半月板缝合系统

Mitek 半月板修复系统 Anatomy Product overview Instructions for use Hands-on workshop Agenda Meniscal function Load transmission负荷转移 Joint stability 稳定关节 Shock absorption 振荡吸收 Joint lubrication 润滑关节 Joint nutrition 营养关节 Anatomy Crescent-shaped fibrocartilage 新月形纤维软骨组织 Collagen fibers arranged 胶原纤维分布 longitudinally and radially 纵形放射状分布 Triangular in cross section 横切面呈三角型 Meniscal Anatomy Lateral - circular shaped Medial - C-shaped Connected anteriorly by transverse meniscal ligament 在前部由半月板横韧带连接 Direct bony attachments at anterior and posterior horns 前后角骨性连接 Lateral and medial coronary ligaments 内外侧有冠状韧带 Lateral Medial Meniscal Anatomy Anatomy Three Zones Red-Red Zone Red-White Zone White-White Zone Meniscal Blood Supply Location in relationship to circumference Anterior 1/3 Middle 1/3 Posterior 1/3 Classification of Tears TRAUMATIC 创伤性 -Younger patients -Usually sports related -More peripheral thus repairable外围可以修补 -May be associated with ACL DEGENERATIVE 变性 性 -Older patients -Complex tears -Usually not repairable -Age group typically not suited for repair Meniscal Tears Treatment Partial Menisectomy Complex degenerative tears 复杂变性撕裂。 Central or radial tears放射状撕裂 Deformed or irreparable bucket-handle tears严重 桶状裂 Tears of the inner edge of meniscus半月板内缘撕 裂 Preserve stable meniscus to preserve joint function Treatment - Repair Factors to consider因素 Patient age年龄 Chronicity of injury是否慢性损伤 Type, location and length of tear类型、 位置、长度 Associated ligamentous injuries联合损 伤 Ideal candidate理想条件 Young person年轻 Acute longitudinal peripheral tear急性 纵相外周损伤 1-2cm in length1-2cm长 Types of Tears Bucket handle/ vertical longitudinal Flap, parrot beak/ oblique Radial/transverse Types of Tears Cleavage/horizontal Degenerative/complex What Is It? Rapidloc Meniscal Repair System Backstop (PLA) Tophat (PLA/PDS) Panacryl/ Ethibond Suture Rapidloc Implant RapidLoc PDS PDS Tophat -Maintains 80% strength at 6 weeks -10% at 12 weeks Rapidloc Meniscal Repair System 27 curved needle 228322 12 curved needle 228321 Straight needle 228320 Rapidloc Meniscal Repair System Arthroscopic Pusher Required - Other pushers do not work. New Pusher - Cutter Arthroscopic Pusher- Cutter for RapidLoc Works as a Knot-Pusher Cuts suture after tophat is compressed to tissue Rapidloc Meniscal Repair System Delivery System Existing Meniscal Applier Less Kickback Surgical Technique Rapidloc Surgical Technique Indicated for bucket-handle lesions in the Vascularized areas of the meniscus. 桶状裂 Preparation of the tear is critical Freshen the tear with a rasp or shaver. 修整创伤面 Rapidloc Surgical Technique Insert the applier through a standard portal 通过标准入路插入填充琦 Through portal alone Through a cannula With the aid of the malleable graft retractor Rapidloc Surgical Technique Use needle and silicone tubing to reduce the tear Rapidloc Surgical Technique Pass the needle through the Meniscal substance and into the Pericapsular tissue Posteriorly. 将针穿过半月板 穿到关节囊后 Rapidloc Surgical Technique Deploy the backstop 展开挡板 Maintain pressure on the gun to prevent kickback保 持压力 Remove needle and applier from joint 撤出针及枪 Rapidloc Surgical Technique Pull on the limb of suture to assure capture and fixation of the backstop推 线确保固定牢靠 Rapidloc Surgical Technique Using the Arthroscopic pusher slide the knot and Tophat down to the surface of the tissue 用推结器将结推到半月板 Use a pull/push action Pull on the suture with slightly more tension to avoid slack in the suture Rapidloc Surgical Technique Cut the limb of suture 剪线 Repeat with additional implants 相同方法植入 Probe to assure tear is stable探钩确 认固定牢靠 Rapidloc Why is it Better? Why Is It Better? Flexibility - More choices for the surgeon No measuring/no fixed length - One implant Dependable compression - Controlled by surg