already well centered. We have nice tension of the inferior glenohumeral ligaments. And now we're going to go complete our Remplissage. And I think this illustrates nicely how difficult it can be to do the Remplissage at the end. Because you can see already our space here is half that of which it was before. We're actually fortunate we can see in this case, because sometimes you get so much soft tissue swelling you can't see at all. So again, it's important to make that decision at the very beginning. So now we have both sets of suture limbs at our posterior cannula. The inferior anchor is here. The superior anchor is the one that I'm tagged by doubling up my assist. And I will take our repair sutures and pass these to each other. And then we will each convert so that the inferior repair limb will be going into the superior anchor, and the superior repair limb will be going into the inferior anchor. In order to create a double mattress knotless configuration. Okay, now both sets of sutures are converted and will simultaneously go back and forth to bring that soft tissue down to the Hill-Sachs defect. Okay, now our Hill-Sachs defect is extra articular and the capsule is right up against that bone bed. So there will be our final tightening. So here's our completed bankart and Remplissage. You see that this technique for the Remplissage in particular, let us complete this Remplissage in a very efficient manner, adding perhaps only five minutes to the case. The key steps being placement of the anchors first, followed by your bankart repair, and then going back and tensioning the Remplissage.

This animation provides an overview of the features and benefits of the Knotless 1.8 FiberTak® soft anchor for the treatment of shoulder instability.

Knotless 1.8 FiberTak® Soft Anchor for Shoulder Instability Repair

Paul E. Caldwell III, MD (Richmond, VA), presents surgical pearls for shoulder instability repair using Knotless 1.8 FiberTak® soft anchors. The pearls discussed throughout the repair review implant placement, suture management, and final knotless tension.

Surgical Pearls for Shoulder Instability Repair with Knotless 1.8 FiberTak® Soft Anchor

I would like to share with you some of my favorite pearls for success using the Knotless 1.8 FiberTak anchor for Shoulder instability. This is our typical setup for shoulder instability. We'll be viewing from the anterior superior portal with Gemini cannulas in both the posterior and anterior inferior portals. This gives you excellent viewing and access to the anterior, posterior and inferior aspects of the glenoid for repair. Inferior anchor placement is often challenging, and as you can see, the standard posterior portal does not provide the proper angle for drill guide placement. Make sure you have the percutaneous set with the peak cannula for all your instability cases, as it is essential for optimal drill guide position. For the 6:00 anchor, I'm going to gently lever the humeral head to achieve the optimal angle for drilling. During drilling, I would recommend cycling the drill in and out of the bone to completely remove any excess debris. This permits easy insertion of the anchor, as well as allowing the sutures to slide without tension. For easy shuttling and tensioning. I highly recommend that the surgeon holds the drill guide in the assistant drills and places the anchor to ensure that the drill position does not shift between drilling and anchor placement. At this point, you're ready to set your anchor, and I would encourage you to take your time during this step. Once the drill guide is removed, I recommend grabbing all the sutures and gently applying a steady pull in line with the cannula to set your anchor. I would also advise visualizing the anchor setting with the scope as well. You can certainly see how sturdy this anchor is, as I am able to tug hard even in cadaveric bone without pullout. After our anchor is set securely, we'll separate our sutures. You can certainly appreciate the repair stitch, which is dark blue, and the shuttle link, which is tiger. We'll set aside the repair stitch and focus primarily on the shuttle link. Before you shuttle your repair stitch, I recommend circling the shuttle link through the anchor to ensure all bone and soft tissue is removed from the socket, and to confirm that the shuttle link slides easily without tension. Once the repair stitch has been passed through, the labrum are ready to shuttle the Shuttle. The repair stitch through the anchor. It's in your best interest to remove all the tangles from the repair suture to allow optimal shuttling. To do this, I'd recommend grabbing each suture individually with a ring grasper and slowly pull them out the cannula before shuttling. Now let's talk about shuttling the repair stitch through the anchor. Using the shuttle link, you can appreciate the purple mark on the repair stitch, which indicates how much of the repair stitch that needs to be placed through the loop of the shuttle link. Once the repair stitch is placed through the loop, have an assistant hold gentle tension on the repair stitch to allow easy sliding of the shuttle link until you can visualize the purple mark ready to enter the anchor. At this point, short quick suture pulls will improve consistency. You can appreciate the end of the repair stitch as it's shuttled through the anchor. Now that our repair stitch is passed, I prefer to take some of the slack out of the repair stitch, but not to fully tension it. If you happen to have twister tangles in your loop, don't panic. I want to show you how to stay out of trouble. Here you see our 7:00 anchor that has a slight tangle, and the key is adding tension to the loop with a ring grasper. This gentle tension allows the repair stitch to slide easily through the anchor without placing undue force across the anchor or the labrum. Being patient during this process is important, as you want to take the slack off the suture, but allow it to gently slide through the anchor. Once we have all our anchors placed and our sutures past, it's time to tension our repair. I like to use a grasper to position the tissue while tensioning the anchors. This typically involves shifting the capsule of labral tissue superiorly and laterally. You can see our final repair. We have an anatomic repair of the labrum with excellent tension on the capsule as well. Thank you for your time and I hope this demonstration has been educational.

Paul C. Brady, MD (Knoxville, TN), presents a challenging case in which he repairs a pan labral tear in the setting of multidirectional instability and decompression of a paralabral cyst. He uses an elevator instrument to prepare the soft tissue, then decompress the paralabral cyst. For anchor placement, Dr. Brady describes his strategy for repairing the 270° labral tear with tensionable Knotless 1.8 FiberTak® soft anchors.&nbsp;

Addressing Complex Multidirectional Instability With the Knotless FiberTak® Anchor

Hi, my name is Doctor Paul Brady, and today I'd like to discuss a patient with a labral tear as well as a large labral cyst. So this is a 45 year old female. She's had a 15 month history of shoulder pain with progressive weakness. On physical exam, while she maintains full range of motion, she has pretty dramatic weakness with external rotation against resistance. First we'll look at the coronal views. And on these views you can see that while her rotator cuff is still intact, she does have this large labral cyst in the spinal glenoid notch. If we transition to the axial views, we see a better view of the septation of this labral cyst, along with a large posterior labral tear. So for this case, I chose to use the 1.8mm knotless FiberTak anchor. I like this anchor because it uses very small drill holes so that you can get more points of fixation in the limited real estate that you have on the glenoid. If we take a look at the case, we'll start out with the diagnostic arthroscopy portion of the case. We can see the large posterior and posterior inferior labral tear with maceration of the labrum. So now I'm visualizing from the anterior superior and I'm looking at the back of the glenoid. I like to place a six millimeter cannula in the low posterior portal. And that's going to be my working portal for really doing the bone bed preparation. And then the elevators allow you to prepare the labrum and in this case decompress that large labral cyst. I like to decompress the cyst as much as possible, utilizing these elevators and just a small twisting motion while you're elevating the labrum off of the bone. We'll start the repair by placing my superior glenoid anchors, and I'll utilize the rotation lasso to pass the repair suture through the tissue. Next, we'll place the repair suture back within the locking splice of the anchor with the shuttle suture. You can notice that I haven't completely tensioned that first anchor. I've left it somewhat loose because I don't want to tighten up the shoulder to decrease my visualization. After we've placed three superior glenoid anchors, I'll take my repair sutures out an alternate portal for later tensioning, and then I'll move on to my anterior portion of the labral repair. Next, we'll turn our attention to the anterior inferior quadrant. I'll place a knotless FiberTak anchor at the inferior portion of my prepared bone bed. Again, we'll load the repair suture into the anchor locking splice. And these anchors I do fully tension at the time of deployment. Then I'll work my way superior along the glenoid, placing an anchor approximately every centimeter or so on the glenoid rim. You can see here the excellent extravasation of of bone marrow and blood that you get from these anchor sites. I call it the lava flow. And you see this with these anchors. And I think that bodes well for healing of this tissue against the bone after the anterior labral repair is completed. I'll turn attention to the posterior labral repair. And again, I'll place these anchors from my low posterior lateral portal. We'll secure each anchor and then just continue to work our way superiorly. After the completion of the anterior and posterior labral repair, I'll finish off the case by tightening my superior labral sutures. And as a final step, we'll take a final view from the posterior portal circumferentially to examine the repair, and we see an see an excellent repair of this pan labral tear. So my post-operative protocol for this patient will be very similar to all labor repair surgeries between weeks one and four. I like to go slow. Shoulder shrugs elbow. Wrist hand range of motion and gentle active assisted external rotation. Between weeks four and eight will progress her to a full range of motion program with physical therapy between weeks eight and 16 will progress to a strengthening program, but we won't do a full release on this patient until 24 weeks. Postoperatively. Thankfully, she's back to full range of motion, almost normal strength. She's playing tennis and pickleball and she has no pain. Thank you so much for your time.

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Knotless 1.8 FiberTak® Soft Anchor for Glenoid Labrum Repair

A list of scientific articles pertaining to a product or procedure.

Eine Liste wissenschaftlicher Artikel zu einem Produkt oder Verfahren.

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Lista de artigos científicos referentes a um produto ou procedimento.

Atualizações científicas

Lista de artículos científicos relacionados con un producto o procedimiento.

Actualizaciones científicas

Scientific Updates

Remplissage for Anterior Instability Scientific Update

Knotless Labral Repair Scientific Update

Knotless FiberTak® Soft Anchor Technique

Child (D)

The Knotless SutureTak anchor simplifies arthroscopic glenohumeral joint instability repair by combining a proven1 and reproducible suture anchor design and insertion procedure with knotless soft tissue fixation. The guide and drill are used to create a pilot hole precisely on the glenoid rim and the suture anchor is inserted through the guide maintaining the same portal and drill trajectory. The suture is passed and then shuttled into the locking mechanism, allowing the user to control the tension of the suture repair for knotless fixation of the soft tissue under direct visualization. This anchor may also be used in an interconnecting fashion to create bridging constructs for PASTA and remplissage repairs.
Reference
1. Arthrex Research and Development. LA1-00017-EN_A. 2015.

Knotless SutureTak® Anchor Technique

The PushLock anchor is designed for simple and secure arthroscopic glenohumeral joint instability repair. The knotless technique saves valuable time and eliminates the possibility of knot impingement. This suture-first technique allows surgeons to independently pass suture through a desired amount of tissue prior to anchor implantation. Multiple suture configurations, including simple cinch and mattress stitches, can be accomplished with FiberWire®, FiberLink® SutureTape, FiberStick™, SutureTape, or LabralTape™ sutures using the Labral Scorpion™ or QuickPass™ SutureLasso™ suture passers. Tissue tension can be visualized and adjusted, if necessary, prior to final anchor implantation.
Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA.

PushLock® Anchor Instability Technique

The SwiveLock® is a knotless suture anchor designed for arthroscopic glenohumeral joint instability repair. It is sized and used similarly as the 2.9 mm PushLock®, except that the threaded and vented anchor body "twists-in" instead of "taps-in". The anchor provides the ability to independently pass the suture through a desired amount of tissue prior to anchor implantation. This feature allows the surgeon to properly capture the amount of capsule or labrum required for the pathology being treated. The surgeon can visualize and adjust tissue tension prior to final implant installation. The anchor is twisted into its final position and the sutures are cut flush. 

The body of the anchor is available in a BioComposite material that combines PLLA with ß-TCP, or a nonabsorbable thermoplastic material, polyetheretherketone (PEEK). Both are strong, revisable and radiolucent implants. Both versions use a PEEK eyelet for superior strength during insertion to allow firm tissue tensioning and shifting.

Knotless Labral, Instability, ALPSA and HAGL Lesion Repair

Knotless FiberTak^® Soft Anchor Technique

Knotless SutureTak^® Anchor Technique

PushLock^® Anchor Instability Technique

SwiveLock^® Instability Technique