Name: Collateral Ligament Repair Using the Nano SwiveLock® Anchor
Uploaded: 2019-11-18T00:00:00Z
Channel: Arthrex

Damon C. Adamany, MD (Phoenix, AZ), demonstrates the repair of a collateral ligament tear at the PIP joint with the InternalBrace™ ligament augmentation procedure.
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.

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VID1-000637-en-US | B | Collateral Ligament Repair Using the Nano SwiveLock® Anchor

Damon Adamany

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

Collateral Ligament Repair Using the Nano SwiveLock® Anchor

Well, we're here talking about the nano SwiveLock anchor. We're very excited about this. The anchor itself is you can see here at the top is is a 2.5 by seven millimeter anchor. It's a peak tip with a fork tip anchor and a titanium body. The kit comes with two K-wires that are 0.86mm, which translates into an oh three 4K wire. And you get two of those. And there are two drills, which is a two millimeter drill and a 2.2mm drill, depending whether or not you have hard bone or soft bone. Of course, we still have our standard drill guide here, which has a depth stop on it built in to make sure we drill the appropriate depth. You can see the laser markers on the K-wires, which are about eight millimeters in length. That tells you the depth that we need to drill for the K-wires. So we're here today. We've got a right hand specimen. We're going to be using the nano SwiveLock anchor, which is the 2.5 by seven millimeter anchor with a peak eyelet and titanium body to fix a collateral ligament at the pip joint of the right long finger. As you can see, we've already pre dissected this out. And the collateral ligament is now free from the proximal phalanx right here. So the technique will be to place a couple of K-wires across obviously one proximally and one distally. We're going to do an anchor approximately first. And in our anchor we're going to have a SutureTape which is 1.3mm with a 400 FiberWire. And we'll show you how this is done. So we're going to go ahead and put the 0.86mm K wire in here. And this will be in the footprint of where the collateral ligament had pulled off from here. You notice I keep the finger slightly flexed so as to not over tighten the repair. So we'll drill this pin in and you can see that there is a depth stop on it. We'll go all the way down to that stop. And then on the distal pin, I've made a space just distal to the collateral ligament, and actually made a little small opening where I'm going to be able to put this in so that we don't get any soft tissue intertwined. This is just near the distal edge of that footprint distally around the middle phalanx. And again we push that right down to the to the black laser line. We're going to go ahead and show what that looks like as we check our position for the K-wires on the fluoroscopy. Okay. Now we'll take our two millimeter drill bit again. We have a 2.2 and A20 drill bit depending on whether or not the bone is hard bone or soft bone. And again the depth gauge is a causes a stop so that you don't drill too far here. So you can see here we have a simulated Pip collateral ligament tear. The ligament has been lifted off proximally. Where it's torn from. You can see the instability and how much this gap is open in the joint prior to prior to the repair. Now that we have our anchor loaded here, we've got our 1.3mm SutureTape and our 400 FiberWire. We'll go ahead and place that in the proximal side first. And it's important to note, to make sure that this anchor body is flush up against the bone before you start to turn the anchor and try to advance it. It's important to have that. Although if for some reason you don't do that and the anchor eyelet and the body separate, you can reload these. That's the great part of using SwiveLock anchors. So now that we've got our SutureTape and our 400 FiberWire, we'll only be using one of the limbs of the SutureTape. We'll use that in just a second. For now, we'll go ahead and use the 400 and FiberWire to do our repair. So again, this procedure is presuming that you have good tissue to repair back. And indeed in this case we do. And you can do whatever stitch you prefer whether it be some sort of simple stitch, or you can even do a mattress configuration. If this is a reconstruction situation, you could certainly just use a 2.5mm screw. And now we've got a repair here and we'll go ahead and tie that down. So again we'll use just one limb here. And this is your internal brace component. This is why we've drilled the second drill hole distally. If you're not sure where your hole is at again you can kind of find that hole by putting your K-wires back in. Pretty easy to find that right there. So this will be coming right over the top of that for your internal brace. And we'll go ahead and bend that a little bit just to make sure we're not too tight on that. Nice thing about these swivel locks. They generally will tension themselves. You load it in the eyelet and it will slide in generally pretty easily for you. Just slow, gentle, even pressure. And you can cut the remainder of that with a blade. And there's your final construct. You can see no more gapping very strong there and nice solid repair postoperatively. We try to get them moving pretty quick, and so we try to get range of motion going fairly quickly. I let the wound heal up for about the next 7 to 10 days, and then I start gentle range of motion a pretty quick right after that.

Collateral Ligament Repair Using the Nano SwiveLock® Anchor

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