Arthroscopic low-profile reconstruction for acute acromioclavicular joint instability
Arthroskopische Low-Profile-Rekonstruktion bei akuter Instabilität des Akromioklavikulargelenks
Set-up and arthroscopic portals
Subsequently, the superior part of the clavicle is unicortically overdrilled using a 5.1-mm drill bit (Fig. 3d, e). The K‑wire is then removed and a nitinol suture passing wire is inserted via the cannulated drill bit into the subcoracoid space and retrieved via the anteroinferior portal (Fig. 3f). The cannulated drill bit can then be removed.
Clavicular and acromial drilling
For horizontal stabilization, a percutaneous AC cerclage is used with a classic anterior cruciate ligament (ACL) drill guide. Therefore, the marking hook is placed via the superior incision behind the clavicle while the drill sleeve is introduced through the anteroinferior portal. The first drilling is performed in a transclavicular approach from anterior to posterior (Fig. 4a, b).
Reduction of the AC joint and coracoclavicular stabilization
The superior incision is closed in two layers including the repair of the deltotrapezial fascia over the sutures and the superior button. The arthroscopic portals are closed in a standard fashion.
For 6 weeks postoperatively, the shoulder is protected in a brace. During that time, the patient is only allowed to perform passive range-of-motion exercises up to a flexion and abduction of 45° in the first 3 weeks and up to 90° in the following 3 weeks. Free passive and early active range-of-motion exercises are allowed from week 7 on. Muscle strengthening exercises are delayed up to 10–12 weeks. The radiographs 3 months postoperatively show an anatomical reduction of the AC-joint (Fig. 8)
Compliance with ethical guidelines
Conflict of interest
P. Moroder and M. Scheibel are consultants for Arthrex. M. Minkus, N. Maziak declare that they have no competing interests.
This article does not contain any studies with human participants or animals performed by any of the authors.
Video: Arthroscopic low-profile reconstruction for acute acromioclavicular joint instability
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