a new technique for arthroscopic knotless rotator cuff...

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 !