Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study

An arthroscopically assisted technique for the treatment of acute acromioclavicular joint dislocations is presented. This pathology-based procedure aims to achieve anatomic healing of both the acromioclavicular ligament complex (ACLC) and the coracoclavicular ligaments. First, the acromioclavicular joint is reduced anatomically under macroscopic and radiologic control and temporarily transfixed with a K-wire. A single-channel technique using 2 suture tapes provides secure coracoclavicular stabilization. The key step of the procedure consists of the anatomic repair of the ACLC ("ACReco"). Basically, we have observed 4 patterns of injury: clavicular-sided, acromial-sided, oblique, and midportion tears. Direct and/or transosseous ACLC repair is performed accordingly. Then, an X-configured acromioclavicular suture tape cerclage ("AC-Bridge") is applied under arthroscopic assistance to limit horizontal clavicular translation to a physiological extent. The AC-Bridge follows the principle of internal bracing and protects healing of the ACLC repair. The AC-Bridge is tightened on top of the repair, creating an additional suture-bridge effect and promoting anatomic ACLC healing. We refer to this combined technique of anatomic ACLC repair and protective internal bracing as the "AC-RecoBridge." A detailed stepwise description of the surgical technique, including indications, technical pearls and pitfalls, and potential complications, is given.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The “AC-RecoBridge” Technique

Izadpanah¹,

Jaeger²,

Ogon³

et al. 2015

“…The surgical technique presented in this article and in Video 1 combines the advantages of arthroscopically positioned CC stabilization with an additional suture cord cerclage of the AC joint capsule for improved horizontal stability (Table 1). 5,6 Perform glenohumeral arthroscopy to evaluate for possible associated glenohumeral lesions. Drill the horizontal tunnel for AC cerclage before the AC joint is reduced to allow better manipulation of the distal clavicle.…”

mentioning

confidence: 99%

Arthroscopically Assisted Treatment of Acute Dislocations of the Acromioclavicular Joint

Braun

Beitzel

Buchmann

2015

Self Cite

Arthroscopically assisted treatments for dislocations of the acromioclavicular joint combine the advantages of exact and visually controlled coracoid tunnel placement with the possibility of simultaneous treatment of concomitant injuries. The clinical results of previous arthroscopically assisted techniques have been favorable at midterm and long-term follow-up. The presented surgical technique combines the advantages of arthroscopically positioned coracoclavicular stabilization with an additional suture cord cerclage of the acromioclavicular joint capsule for improved horizontal stability.

“…10,14,20 In a recent study, Scheibel et al 21 described persistent horizontal instability in 41% cases after isolated CC double ligament stabilization. Saier et al 22 could show biomechanically that only combined AC and CC reconstruction can adequately restore physiological horizontal AC joint stability. In addition, a recently published study showed that triple-bundle reconstruction including AC graft augmentation yielded superior clinical and radiological outcome than single-bundle CC reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability

Martetschläger

Tauber

Habermeyer³

et al. 2016

Acromioclavicular (AC) joint injuries are common injuries, especially in the young and active, male population. AC joint injuries account for 12% of all injuries of the shoulder girdle in the overall population. Although conservative treatment is recommended for Rockwood type I and type II injuries, there is controversial debate about optimal treatment for type III injuries. High-grade injuries are typically treated operatively to avoid painful sequelae. A vast number of different surgical methods have been described over the past few decades. Recent advances in arthroscopic surgery have enabled the shoulder surgeon to treat acute and chronic AC lesions arthroscopically assisted. Clinical studies have already shown good and reliable results. Although surgeons agree that a biological augmentation is required to minimize the risk of recurrent instability in chronic cases, a gold standard still needs to be defined. We present an arthroscopically assisted biological augmentation technique to reconstruct the AC and coracoclavicular ligaments, protected by a button-suture tape construct for chronic AC joint instability. The presented arthroscopic biological augmentation technique uses less and/or smaller drill holes in the clavicle and coracoid than previously described, thus reducing weakening of the bony structures. At the same time it enhances both horizontal and vertical stability.