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Trocar Site Closure Device: A Fast, Simple, and Safe Way to Pass Transosseous Sutures for Quadriceps Tendon Repair

Thavarajah, Dushan MBBS, MRCS; Middleton, Robert G. MBBS, FRCS (Orth)

Techniques in Orthopaedics: March 2014 - Volume 29 - Issue 1 - p 37
doi: 10.1097/BTO.0b013e318296aeb1
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We describe a simple method for passing the ethibond suture through the patella relatively, quickly, simply and safely using an Endo Close Auto Suture, which is a trocar site closure device commonly used in abdominal surgery.

Department of Trauma and Orthopaedics, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK

The authors declare that they have nothing to disclose.

Address correspondence and reprint requests to Dushan Thavarajah, MBBS, MRCS, Trauma and Orthopaedics, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset BH15 2JB, UK. E-mail: dushanthavarajah@yahoo.com.

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TIP

The Krackow stitch for quadriceps tendon rupture repair describes grasping either a tendon, a sheet of fascia, or other forms of soft tissue by parallel running locked sutures. The locking loops tighten and stabilize their grasp on the tissue as the strands of the suture are pulled to remove slack, and later as the repair or reconstruction is stressed. The strands are then passed through three 2-mm transosseous drill holes, which are tied off1 (Fig. 1).

FIGURE 1

FIGURE 1

We identified difficulty with passage of the flexible suture needle passed through the patella, because of its malleability it does not pass very easily through the transosseous tunnel (Fig. 2).

FIGURE 2

FIGURE 2

We describe a simple method for passing the ethibond (Ethicon, Somerville, NJ) suture through the patella relatively, quickly, simply, and safely using an Endo Close Auto Suture (Covidien, Mansfield, OH), which is a trocar site closure device commonly used in abdominal surgery (Fig. 3). The trocar is passed in a retrograde manner from distal to proximal through the patella drill hole. Compression of the central mechanism opens the Endo Close Auto Suture (Covidien, Mansfield, OH) for purchase of the suture. Release of the central mechanism purchases the suture and allows it to be passed through the predrilled tunnel.

FIGURE 3

FIGURE 3

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REFERENCE

1. Krackow KA, Thomas SC, Jones LC.A new stitch for ligament-tendon fixation. Brief note.J Bone Joint Surg Am.1986;68:764–766.
Keywords:

transosseous sutures; trocar; passage

© 2014 by Lippincott Williams & Wilkins