Dataset Information

Free Hand Drilling Technique to Enhance Central Position of Tunnels in Arthroscopic Acromioclavicular Joint Fixation Using TightRope System.

ABSTRACT: Acromioclavicular joint (ACJ) dislocations represent one of the most common lesions in the shoulder. Arthroscopic reduction and ACJ fixation with the button system is one of the most used techniques for displaced and unstable dislocations. Difficulties with placing the tunnels in the central and correct position of the clavicular and coracoid can occur with the use of a guide, which can result in fractures, eccentric tunnel position, cortical rupture, prolongation of surgical times with its complications as bleeding, tissue infiltration, difficult visualization, and increased risk of infection. Prior free hand central tunnel placement in the clavicle with a 3.2 mm drill helps to keep in place the pin guide over the superior cortical of coracoid with reduction of guide movement to enhance the correct position of tunnel in the coracoid process avoiding bone complications.

SUBMITTER: Olivos-Meza A

PROVIDER: S-EPMC8322672 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Free Hand Drilling Technique to Enhance Central Position of Tunnels in Arthroscopic Acromioclavicular Joint Fixation Using TightRope System.

Olivos-Meza Anell A Rodríguez-Argueta Miguel Estuardo ME Suarez-Ahedo Carlos C Jiménez-Aroche César Alejandro CA Pérez-Jiménez Francisco Javier FJ Rodríguez-Santamaria Irene I

Arthroscopy techniques 20210722 7

Acromioclavicular joint (ACJ) dislocations represent one of the most common lesions in the shoulder. Arthroscopic reduction and ACJ fixation with the button system is one of the most used techniques for displaced and unstable dislocations. Difficulties with placing the tunnels in the central and correct position of the clavicular and coracoid can occur with the use of a guide, which can result in fractures, eccentric tunnel position, cortical rupture, prolongation of surgical times with its comp ...[more]

PMID: 34336582

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Project description:PurposeTo determine the location of coracoid inferior tunnel exit with superior-based tunnel drilling and coracoid superior tunnel exit with inferior-based tunnel drilling.MethodsFifty-two cadaveric embalmed shoulders (mean age 79 years, range 58-96 years) were used. A transcoracoid tunnel was drilled at the center of the base. Twenty-six shoulders were used for the superior-to-inferior tunnel drilling approach and 26 shoulders for the inferior-to-superior tunnel drilling approach. The distances to the margins of the coracoid process, from both the entry and exit points of the tunnel, were measured. Paired Student t-tests were used to compare the distance from the center of the tunnel and the medial and lateral coracoid border and the apex.ResultsThe mean difference for the distances between superior entry and inferior exit from the apex was 3.65 ± 3.51 mm (P = .002); 1.57 ± 2.27 mm for the lateral border (P = .40) and 5.53 ± 3.45 mm for the medial border (P = .001). The mean difference for the distances between inferior entry and superior exit from the apex was 16.95 ± 3.11 mm (P = .0001); 6.51 ± 3.2 mm for the lateral border (P = .40) and 1.03 ± 2.32 mm for the medial border (P = .045). Inferior-to-superior drilling resulted in 4 (15%) cortical breaks.ConclusionsBoth superior-to-inferior and inferior-to-superior tunnel drilling directed the tunnel from a more anterior and medial entry to a posterior-lateral exit. Superior-to-inferior drilling resulted in a more posteriorly angled tunnel. When using a 5-mm reamer and inferior-to-superior tunnel drilling, cortical breaks were observed at the inferior and medial margin of the tunnel exit.Clinical relevanceArthroscopic-assisted acromioclavicular joint reconstruction using conventional jigs may result in an eccentric coracoid tunnel, possibly introducing stress risers and fractures. To avoid cortical breaks and eccentric tunnel placement, open drilling from superior-to-inferior with a superiorly centered guide pin and arthroscopic visualization of a centered inferior exit should be considered.

Dataset Information

Free Hand Drilling Technique to Enhance Central Position of Tunnels in Arthroscopic Acromioclavicular Joint Fixation Using TightRope System.

Publications

Free Hand Drilling Technique to Enhance Central Position of Tunnels in Arthroscopic Acromioclavicular Joint Fixation Using TightRope System.

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