Innovations in Glenohumeral Instability Management Brian J. Cole, - - PowerPoint PPT Presentation

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Innovations in Glenohumeral Instability Management Brian J. Cole, - - PowerPoint PPT Presentation

Oct 04, 2022 258 likes •503 views

Innovations in Glenohumeral Instability Management Brian J. Cole, MD, MBA Professor, Vice-Chairman, and Managing Partner Department of Orthopedics Chairman of Surgery, Rush OPH Section Head, Rush Cartilage Restoration Center Team Physician,

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Innovations in Glenohumeral Instability Management

Brian J. Cole, MD, MBA

Professor, Vice-Chairman, and Managing Partner Department of Orthopedics Chairman of Surgery, Rush OPH Section Head, Rush Cartilage Restoration Center Team Physician, Chicago White Sox and Bulls

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SLIDE 2

I (and/or my co-authors) have something to disclose.

Detailed disclosure information is available via:

Printed Final Agenda Meeting App Meeting Website www.aana.org/annual

  • r

AAOS Orthopaedic Disclosure Program on the AAOS website at http://www.aaos.org/disclosure

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SLIDE 3

The Virtues of Knotless Repair

  • No Knots! (and loop failure)
  • Customized repairs
  • Low profile
  • Versatile and Consistent
  • Faster

AJSM, 2014 Arthroscopy, 2013

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SLIDE 4

Joint Friendly

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  • Eliminates suture abrasion on chondral

surfaces, synovium and cuff

  • Restores anatomic meniscoid position of

labrum on glenoid

  • Biomechanically superior construct
  • Cannulated anchor provides extra channel

for marrow elements

Knotless Labral Repair with Pushlock Anchors

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SLIDE 6

Mechanical Superiority

50 100 150 200 Load 2mm Displacement Ultimate Load Failure 66.5 173.1 35 167.9 Load (N)

Part 1: Biomechanical Testing

SSA KSA

AJSM, 2014 Arthroscopy, 2005

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SLIDE 7

Labrum and Capsule

 Capsular shift (6.8 vs 4.3 mm)

  • Berg et al, 2002

Arthroscopy, 2010 Traditional Knotless

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SLIDE 8

Versatility

Simple Mattress Double Cinch

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SLIDE 9

OR TIME

24.2 Minutes Faster - 721 Patients

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SLIDE 10

The Benefits of Tape

Arthroscopy, 2015

37% more resistant to tear through Increased inferential friction Higher Failure Loads for Complex Suture Configurations

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SLIDE 11

Suture Tape Running Locked Configuration

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SLIDE 12

Basic Pearls

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SLIDE 13

Posterior Anterior - Superior Midglenoid Posterior – Inferior (7 O’clock)

Portal Placement

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SLIDE 14

7 O’clock Portal

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My Go-To

Short 2.9mm PushLock with LabralTape

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Inverted Mattress SLAP Repair

Labral Tape and PushLock

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SLIDE 17

270 Degree Knotless Repair

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SLIDE 18

2.4 mm PL Percutaneous

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SLIDE 19

 42 shoulders  Average fragment 24.8%  F/U = 34 months  39/42 Good/excellent (93%)  Minimal loss ER

JBJS 2005

Bony Bankart

Two 3.5 mm SL Medially/Three PL on Rim

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SLIDE 20

Results

Instability: Same as Suture Knots

Arthroscopy, 2006 Arthroscopy, 2014 Knee Sp Trauma, 2009

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SLIDE 21

New Alternatives

3 mm Knotless SutureTak

  • Drill and insert through guide
  • Pass core suture
  • Remplissage/PASTA Repair
  • Controlled Tensioning
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SLIDE 22

Why I use them…versatility, ease and speed

Posterior superior Anterior Superior Posterior Anterior Inferior

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SLIDE 23

www.BrianColeMD.com

THANK YOU

First Annual AANA/AOSSM/AAOS SKI COURSE January 31-February 3, 2018 Park City, Utah