A new method of arthroscopic reconstruction of the dislocated acromio-clavicular joint

Abstract

Background: Symptomatic total acromio-clavicular joint dislocation (Rockwood et al. types III-VI) may be treated by surgical reconstruction. Aim: To describe an arthroscopically assisted technique to reconstruct anatomically the coracoclavicular ligaments in acute or chronic (> 6 weeks) acromio-clavicular joint dislocation. Methods: This new technique involves arthroscopic exposure of the coracoid process. Prior to introducing this technique, cadaveric studies were undertaken.Results: Five patients underwent this procedure. All engaged in regular sports or manual-type work. All patients were discharged the same day with the shoulder immobilised for 4 weeks, with no heavy lifting for 3 months. All patients were pain-free at 6 weeks with full function and maximum Constant scores at 3 months. There have been no complications. Conclusions: A new, safe technique is described which provides a cosmetically acceptable, anatomically solid reconstruction of the coraco-clavicular ligaments.

Postoperative coracoid fracture after transcoracoid acromioclavicular joint reconstruction

“…Similar fixation devices have been used arthroscopically with good results. 3,14 Another option for AC reconstruction involves an anatomic reconstruction using tendon grafts, which has been shown in biomechanical studies to have good stability. 11,13 The two predominant ways to accomplish anatomic reconstruction of the coracoclavicular ligaments are by looping the tendon graft around the coracoid and anchoring it to the clavicle or by passing the graft through a coracoid bone tunnel and anchoring it to, or passing it around, the clavicle.…”

A Modified Technique of Arthroscopically Assisted AC Joint Reconstruction and Preliminary Results

“…Various arthroscopic AC joint and coracoclavicular ligament reconstruction techniques have been described in the literature. Some of these techniques involve releasing the middle and superior glenohumeral ligaments or the rotator interval through an intraarticular approach to visualize the coracoid [14,18]. Others describe an arthroscopic approach to assist with insertion of screws or plates to reduce the AC joint [4,13].…”

Arthroscopic Acromioclavicular Joint Repair

“…A vast number of arthroscopic or arthroscopicassisted techniques have been described in the literature with several so fardemonstrating similarly good results to open fixation techniques. [8][9][10][11][12][13]27,28 Clavicle fracture after AC joint repair is relatively uncommon. However, several reports in the literature have documented clavicle or coracoid fracture due to drill holes after AC joint repair or reconstruction.…”

“…This has led to the development of various arthroscopic or arthroscopic-assisted techniques that allow for improved visualization, less extensive soft tissue dissection, and smaller incision. [8][9][10][11][12][13] Often these reconstruction techniques rely on drilling substantial tunnels through the clavicle and/or coracoid for suture passage. The creation of multiple tunnels in the clavicle and/or coracoid raises concern for potential fracture, 12,13 and this concern has been in fact realized with several reports in the literature.…”

“…[8][9][10][11][12][13] Often these reconstruction techniques rely on drilling substantial tunnels through the clavicle and/or coracoid for suture passage. The creation of multiple tunnels in the clavicle and/or coracoid raises concern for potential fracture, 12,13 and this concern has been in fact realized with several reports in the literature. [14][15][16][17] In this article, we present a novel arthroscopic technique for surgical treatment of acute AC joint disruption using a hybrid fixation device consisting of FiberTape (Arthrex, Naples, FL) secured with Endobuttons (Smith&Nephew, London, UK).…”