• Oper Orthop Traumatol · Jun 2014

    [Arthroscopically assisted reconstruction of acute and chronic AC joint separations].

    • S Braun, F Martetschläger, and A B Imhoff.
    • Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland, sebra16@mac.com.
    • Oper Orthop Traumatol. 2014 Jun 1;26(3):228-36.

    ObjectiveThe surgical procedure aims at anatomic reduction and stabilization of the acromioclavicular joint in vertical and horizontal planes for acute separations using a trans-clavicular and trans-coracoidal suture tape fixation with additional acromioclavicular joint augmentation with a PDS cord cerclage. For chronic instability adding a tendon graft is essential for sustainable stability.IndicationsAcute und chronic acromioclavicular joint separations type Rockwood III-VI. Recurrent AC-joint instability with intact coracoid process (with tendon graft).ContraindicationsAcromioclavicular joint separations type Rockwood I-II. Asymptomatic chronic AC-separations type Rockwood III-IV. Fracture close to base of coracoid process General contraindications for (elective) surgery.Surgical TechniqueVertical reconstruction of the coraco-clavicular ligaments using a drill-guide for trans-clavicular and trans-coracoidal tunnel placement for high-strength suture tapes over titanium buttons. Additional stabilization of the AC-joint with a transosseus figure of 8 PDS suture cord cerclage.Postoperative ManagementPostoperatively the arm is put in a regular sling for 6 weeks. Free active range of motion of wrist and elbow. Shoulder range of motion is limited to 30° of flexion and abduction and 80° internal and 0° external rotation for 2 weeks. Extended to active-assisted 45° flexion and abduction in weeks 3 and 4 and advanced to 60° flexion/abduction and free internal/external rotation in weeks 5 and 6. Range of motion is unlimited from week 7. Full daily life activities after 3 months, high-impact sports after 5-6 months postoperatively.ResultsThe presented surgical technique reliably stabilizes the acromioclavicular joint. It's biomechanical properties with only the single-tunnel coracoclavicular suture tapes is on the level of the native vertical stability, which can be additionally improved for better horizontal stability with the cerclage over the AC-joint.

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