a new technique for arthroscopic knotless rotator cuff...
TRANSCRIPT
VersalokVersalokA New Technique for A New Technique for
Arthroscopic Knotless Rotator Cuff RepairArthroscopic Knotless Rotator Cuff Repair……....
Jeffrey Halbrecht, MDJeffrey Halbrecht, MD
San Francisco, CA San Francisco, CA
USAUSA
Optimal Cuff RepairOptimal Cuff RepairArthroscopicArthroscopicKnotlessKnotlessSecure fixationSecure fixationSimple techniqueSimple techniqueNothing protruding into Nothing protruding into SA spaceSA spaceAllow tensioning of Allow tensioning of repairrepairVersatile techniqueVersatile techniqueSingle or Dual RowSingle or Dual Row
Knotless: Existing OptionsKnotless: Existing Options……
TacksTacks–– Fragments in SA spaceFragments in SA space–– 13/25 failed 13/25 failed ( Elias AOSSM annual ( Elias AOSSM annual mtgmtg 2004)2004)
–– Revision rate 33%Revision rate 33% ( Arthroscopy 2003)( Arthroscopy 2003)
OpusOpus–– Cumbersome techniqueCumbersome technique–– Large metal anchorLarge metal anchor–– Stainless steel Stainless steel
PushlockPushlock–– Poor fixationPoor fixation–– Poor tensioningPoor tensioning
The The VersalokVersalok::AdvantagesAdvantages
KnotlessKnotless4.9mm insertion 4.9mm insertion diameterdiameterNo preNo pre--drillingdrillingEasy techniqueEasy techniqueAccurate tensioningAccurate tensioningVersatileVersatile
= Fast= Fast
PrePre--deploymentdeployment PostPost--deploymentdeployment
Self locking Self locking anchor:anchor:
Locks suture within Locks suture within
anchor afteranchor after
deploymentdeploymentTitanium coreTitanium core
PEAK ShellPEAK Shell
VersalokVersalok: Deployment: Deployment
Ø4.9mm(Pre-Deployed OD)
Ø6.3mm (Post-Deployed OD)
1. Tapinserter to laser
line.
2. TensionRotator Cuff
w/tension wheel or manually
3. Deploy Anchor
Lock sutureby fully squeezing
trigger
4. Unscrew & Remove anchor shaft by
turning inserter counter-clockwise.
Sub-cortical fixation
Expanding anchor locks sutures and fixes anchor to boneExpanding anchor locks sutures and fixes anchor to bone……
Protect sutures
The The VersalokVersalok: Tensioning Gun: Tensioning Gun
Tensioning wheel
Cadaveric Anatomical Pullout LoadAfter 200 Cycles of Cyclic Load
0
50
100
150
200
250
300
350
400
VERSALOK Opus* PushLock*
Max
Loa
d (N
)
n=6 n=6 n=2, 4 Repairs Failed Prior To The 200 Cycles
VersalokVersalok: STRONG !: STRONG !
79 lbs68 lbs
31 lbs
VersalokVersalok Benefits: SimplicityBenefits: Simplicity
Simple technique:Simple technique:–– No drillingNo drilling
Single step insertionSingle step insertion
–– Single or double Single or double loading loading
–– Easy/accurate Easy/accurate tensioningtensioning
VersalokVersalok Benefits: SecurityBenefits: Security
Secure fixation even Secure fixation even in poor quality bone !in poor quality bone !–– Circumferential Circumferential
compressioncompression–– Cortical and Cortical and
subcorticalsubcortical fixationfixation–– Excellent pullExcellent pull--out out
strengthstrength
Expansion within bone
VersalokVersalok Benefits: Benefits: Versatility !Versatility !
Can use any sutureCan use any sutureCan use any suture Can use any suture passing methodpassing methodSingle or double Single or double load anchorload anchorSuture first, or Suture first, or anchor firstanchor first
VersalokVersalok Benefits: TensioningBenefits: Tensioning
Allows tensioning of Allows tensioning of repair repair afterafter anchor anchor inserted ! (before inserted ! (before deployment)deployment)Secure suture Secure suture tension every timetension every timeTensioning wheel Tensioning wheel for accuracyfor accuracy
VersalokVersalok: : Versatile Technique OptionsVersatile Technique Options
Single row lateral Single row lateral fixation:fixation:
Simple sutureSimple sutureInverted mattressInverted mattressArthroscopic Mason Arthroscopic Mason Allen (single step)Allen (single step)
Double row fixation Double row fixation (improved footprint)(improved footprint)
Separate Medial & Separate Medial & lateral suture rowslateral suture rowsMedial mattress, Medial mattress, footprint compression footprint compression (suture spanning)(suture spanning)
VersalokVersalok technique #1:technique #1:Single row lateral fixationSingle row lateral fixation
simplesimple Inverted Inverted matttressmatttress Arthroscopic Mason Arthroscopic Mason Allen (Allen (““riprip--stopstop””))
Single row lateral fixation:Single row lateral fixation:using simple suturesusing simple sutures
VersalokVersalok TechniqueTechnique
Express Sew
VersalokVersalok TechniqueTechnique
VersalokVersalok TechniqueTechnique
Lateral Lateral ““AnatomicAnatomic”” PositionPosition
Beach ChairBeach Chair
LateralLateral
Video Example of Lateral Video Example of Lateral Anatomic View Anatomic View
(Compared to Beach Chair)(Compared to Beach Chair)
VersalokVersalok Technique #2:Technique #2:Inverted MattressInverted Mattress
VersalokVersalok::Simple Lateral RowSimple Lateral Row
Double LoadedDouble Loaded
VersalokVersalok : Single Step: Single StepLateral Lateral ““VV”” ClosureClosure
Larger repair footprint !Larger repair footprint !
Medial and lateral row fixationMedial and lateral row fixation
VersalokVersalokDual Row FixationDual Row Fixation
Benefit:Benefit:–– Maximizes compression onto Maximizes compression onto
tuberositytuberosity–– increasing increasing fixation footprintfixation footprint–– Decreased movement of cuffDecreased movement of cuff--
bone interface during healingbone interface during healing–– Minimize Minimize synovialsynovial fluid infiltrationfluid infiltration
TechniqueTechnique–– Medial row: Medial row:
VersalokVersalok: knotless mattress: knotless mattressSpiralokSpiralok: standard mattress : standard mattress
–– Lateral row: Lateral row: Suture spanningSuture spanningSeparate rowSeparate row
Dual RowDual Row
Medial Row Mattress: KnotlessMedial Row Mattress: Knotless
Two Separate RowsTwo Separate RowsMedial row standard Medial row standard mattressmattress
Separate Separate lateral rowlateral row
Dual Row: Dual Row: Crossover : Suture Spanning TechniqueCrossover : Suture Spanning Technique
SingleSingle crosscross CrissCriss--crosscross
Two Double loadedmedial anchors
Tie Two medial mattress
Criss-Cross for footprint
compression
Single large medial matress
One double loaded medial
anchor
Cross for footprint
compression
Dual Row:Dual Row:Medial Mattress / Simple Lateral Medial Mattress / Simple Lateral
Dual Row:Dual Row:CrissCriss-- CrossCross
Dual Row : Dual Row : CrissCriss-- CrossCross
Medial Row anchorsMedial Row anchors-- double loadeddouble loaded Shuttle sutures through tissueShuttle sutures through tissue
Dual Row:Dual Row:CrissCriss Cross Cross ––cont.cont.
Repeat Two AnchorsRepeat Two Anchors
Dual Row:Dual Row:CrissCriss CrossCross-- cont.cont.
Dual Row:Dual Row:CrissCriss Cross Cross --contcont
Dual Row:Dual Row:CrissCriss Cross cont.Cross cont.
Dual Row:Dual Row:CrissCriss ––CrossCross-- cont.cont.
Dual Row: Dual Row: CrissCriss CrossCross
SummarySummary
VersalokVersalok offers significant offers significant advantages for arthroscopic advantages for arthroscopic RTC repairRTC repair–– KnotlessKnotless–– VersatileVersatile–– SimpleSimple–– Multiple options for Multiple options for ‘‘double double
rowrow’’ fixationfixation–– Best fixation of any knotless Best fixation of any knotless
anchor after cyclic loading anchor after cyclic loading
THANK THANK YOU !YOU !