This video presents a technical demonstration of a knotless Bankart repair utilizing the Knotless 1.8 FiberTak® implant system on a cadaveric right shoulder displaying an anterior-inferior labral tear (6 to 2 o'clock). The procedure outlines specific arthroscopic portal placement—a 5mm low-profile anterior superior portal and an 8.25mm trans-subscapular accessory portal—to optimize access to the inferior glenoid. Key technical aspects include the use of a curved drill guide to achieve perpendicular anchor placement and provide posterior head reduction, and the critical step of ensuring anchor deployment by setting the soft tissue anchor post-insertion. The technique demonstrates both mattress and simple suture configurations, focusing on the system’s tensionable knotless mechanism, which allows precise adjustment of tissue reduction to restore the glenoid bumper while customizing laxity based on patient profile (e.g., multi-directional instability vs. throwing athlete).
Tensionable Knotless Bankart Repair Using the Knotless 1.8 FiberTak® Implant System
0:07 Lesion Identification: The procedure addresses an extensive right anterior-inferior labral tear extending from approximately the six o'clock to the two o'clock position.
0:19 Portal Configuration: Two cannulas are established: a 5mm low-profile cannula through the anterior superior portal (above the subscapularis) and an 8.25mm cannula via the trans-subscapular accessory anterior portal.
0:45 Tool Utilization: Curved FiberTak drill guides are utilized, allowing access past the midline to the inferior glenoid (six o'clock). The guide is used as a lever to reduce the humeral head posteriorly, facilitating a perpendicular trajectory for drilling.
1:13 Anchor Deployment: The nitinol wire is drilled to a preset depth. The 1.8mm knotless FiberTak anchor is inserted, typically using light mallet pressure, until fully seated.
1:55 Critical Setting Step: It is emphasized that the soft anchor must be set post-deployment by pulling the anchor back a few millimeters to ensure proper fixation within the glenoid bone.
2:08 Suture Management: The blue and white repair stitch is temporarily removed from the main field via the accessory portal to maintain organization and prevent entanglement with the shuttle suture.
3:09 Mattress Suture Technique (Lowest Anchor): The lowest anchor (six o'clock) is secured with a mattress suture configuration, preferred for pulling soft tissue firmly against the glenoid neck to re-establish the capsulolabral bumper effect. The technique requires passing the suture lasso retrograde (free end first) through the labrum and capsule.
4:45 Knotless Tensioning: The knotless mechanism involves passing the repair stitch through the loop of the rounded shuttle suture end. The repair stitch is pulled to a marked purple point, doubled over, and held under tension while the shuttle suture is pulled through the anchor.
5:49 Tension Customization: The anchor allows for adjustable tensioning, ranging from light reduction (for poor tissue quality or minimal tightening) to a maximal pull for tight fixation, which must be tailored based on patient laxity requirements.
6:06 Suture Trimming: An open-ended cutter is used via the 8.5mm cannula to hook the suture and cut it close to the glenoid, leaving a minimal tag.
6:31 Second Anchor Placement (Simple Stitch): The second anchor (approximately five o'clock) is placed using a simple stitch configuration. The 1.8mm diameter allows for close placement (approximately one hour on the clock face) without compromising bone stock.
9:27 Resultant Reduction: The use of the simple stitch for the second anchor is shown to effectively pull the cut surface created by the initial mattress suture down against the glenoid, resulting in an aesthetically favorable reduction.