Arthroscopic Shoulder Repair Using the Smith & Nephew KINSA ...

14.Release the ULTRABRAID Suture by first pullingthe suture clockwise. This will “walk” thesuture around the knob, following the arrow(Figure 16a), until it slips out of the straight slot(Figure 16b). With the suture clear of the straightslot, reverse direction (Figure 16c), turningcounterclockwise, until the suture slips out of the“L”-shaped slot (Figure 16d). Remove and discardthe knob and inserter.15.Remove and discard the colored suture leader.Cut the ULTRABRAID Suture with theSmith & Nephew ELITE Sliding Suture Cutter.Probe the repair to check the quality of thefixation (Figure 17).acbdTechnical Tips and Pearls• To aid in verifying the alignment of the drilledhole, after removal of the drill guide and bit, aguide wire can be inserted to relocate the holeand check alignment. Remove the guide wirewhen verified.• Do not use excess force when advancing theKINSA Inserter down the cannula. Gently pullon the colored suture leader only enough tokeep tension on the suture and to avoid suturetangling.• During loop reduction, if one leg of suturetightens faster than the other it is best to stoppulling on the suture. Use a probe or hook toloosen the tight suture leg until its tension isequal to the loose suture leg. Continue with thereduction, repeating the loosening technique asnecessary. Uneven loop reduction is sometimesseen when a twist occurs in the suture, makingloop reduction difficult.• The fixation tension can be adjusted by pullingon the ULTRABRAID Suture anytime prior tocutting the suture. A probe can be used to verifythe fixation before or after the impaction knoband inserter are removed.• If bone quality is of concern, remove theimpaction knob and inserter early – during thetissue reduction step. Introduce and hold a knotpusher against the fixation site to support theanchor during suture loop reduction.• Do not remove the inserter prematurely, as itaids in suture sliding. Once disengaged, do notuse the inserter as a knot pusher.Figure 16Figure 179