Domain Analysis: Orthopedic Surgery (Arthroscopy), specifically Rotator Cuff Repair.
Expert Persona Adopted: Top-Tier Senior Orthopedic Surgeon, specializing in Sports Medicine and Shoulder Arthroscopy.
Abstract
This video provides a technical demonstration of an all-knotless, double-row rotator cuff repair using the Speed Bridge kit on a 58-year-old male presenting with an acute-on-chronic medium-sized supraspinatus tear extending into the infraspinatus. The tear is crescent-shaped, as confirmed by preoperative MRI. The surgical objective is to achieve a biomechanically robust and biologically optimized repair construct.
The procedure emphasizes meticulous preparation, including thorough debridement of the humeral footprint to maximize bone-to-tendon healing surface. The medial row utilizes fully-threaded 4.75mm bio-composite SwivelLock anchors, positioned perpendicular to the bone, with venting to facilitate marrow access. Suture passage employs specialized devices (lasso, taper retriever with roller) to manage friction from the FiberTape and secure precise anatomic reduction at the articular margin. The lateral row completes the construct using two additional SwivelLock anchors, leveraging strong bone laterally after periosteal removal. Proper arm positioning (abduction and internal rotation via the Trano positioner) is shown to be critical for optimizing access and tensioning during final anchor placement.
0:00 Case Introduction: The patient is a 58-year-old gentleman with an acute-on-chronic medium-sized, crescent-shaped tear of the supraspinatus extending into the leading edge of the infraspinatus. The surgical goal is to create a strong, biologically friendly cuff repair.
0:33 Footprint Preparation: An elevator is used to retract the torn tendon, allowing for meticulous debridement of the footprint to remove soft tissue, ensuring optimal surface contact for bone-to-tendon healing.
0:46 Kit Components: The Speed Bridge kit utilizes four anchors: two pre-loaded for the medial row and two for the lateral row.
1:14 Medial Anchor Insertion (Posterior Medial): A 4.75mm bio-composite SwivelLock anchor is placed perpendicular to the bone, flush with the cortex. The anchor features vents to allow access to the bone marrow, promoting biological healing.
1:48 Suture Management (Knotless Technique): The repair is performed entirely knotless. Sutures are passed through the cuff using a 90-degree straight lasso (via the posterior portal) and retrieved, with pre-attached tapes consolidating into a single suture for easier passage.
2:48 Medial Anchor Insertion (Anteromedial): The second medial anchor is positioned approximately 1 cm from the first, utilizing the articular margin as a key landmark. The fully-threaded design maximizes initial fixation strength by engaging the strong cortex.
3:58 Anatomic Reduction: Percutaneous suture passage is performed to visualize the smooth synovial tissue, ensuring the tendon is reduced precisely to its anatomic footprint at the articular margin, avoiding over-reduction.
5:04 Biological Augmentation: A 45-degree power pick is used to create additional healing channels (microfracture) in the footprint, providing little anchor points for the tendon.
5:28 Lateral Suture Retrieval: A specialized suture taper retriever with an integrated roller is utilized to overcome the friction associated with the FiberTape, facilitating retrieval for the lateral row placement.
5:49 Lateral Row Site Preparation: The periosteum is removed laterally to expose the cortical bone, identified as the second strongest area for anchor fixation (after the articular margin).
6:11 Anterolateral Anchor Loading and Placement: The anchor is loaded onto a threader, ensuring the sutures are aligned to exit medially-to-laterally to prevent twisting. Approximately 8mm of slack is pre-tensioned into the system before tapping the anchor down and securing it flush.
8:13 Positional Adjustment for Access: Internal rotation of the arm using the Trano positioner is employed to create adequate working space (real estate) for the final posterolateral anchor insertion.
8:31 Posterolateral Anchor Placement: The final anchor is punched into the prepared site and secured with 8-10mm of measured slack.
9:31 Final Construct Assessment: The final double-row construct is confirmed to be solid. Blood is observed coming out of the anchor sites, confirming adequate venting to the tuberosity and marrow access.
20:10 Conclusion: The repair is successfully completed, demonstrating a stable, all-knotless fixation pattern.