Abstract
Objective. The 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. Indications. Acute und chronic acromioclavicular joint separations type Rockwood III-VI. Recurrent AC-joint instability with intact coracoid process (with tendon graft). Contraindications. Acromioclavicular 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 technique. Vertical 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 management. Postoperatively 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. Results. The 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.
| Translated title of the contribution | Arthroscopically assisted reconstruction of acute and chronic AC joint separations |
|---|---|
| Original language | German |
| Pages (from-to) | 228-236 |
| Number of pages | 9 |
| Journal | Operative Orthopadie und Traumatologie |
| Volume | 26 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jun 2014 |