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

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.

• Authors: S Braun, F Martetschläger, A B Imhoff
• Journal: Operative Orthopadie und Traumatologie (Oper Orthop Traumatol) Vol. 26 Issue 3 Pg. 228-36 (Jun 2014) ISSN: 1439-0981 [Electronic] Germany
• Vernacular Title: Arthroskopisch assistierte Stabilisierung bei akuter und chronischer Akromioklavikulargelenksprengung.
• PMID: 24924503 (Publication Type: Journal Article)

Topics

• Acromioclavicular Joint
• Arthroplasty (instrumentation, methods, rehabilitation)
• Humans
• Immobilization (methods)
• Joint Dislocations (complications, rehabilitation, surgery)
• Joint Instability (etiology, rehabilitation, surgery)
• Suture Techniques
• Treatment Outcome