The combined arthroscopically assisted and image intensifier--controlled double TightRope technique using implants of the first-generation represents a safe technique and yields good to excellent early clinical results despite the presence of partial recurrent vertical and horizontal AC joint instability.

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Only a few reports exist on the management of severe anteroinferior glenoid defects in case of recurrent shoulder instability most of them including open approaches. We describe an all-arthroscopic reconstruction technique of the anteroinferior glenoid that includes an autologous iliac crest bone grafting using bio-compression screws and a capsulolabral repair using suture anchors. This technique recreates the bony and soft-tissue anatomy of the anteroinferior glenoid while preserving the integrity of insertion of the subscapularis (SSC) tendon.

The Double-TightRope technique yields good to excellent clinical results in both V-shaped and parallel drill hole placement. Partial recurrent vertical and horizontal instability represents a problem in both techniques. So far, no significant differences regarding clinical or radiologic results have been found. Long-term results are needed to reveal possible advantages in terms of clinical and radiologic acromioclavicular stability.

echanical trauma of the acromioclavicular (AC) joint can result in the rupture of the ligament complex extending between the acromion, the clavicle and the coracoid process. Corresponding to the magnitude of the force to the shoulder, the severity of the injury is classified into various grades. Higher-grade injuries with complete rupture of the coracoclavicular ligaments may result in permanent impairment of shoulder function. In addition, the marked bulging of the lateral clavicle compared to the unaffected side occasionally gives rise to esthetic concerns.For decades, the correct diagnosis and management of acute injuries to the AC joint have remained the subject of controversy among orthopedic surgeons and trauma surgeons. Using arthroscopically assisted surgical techniques, today the injury can be treated less invasively.This article presents the current aspects of the diagnosis and treatment of acute instability of the AC joint based on a selective search of the literature. Particular attention was given to high level of evidence studies, to the extent these were available. EpidemiologyAcute dislocation of the AC joint typically occurs in young, athletic adults and is one of the most common injuries of the shoulder girdle (4-12%) (1). Its absolute incidence is approximately 3-4/100 000 population (2). The native stabilizers of the AC joint are frequently damaged during high-risk/high-energy contact sports, such as ice hockey, rugby or handball (3). In alpine skiing, approximately 20% (77/393) of all injuries to the shoulder girdle affect the AC joint (4). Mechanism of injuryIn case of a direct blow to the shoulder girdle, the forces act directly on the AC joint and the acromioclavicular and coracoclavicular (CC) ligaments. By contrast, in case of a fall on an extended arm, the force acts indirectly on the AC joint. Here, the humeral head presses against the acromion; thus, the mechanism is an axial compression. Clinical diagnosis and physical examinationDuring the clinical examination for acute AC joint injury, patients typically present holding their arm adducted to relieve the pain. In addition, there is painful limitation of mobility of the affected shoulder SummaryBackground: The acromioclavicular joint (ACJ) is one of the more common sites of shoulder girdle injury, accounting for 4-12% of all such injuries, with an incidence of 3-4 cases per 100 000 persons per year in the general population. Current topics of debate include the proper standard diagnostic evaluation, the indications for surgery, and the best operative method.Methods: This review is based on publications retrieved by a selective literature search.Results: Mechanical trauma of the ACG can tear the ligamentous apparatus that holds the acromion, clavicle, and coracoid process together. Different interventions are indicated depending on the nature of the injury. In recent years, the horizontal component of the instability has received more attention, in addition to its vertical component. Persistent instability can lead to chronic, painful...

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Measuring the OL is a convenient way for quantifying DPT in modified Alexander views. It showed significant correlation with clinical scores, indicating the relevance of DPT in patients with AC-joint injury.