Arthroscopic epenocT Bs i s dei s - Zimmer Biomet · Tenotomy and Debridement of Residual Superior...

Arthroscopic Biceps TenodesisUsing the SnapShot™ Fixation System

Surgical Technique

Design Concept ........................................................................................................ 2

Patient Positioning and Glenohumeral Arthroscopy ............................................... 2

Step One: Arthroscopic Biceps Tenotomy and Debridement of Residual Superior Labrum ............................................................. 3

Step Two: Accessory Portal Placement with Subacromial Bicipital Groove Identification and Preparation ......................... 3

Step Three: Implant Insertion ................................................................................... 5

Post-operative Care & Rehabilitation ....................................................................... 8

Ordering Information ............................................................................................... 9

Indications For Use ................................................................................................... 9

Contraindications ..................................................................................................... 9

Table of Contents

2 | Arthroscopic Biceps Tenodesis Using the SnapShot Fixation System Surgical Technique

Design ConceptThe SnapShot Fixation System is designed to facilitate a simple arthroscopic technique to achieve a reliable and secure biceps tenodesis in the suprapectoral location. It accomplishes an onlay biceps tenodesis by using low profile spiked rivets to achieve tendon-to-bone contact for healing along the prepared bicipital groove. This technique does not require tendon preparation, suture passing or tying.

Patient Positioning and Glenohumeral ArthroscopyPosition the patient in either a beach chair or lateral decubitus position. Enter the glenohumeral joint using standard arthroscopic portals. Use the SnapShot Fixation System to complete the arthroscopic biceps tenodesis in the three step described on the following pages.

Surgical Technique


Step Two: Accessory Portal Placement with Subacromial Bicipital Groove Identification and PreparationEnter the subacromial space using the standard posterolateral viewing portal and create the straight lateral portal, typically used for arthroscopic acromioplasty. The lower portion of the transverse ligament and tenosynovium over the biceps may be removed with a combination of electrocautery and a shaver.

Note: The ascending branch of the anterior humeral circumflex artery runs along the lateral edge of the bicipital groove. The biceps tendon lies just medial to this vessel and is best controlled preemptively with electrocautery.

Step One: Arthroscopic Biceps Tenotomy and Debridement of Residual Superior LabrumWhile viewing intra-articularly from a posterior portal, utilize arthroscopic scissors via the anterior portal to accomplish the biceps tenotomy (Figure 1). Debride any remaining biceps stump and leave the superior labrum intact if it is stable. If the tenodesis is being done for a SLAP lesion, the superior labrum may be debrided as well.

Note: A surgeon may consider leaving the biceps tendon attached while performing the tenodesis. However, this approach puts the biceps tendon at risk during the bicipital groove preparation and may lead to a slight popeye deformity due to undertensioning of the tendon.

Figure 1


Step Two: Accessory Portal Placement with Subacromial Bicipital Groove Identification and Preparation (cont.)Move the arthroscope to the lateral portal for a more direct view of the biceps and the bicipital groove. Create an accessory anterior portal directly over the bicipital groove. This will be the working portal for the preparation of the bicipital groove and for the insertion of the SnapShot implant. Localize this portal by using a spinal needle and place approximately 3-4 cm inferior to the anterior margin of the acromion. Insert the cannula, which is included in the packaging, into this same location (Figure 2).

Using a locking grasper through the posterolateral portal, pull the biceps aside to expose the groove. Utilize a standard acromioplasty burr to lightly roughen approximately 2 cm of the surface of the groove in the flat suprapectoral position (Figure 3).

Figure 3Figure 2


Figure 4 Figure 5

Step Three: Implant InsertionOnce the groove is prepared, use a locking grasper to pull the tendon superiorly until appropriate tension is achieved. Center the tendon in the groove and advance the drill down the cannula, piercing the center of the tendon in the inferior portion of the prepared surface (Figure 4). Press the teeth of the cannula against the tendon to pin the tendon securely to the bone.

Drill through the tendon and bone until the stop bottoms out on top of the tendon (Figure 5). Remove the drill, taking care to maintain the position of the cannula, which is holding the tendon in place over the hole.


Figure 6a

Figure 6

Step Three: Implant Insertion (cont.)Insert the implant through the cannula, through the tendon and into the bone until the head of the implant bottoms out on the tendon (Figures 6 and 6a).

Keep pressure on the tendon while squeezing the trigger of the gun until it clicks (Figure 7).

The anchor is now deployed and the tendon should be secure. A second SnapShot implant is inserted superior to the initial implant by repeating this sequence (Figure 8). Once tenodesis has been completed, use arthroscopic scissors to cut the excess proximal tendon and remove it through the cannula.

Figure 8

Figure 7


Reload InstructionsThe Deployment Gun in the Mini Open or Arthroscopic kits may be reloaded during the procedure so that a second implant can be used.

Note: The Deployment Gun is Single-Patient use and is not intended to be sterilized after the initial use.

First, remove the spent implant and interface rod by pushing the button at the rear end of the Deployment Gun and tipping the gun forward. The interface rod should slide out and can be discarded (Figure 9).

Take the Implant Reload and slide the end of the interface rod that is furthest from the implant into the tube of the gun. The implant will not be fully seated until the button is pressed (Figure 10 shows the loaded implant assembly prior to being fully seated).

Figure 10Figure 9


Postoperative Care and RehabilitationCarry out postoperative regimen, per surgeon preference, similar to the following: On postoperative day number one, allow the patient out of the sling for gentle activities of daily living (key boarding, eating, etc.) and avoid resisted biceps flexion. Encourage gentle shoulder ROM exercises, especially external rotation. At six weeks the patient may resume active biceps flexion with no lifting in excess of 10 pounds. At three months postoperative, patient may return to essentially full, unrestricted activities and athletics; however, reserve isolated biceps curls and pull-ups until four months postoperative.

Reload Instructions (cont.)When the button is held down, the implant assembly can be fully slid into the gun (Figure 11). When the button is released, it will lock the implant assembly in place (Figure 12). Ensure the implant assembly is locked into place by tugging gently on the middle of the implant. Do not place sideways pressure on the implant.

Figure 11 Figure 12


Instrumentation

Part Number Description

110018165 SnapShot Full Kit

110019010 SnapShot Mini Open Kit

110018166 SnapShot Implant Reload

110024938 SnapShot Drill

Ordering Information

INDICATIONS FOR USEThe SnapShot Fixation System is indicated for use in soft tissue reattachment procedures in the following shoulder procedures: biceps tenodesis.

The SnapShot Fixation System is also indicated for supplementary fixation when used in conjunction with a primary fixation device in surgical procedures requiring graft fixation.

CONTRAINDICATIONS1. Infection.

2. Patient conditions including blood supply limitations, obesity, insufficient quantity or quality of bone stock or latent infection.

3. Patients with mental or neurologic conditions who are unwilling or incapable of following postoperative care instructions.

4. Foreign body sensitivity. Where material sensitivity is suspected, testing is to be completed prior to implantation of device.

All content herein is protected by copyright, trademarks and other intellectual property rights, as applicable, owned by or licensed to Zimmer Biomet or its affiliates unless otherwise indicated, and must not be redistributed, duplicated or disclosed, in whole or in part, without the express written consent of Zimmer Biomet.

This material is intended for health care professionals. Distribution to any other recipient is prohibited.

Check for country product clearances and reference product specific instructions for use.

For product information, including indications, contraindications, warnings, precautions, potential adverse effects and patient counselling information, see the package insert and www.zimmerbiomet.com.

Zimmer Biomet does not practice medicine. This technique was developed in conjunction with a health care professional. This document is intended for surgeons and is not intended for laypersons. Each surgeon should exercise his or her own independent judgment in the diagnosis and treatment of an individual patient, and this information does not purport to replace the comprehensive training surgeons have received. As with all surgical procedures, the technique used in each case will depend on the surgeon’s medical judgment as the best treatment for each patient. Results will vary based on health, weight, activity and other variables. Not all patients are candidates for this product and/or procedure. Caution: Federal (USA) law restricts this device to sale by or on the order of a surgeon. Rx only.

©2018 Zimmer Biomet

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Legal ManufacturerBiomet Sports Medicine P.O. Box 58756 E. Bell DriveWarsaw, Indiana 46581-0587 USA

www.zimmerbiomet.com

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