Domain Analysis: Orthopedic Surgery (Sports Medicine/Arthroscopic Shoulder Reconstruction).
Adopted Persona: Top-Tier Senior Orthopedic Surgeon and Medical Device Analyst.
Abstract
This instructional video provides a detailed cadaveric demonstration of an arthroscopic Bankart repair utilizing the Knotless 1.8 FiberTak® implant system. The procedure, demonstrated by Dr. Peter J. Millett, emphasizes techniques for achieving precise anatomical restoration and stable fixation using knotless, low-profile implants. Key technical aspects covered include the strategic use of a new 5 mm percutaneous cannula for flexible anchor placement and meticulous capsulolabral mobilization until the subscapular fibers are exposed. The sequential process of anchor insertion, repair suture shuttling using a 25-degree lasso, and the critical role of a counter-traction suture to facilitate untwisted knotless conversion are detailed. A primary advantage highlighted is the ability to perform sequential tensioning of all repair sutures post-implantation, which laboratory data suggests yields an additional millimeter of tissue tensioning and optimizes force distribution across the repair construct.
Tensionable Knotless Bankart Repair Using the Knotless 1.8 FiberTak® Implant System
0:03 Procedural Focus: Demonstration of arthroscopic Bankart repair using the Arthrex 1.8 mm Knotless FiberTak® implant system.
0:11 Portal Access: Establishment of standard posterior and an 8.25 mm working cannula, supplemented by the use of a new 5 mm percutaneous cannula placed over a spinal needle and guide wire for variable anchor positioning, enhancing surgical flexibility.
1:31 Tissue Preparation: Mobilization of the labrum and capsule must be completed until the underlying subscapular muscle fibers are clearly visible.
1:54 Anchor Insertion (Initial): The first anchor is typically placed around the 5 o’clock position using a curved guide. The flexible drill should be cycled 3-4 times in dense bone to ensure all bone debris is cleared from the tunnel prior to anchor introduction.
3:20 Suture Management: The 1.8 mm anchor features three sutures; the repair suture (color-coded, e.g., blue) is retrieved superiorly, while the shuttling suture remains inferiorly to assist in conversion. Suture "milking" is recommended to remove longitudinal twists.
3:49 Capsular Penetration: A 25-degree left curved lasso is used, approaching the capsule perpendicular to the tissue plane, facilitating precise placement of the repair suture limb around the labrum.
4:50 Knotless Conversion Technique: A separate counter-traction suture is introduced to loop the repair suture. This traction maintains tension during the conversion process, ensuring the anchor loop enters the cannula smoothly and prevents twisting, simplifying deployment.
5:58 Anatomical Reduction: Before final tensioning, the soft tissue is secured and manually reduced (pulled up) using a grasper to restore the anatomical position of the labrum against the glenoid face.
6:29 Suture Isolation: After placing the first knotless anchor, the repair suture is often temporarily removed from the cannula (via a switching stick) to prevent entanglement during the insertion of subsequent anchors.
7:02 Sequential Anchor Placement: Subsequent anchors (typically four total, sometimes five for large defects) are placed superiorly, often near the 4 o’clock and 3 o’clock positions, utilizing different colored repair sutures (e.g., white/light blue) for easier differentiation.
10:53 Sequential Tensioning (Key Takeaway): After all anchors are placed, all repair sutures are retrieved and individually re-tensioned, starting from the lowest anchor. This critical step provides approximately 1 mm of additional tension and effectively distributes the load across the entire fixation construct, optimizing final stability.
11:40 Technical Pearl (Cutting): When cutting the suture, the instrument must be positioned precisely in the center of the loop to achieve a clean cut and avoid frayed edges.
11:50 Outcome Summary: The 1.8 mm Knotless FiberTak system provides a low-profile, multi-point, strong repair with minimal bone removal, offering the distinct advantage of post-fixation retensioning.