Arthroscopic-Assisted Acromioclavicular Joint Reconstruction Using the TightRope Device With Allograft Augmentation: Surgical Technique

Abstract

Surgical management of acromioclavicular (AC) joint separations remains challenging, especially in the revision setting. Most commonly, Rockwood type I and II injuries are managed nonoperatively whereas type IV, V, and VI injuries are managed with surgery. Type III separations are more controversial, with evidence supporting both nonoperative and operative treatment options. Multiple different arthroscopic techniques have been described; however, there is no current gold standard. AC joint reconstruction with the TightRope device (Arthrex, Naples, FL) with the patient in the lateral decubitus position is a method of restoring joint stability that allows for a minimally invasive, low-profile fixation construct using a single drill hole through the clavicle. Allograft augmentation of this fixation construct helps to eliminate the stress risers potentially created by this device while increasing overall repair construct stability. The purpose of this article is to describe the surgical technique for arthroscopic AC joint reconstruction using a TightRope device with allograft augmentation.

Acromioclavicular joint injuries: diagnosis, classification and ligamentoplasty procedures

“… 42 On the other hand, the requirement of multiple drill holes in the clavicle can also create stress risers on bone that might result in implant cut-out. 43 Other complications are acromial osteolysis and fracture, AC joint osteoarthritis, subacromial impingement and rotator cuff tears. The need for a second surgery for implant removal is another disadvantage that might lead to late fracture of the distal clavicle after a low-energy trauma.…”

Arthroscopic Acromioclavicular Joint Treatment With Coracoclavicular Fixation and Allograft Coracoclavicular Ligament Reconstruction for Acute Acromioclavicular Dislocations

“…7 Our technique uses a tensioning device to reduce, in a controlled fashion, the superiorly migrated clavicle to the acromion. Prior techniques of manually forcing the clavicle inferiorly with an instrument while axially loading the arm superiorly to elevate the acromion 8 are imprecise and potentially dangerous because the instrument on the superior clavicle can easily slip and injure the neurovascular structures just underneath the clavicle.…”

Novel Double Endobutton Technique Combined with Three‐Dimensional Printing: A Biomechanical Study of Reconstruction in Acromioclavicular Joint Dislocation

“…In this study, with the stress displacement gradually increased, the CC ligaments of the normal group first showed a fibrous tear and, finally, ruptured, while both of the techniques failed mainly because of tunnel fractures. Numerous studies have demonstrated that the strength of the suture button construct is better than that of the natural ligaments 13 . Chernchujit et al 27 reported the ultimate tensile strength of a two-anchor system with FiberWire No.…”

“…On the basis of the Weaver–Dunn procedure, which uses the native AC ligament in AC joint reconstruction, there are many surgeries that can be performed to reconstruct the coracoclavicular (CC) ligament through tendon grafts or plate fixation 10,11 . The TightRope (TR) technique, involving two connected buttons and FiberWire sutures, is a common fixation surgery 12,13 . This technique prevents the CC ligament from separating and maintains the stability of the AC joint.…”