PREPRINT
jkl keys enabled
397 views

Tying Arthroscopic Knot for Glenoid Suture Anchor

Matthew Provencher, MD
Massachusetts General Hospital

Transcriptions

I'm going to take this one out ‘cause I don't need it. I had it in there just in case something happened, but there's my first repair stitch right there. The post limb is always in the capsule. The non-post is on the glenoid. And so we going to load this up like this. The post limb is now shorter than the non-post limb, and we're going to tie our - tie a sliding, locking knot. We shorten up the post to about six inches.

At this point we put our Webster needle driver on. Webster in the needle driver. So then we do the loop here. We go under one, i.e. just the post - bring it around. Under both, which is both the post and this. Under one. And then down through this triangle we just created, okay.

So then what you can see here as I tighten this, you get locking areas both close to the labrum and then further away from labrum, so it's kind of a double locking knot - the more you push down, the tighter it gets.

So at this point we're not going to touch this end it all. You leave that end alone. That's the non-post limb, and you just cinch this down, past parallel - in other words, these limbs are going down parallel. One of the things you want to do is make sure you cinch this in the right position. And so here you can see, I want to push this over a little bit to get this in the right position, so it's optimize biomechanically.

And now what I want to do is I just want to kind of rock back and forth like this, and it's kind of just takes slack out of the system. Basically, we now just have the soft tissue there being held. Now we pull both with a knot pusher on the knot, and then bring this back.

And we’re going to do a couple half hitches - that was just a half hitch like that. We push down the same post. You can see that half hitch going down the post. And we’re going to do another half hitch - bring this back - this time over. We’re going to push this down - and this is when we flip posts so we’re going to push past actually, and flip post on this one. This is nice little trick here where you put a crochet hook - through a cutter device.

So now we have that easily fed in. We’re going to come down. This automatically gives you a couple millimeters at the end of the knot if you bring this down to the end of the knot, and it automatically cuts it and leaves it like that.

So that’s our posterior, posterolateral approach. And now we have one anchor in place. And we’re probably going to put 2 more. Now we’re going to use a knotless configuration, so we knot - hook to the left. We’re going to pass what we call a labral tape.