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Placing Knotless Suture Anchor through Mid-Glenoid Portal

Matthew Provencher, MD
Massachusetts General Hospital

Transcriptions

CHAPTER 5B

And then we’re going to load up the labral tape. And so here’s the labral tape. It's a non-cylindrical suture - in other words, it’s a small flat, just polyester blended tape. So we’re going to go around the labrum like this. Nice flat construct on there, and then it's going to be held in a knotless fixation device that gets sunk into the glenoid.

And so here's what we have for our labral tape coming out. Now, we're going to drill. I want to get a nice robust repair, so that's where that stitch is coming out right there. So go ahead and take the spear out. The other thing is I want to make sure we're just at the edge of the cliff - maybe 1 to 2 mm on the face of the glenoid. I'm always looking at my other anchor. I don't want to pop that one out with another drill, so want to move far enough away and at an angle that's going to be good for this. So you can see, I’m bringing the angle up a little bit. So we mallet it just to hold it in position - drill.

Here is the anchor - it’s an interference anchor. The tape is going to pass through this eyelet, and then this device is going to go and be malleted down over the eyelet to seal the tape in place with the eyelet. And so we basically just passed a short distance - the shorter you pass, the better - makes it easier to pull through. So I pulled it, pulled it - and hemostat please - and then we hemostat it as we go down the shoulder.

And we’re going to put that in the hole right here. We’re going to pull these individually. What you’re going to see happening on the screen is you can see how it tightens it down - see that right there?

Once you get it to optimal tension, the next thing you do is you’re going to do is mallet it so the plastic implant - this peak plastic yellowish implant - comes in contact with the bone.

Once you’re at the bone, you take off this little orange tab, and now you mallet the interference portion all the way down to the black line. Keep going - you’ll start hearing the pitch change - keep going. You just want to make sure this goes down deep enough - and there you go.

Now we take this six counterclockwise turns to unload the device, and we pull it out. These are open cutters. They will go down on the tape, and cut. Load these in over the top.

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