Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the Tight Rope device: a technical note

Abstract

We present a new arthroscopic technique for chronic AC joint dislocations with coracoacromial ligament transposition and augmentation by the Tight Rope device (Arthrex, Naples, USA). First the glenohumeral joint is visualised to repair concomitant lesions, such as SLAP lesions, if needed. Once the rotator interval is opened and the coracoid is identified, the arthroscope is moved to an additional anterolateral portal. A 1.5 cm incision is made 2 cm medial to the AC joint. After drilling a 4 mm hole with a cannulated drill through the clavicle and coracoid a Tight Rope is inserted, the clavicule is reduced and stabilized with the implant. The arthroscope is moved to the subacromial space and a partial bursectomy is performed to visualise the CA ligament and lateral clavicle. The CA ligament is armed with a strong braided suture using a Lasso stitch and dissected from the undersurface of the acromion. It is then reattached to the distal part of the clavicle by transosseous suture fixation after abrasion of its undersurface. Although this combined arthroscopic procedure of AC joint augmentation with a Tight Rope combined with a ligament transposition is technically demanding, it is a safe method to reconstruct the coracoclavicular ligaments and achieve a sufficient reduction of the clavicle without the need of further implant removal or autologous tendon transplantation.

Complications After Arthroscopic Coracoclavicular Reconstruction Using a Single Adjustable–Loop-Length Suspensory Fixation Device in Acute Acromioclavicular Joint Dislocation

“…[18][19][20] Reconstruction using 2 adjustableeloop-length suspensory fixation devices showed greater vertical strength and horizontal strength compared with the native ligament in a cadaveric biomechanical study. Hosseini et al 21 suggested that simultaneous use of both the coracoacromial ligament transfer and the CC fixation technique using the single adjustableeloop-length suspensory fixation device can be effective for the treatment of AC joint dislocation.…”

Clinical and Radiological Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Hook Plate Fixation with Single Tight Rope Technique

“…33,34) However, the first generation of this device consisted of a smaller round proximal button that had the potential to erode the clavicle and led to loss of reduction. 35,36) Since a larger proximal button was developed, no erosion or failure has occurred using this surgery. The titanium buttons, which are positioned centrally on top of the clavicle and under the coracoid, are connected with a continuous loop of No.…”

Minimalinvasive Schultereckgelenkstabilisierung mit freiem Sehnentransplantat

“…Verschiedene weitere Techniken wurden beschrieben, zum einen, um die mechanischen Eigenschaften des CC-Bandes bei dessen Transfer zu verbessern, zum anderen, um nur einen Teil des Bandes zu transferieren [24,44]. So kombinierten Hosseini et al [19] den Transfer mit einem TightRope™, um eine bessere und sicherere Stabilisierung zu erhalten. Auch Lafosse et al [24] und Boileau et al [1] führen diese modifizierte Weaver-Dunn-Technik arthroskopisch durch und vermeiden damit Komplikationen der offenen Operationstechnik.…”