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Arthroscopically Assisted Acromioclavicular Joint Reconstruction Using the Infinity-Lock Button System With Allograft Augmentation.

ABSTRACT: Acromioclavicular (AC) joint injuries are extremely common in the athletic population. Although most low-grade injuries can be managed nonoperatively, high-grade injuries often require reconstruction of the AC joint. Various reconstructive options have been described with varying risks and benefits to each. Implant or graft failure with loss of reduction as well as clavicle and coracoid fracture are a few of the more common complications following AC joint reconstruction surgery. Currently, no gold standard exists. This technical paper describes an arthroscopically assisted AC joint reconstruction technique using the Infinity-Lock Button System with hamstring allograft augmentation. This technique provides an anatomic, minimally invasive, low-profile reconstruction that may minimize risk of clavicle and coracoid fracture. It also provides augmented stabilization across the AC joint, which may also help resist naturally occurring horizontal and rotational displacing forces.

SUBMITTER: MacLean IS

PROVIDER: S-EPMC7768236 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Arthroscopically Assisted Acute Acromioclavicular Joint Reconstruction Using the Infinity-Lock Button System.

Project description:Acromioclavicular (AC) joint injuries are the most common shoulder injuries in the athletic population. The literature is rife with various surgical techniques and implants as well as opinion on proper timing of surgical options. Patient outcomes are generally similar across fixation method. Complications are common following reconstruction, and the specific type of complication may depend on the technique used. Fracture and graft elongation are associated with use of allograft, whereas button cutout and skin irritation can occur with cortical suture-fixation methods. This technical paper describes an arthroscopically assisted acute AC joint reconstruction technique using the Infinity-Lock Button System. This technique provides a minimally invasive, low-profile reconstruction that may minimize risk of clavicle and coracoid fracture as well as overlying skin irritation. Acute reconstruction may permit healing of the native coracoclavicular and AC ligaments and mitigate risk of future AC joint arthritis.

| S-EPMC7768235 | biostudies-literature

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

Project description: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.

| S-EPMC5263099 | biostudies-literature

Arthroscopic-Assisted Acromioclavicular Joint Reconstruction Using the TightRope Device With Allograft Augmentation: Surgical Technique.

Project description:Surgical management of acromioclavicular (AC) joint separations remains challenging, especially in the revision setting. Most commonly, Rockwood type I and II injuries are managed nonoperatively whereas type IV, V, and VI injuries are managed with surgery. Type III separations are more controversial, with evidence supporting both nonoperative and operative treatment options. Multiple different arthroscopic techniques have been described; however, there is no current gold standard. AC joint reconstruction with the TightRope device (Arthrex, Naples, FL) with the patient in the lateral decubitus position is a method of restoring joint stability that allows for a minimally invasive, low-profile fixation construct using a single drill hole through the clavicle. Allograft augmentation of this fixation construct helps to eliminate the stress risers potentially created by this device while increasing overall repair construct stability. The purpose of this article is to describe the surgical technique for arthroscopic AC joint reconstruction using a TightRope device with allograft augmentation.

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Arthroscopically Assisted Treatment of Acute Dislocations of the Acromioclavicular Joint.

Project description: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.

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Arthroscopically Assisted Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption.

Project description:The surgical management of acute high-grade acromioclavicular (AC) joint (ACJ) injuries has evolved during the last decades. Numerous surgical techniques exist and recently arthroscopically assisted or all endoscopic techniques have gained popularity due to certain advantages. The goals of the new anatomic coracoclavicular ligament reconstruction techniques are to achieve anatomic reduction of the ACJ to allow and facilitate primary healing of AC and coracoclavicular (CC) ligaments, and also to minimize the risk of associated complications. We regularly use the open repair with double-loop sutures for the acute ACJ disruption, as described by Dimakopoulos et al. at 2006. In this surgical technique article, we present the arthroscopically assisted technique for the double-loop suture repair.

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Anatomic Acromioclavicular Joint Reconstruction With Semitendinosus Allograft: Surgical Technique.

Project description:Acromioclavicular joint separations are common shoulder injuries in the active patient population. Nonoperative management is recommended for Rockwood type I and II injuries, whereas surgical reconstruction is recommended for type IV and VI separations. The management for type III and V injuries is more controversial and is determined on a case-by-case basis. A multitude of surgical reconstruction techniques exist, and there is little evidence to support one technique over another. The anatomic technique aims at reconstructing the coracoclavicular ligaments and bringing the clavicle back into its anatomic position. When the anatomic technique is augmented with a graft, biomechanical studies have shown superior reconstruction strength and stability compared with standard nonanatomic techniques. Additionally, anatomic reconstruction allows for better cosmesis and functional outcome measures at midterm follow-up compared with nonanatomic techniques. In this Technical Note, we describe our preferred technique for anatomic repair of acromioclavicular joint separation using a semitendinosus allograft.

| S-EPMC5793897 | biostudies-literature

Arthroscopically Assisted Comprehensive Double Cerclage Suture Fixation Technique for Acute Acromioclavicular Joint Separation.

Project description:Acromioclavicular dislocations are some of the most frequently recorded and controversial injuries in the athletic population. These injuries have historically been a matter of disagreement between surgeons, particularly when it comes to the surgical technique used to treat them, its approach, or its timing. Consensus over the "gold standard" procedure to treat them is yet to be established. Even though numerous surgical techniques have already been described, the number of complications and loss of reduction remains a matter of concern for treating physicians. Here, we present an arthroscopically assisted coracoclavicular and horizontal acromioclavicular fixation technique in a modified figure-of-eight configuration using 2 strong FiberTape Cerclage sutures, with measurable tension, for the comprehensive treatment of acromioclavicular joint dislocations.

| S-EPMC7587229 | biostudies-literature

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

Project description: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 ("AC-Reco"). 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.

| S-EPMC4454896 | biostudies-other

Arthroscopically Assisted Tensionable Cerclage Reconstruction of an Acromioclavicular Separation With Combined Fixation of the Coracoclavicular and Acromioclavicular Ligaments

Project description:A variety of surgical techniques are currently available to manage high-grade acromioclavicular (AC) separations, including hook plates/wires, nonanatomic ligament reconstruction, and anatomic cerclage with or without biological augmentation. Traditional reconstructions focused on the coracoclavicular ligaments alone and often were associated with high rates of recurrent deformity. Biomechanical and clinical data have suggested that additional fixation of the AC ligaments is beneficial. This Technical Note describes an arthroscopically assisted approach for combined reconstruction of the coracoclavicular and AC ligaments with a tensionable cerclage. Technique Video Video 1 The video for an arthroscopically assisted cerclage fixation and biologic reconstruction of the coracoclavicular and acromioclavicular ligaments for acromioclavicular joint separation on a right shoulder in a patient in lateral decubitus position.

| S-EPMC10066044 | biostudies-literature

Open Acromioclavicular Joint Reconstruction With Semitendinosus Allograft Utilizing the Cerclage Technique.

Project description:Acromioclavicular (AC) joint injuries most commonly occur in young males after a direct injury at the acromion. General consensus stresses nonoperative treatment for type I and II injuries and surgical treatment for types IV through VI, whereas management of type III injuries is more controversial. If surgery is indicated, there are multiple techniques including hook plate, screw fixation, coracoclavicular fixation, and anatomic and nonanatomic reconstruction. The overall complication rate is high (14%), regardless of technique. In this Technical Note, we outline a technique for open repair of a chronic AC joint separation using a semitendinosus allograft using the cerclage for enhanced fixation.

| S-EPMC7189343 | biostudies-literature

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