Arthroscopy-Assisted All-Suture Coracoclavicular and Acromioclavicular Joint Stabilization in Acute Acromioclavicular Joint Injuries

Abstract

The existing literature agrees on surgical management for Rockwood grade IV and V injuries, but there is no consensus which type of surgery is the most appropriate one. More than 150 surgeries have been described for this condition in the literature. In an injury of less than 3 weeks, most surgeons prefer suture-button devices for coracoclavicular stabilization. Recent biomechanical studies have demonstrated that coracoclavicular stabilization provides good vertical stability but poor horizontal stability of acromioclavicular joint. Hence, they recommend acromioclavicular stabilization along with coracoclavicular stabilization. The use of a suture-button device for coracoclavicular stabilization requires special implants and instruments along with high surgical skills to drill precisely placed holes in the clavicle and the coracoid in order to avoid fractures from the drill hole. Due to relatively smaller clavicle and coracoid in Asian population, making holes in the clavicle and the coracoid has increased risk of fracture. We describe a technique in which no drill holes are made in the clavicle or the coracoid. In our technique, suture tape is used, which is looped around the coracoid and the clavicle, and the limbs are tied over the clavicle to maintain the coracoclavicular distance. The remaining limbs of suture tape is further looped through the tunnels made in acromion and tied over the acromion to augment the acromioclavicular ligament. The potential advantages of this technique are no costly implant and instruments are required, avoidance of complications associated with drill holes in coracoid and clavicle, both coracoclavicular and acromioclavicular joints are stabilized, direct repair of the acromioclavicular ligament can be performed, and no need of second surgery for implant removal.

Arthroscopically Assisted Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption

“…Numerous surgical techniques have been described for the treatment of acute AC joint dislocation. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 The goals of the new anatomic CC ligament reconstruction techniques are to achieve anatomic reduction of the ACJ and adequate fixation in order to allow and facilitate primary healing of AC and CC ligaments, and also to minimize the risk of associated complications.…”

“…These arthroscopic techniques have the advantage of a minimally invasive approach, facilitate management of associated intraarticular lesions, and offer adequate visualization of the coracoid. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 However, these new methods have resulted in some new complications such as tunnel widening, coracoid or clavicle fractures, and implant failure additionally to the already known complications of loss of reduction and redislocation. 2…”