This video demonstrates a secure double row fixation technique for properly selected tears of the gluteus medius. In this case, a 64 year-old female is being treated for a persistently symptomatic tear of the left gluteus medius. A substantial full thickness sleeve avulsion type tear of the gluteus medius is identified, which is well suited for the necessities of a double row fixation method. The bony footprint is lightly removed, freshening it for the repair site. The Smith & Nephew Double Loaded Healicoil Anchor System selected for this case does not rely on cortical fixation. Two transfers double loaded anchor systems will be used for proximal fixation. The anterior side is tapped and the hollow cord Healicoil Anchor is seeded. In certain cases the open centers seem to provide a direct conduit to the underlying merial products. With the Healicoil Anchor seeded, all four suture limbs will be passed proximally through the tendon in a mattress fashion, to optimize the first row of fixation. Soft tissue preparation exposing the tendon is important in order to accomplish this in a simple fashion using a tendon penetrating device. After completing placement of the anterior sutures a probe exposes the site for the posterior anchor. Logically, the conduit created by the open center of the Healicoil Anchor seems to provide a more biological healing environment for the tendon repair. Like the anterior anchor, all four suture limbs are placed proximally through the tendon. It is especially important that the superficial surface of the tendon is cleared of all debris in order to have a clean repair site. Once all sutures have been passed they are sequentially tied beginning from posterior to anterior. With each knot, one limb of the suture is left in place that will be incorporated into the distal fixation. The proximal fixation is inspected prior to beginning the distal fixation process. For the next row, the Smith & Nephew Footprint Anchor which is specifically designed for distal fixation will be employed. First, the more anterior bony site is prepared with ALL. This is removed and then the most anterior two sutures are retrieved in the cannula through which the distal footprint anchor will be placed. The two sutures are brought into the Knotless Footprint System. Slight tension is held while the Anchor is delivered through the cannula to the repair site. The Footprint is aligned and driven into place. At this point, the sutures still pass freely and can be individually tensioned to provide optimal approximation of the tendon without strangulation. As the tension is titrated the sutures are cleated into the inserter handle. Once the desired tension has been achieved, the sutures are locked by tightening the knob on the inserter. The sutures are released from the cleats, the inserter removed and the limbs are cut flush from the bone. The second, more posterior Footprint Anchor is then seeded in an identical fashion. The sutures are again individually tensioned to provide optimal approximation of the tendon at the repair site. The limbs are cut and the final repair is inspected. Some disrupted fibers of the origin of the vastus lateralis are identified and these are approximated with a pair of interrupted number two absorbable sutures. Lastly, the integrity of the entire repair construct is carefully inspected. Secure fixation is essential to the rehab strategy that will ensure an optimal outcome.

• published: 23 Oct 2015
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