Operative technique ASB Technique We are describing here the anatomic technique of reconstructing the CC ligaments with the semitendinoses graft as described by the senior author. Fixation techniques Involves the use of various types of materials, for example, heavy suture or surgical tape, allograft, or autograft, which are placed around the base of the coracoid and through the distal end of the clavicle and fixed in place with various fixation means, such as suture anchors, suture buttons, and interference screws. The 2 ends of the semitendinoses graft are then pulled through, underneath the deltoid. So it is advisable to have a biologic graft around the coracoid. The anatomic coracoclavicular ligament reconstruction:
Patients are discharged on the second postoperative day after a wound dressing. Reconstruction of the coracoclavicular ligaments with tendon grafts: The anatomic coracoclavicular ligament reconstruction: Arch Orthop Trauma Surg. CC ligament reconstruction This is described as a ligament reconstruction between the coracoid and the clavicle.
The most common cause of discomfort is the scapular dyskinesia, which leads to medial scapular or posterior midthoracic pain or discomfort. Even among surgeons, there is a choice between acromioclavicjlar repairs and the latest—arthroscopic reconstructions. The anterior-posterior displacement of AC joint also tends to cause more symptoms, which may be unaddressed, by merely restoring the superior inferior stability with CC ligament reconstruction.
Mechanism of injury The mechanism of injury usually involves a direct blow to the lateral aspect of the shoulder with the arm in an adducted position, leading to downward displacement of the scapula opposed by impaction of the clavicle onto the first rib [ 3 ].
In a type IV and V dislocation aromioclavicular, gross deformity and tenting of Trapezius and deltoid is significant along with displacement of skin.
Bosworth screw Stabilization of AC joint with a screw between clavicle and coracoid. So it is advisable to have a biologic graft around the coracoid. The technique remains the same, while the challenge is to loop the graft around the coracoid base. Computerized axial tomography— a method of localizing Steinmann pin migration: Visualization of the acromion anterior to the clavicle will indicate a type IV lesion.
Acromioclavicular joint dislocations
Complications Across the board, each technique has its typical fault lines. There was noticeable superior migration of the clavicle in 4 of the 43 patients but none of them were clinically symptomatic. An arthroscopic CC ligament reconstruction is very much practiced, and there are many techniques of achieving the same. When the clavicle drill hole is made lateral to the coracoid, the 2 strands of the graft chart a different vector, with each strand charting different course—mimicking the conoid and trapezoid path.
A acromiocalvicular fixation between Coracoid and clavicle has been an appealing prospect in the form of acromioclavixular.
National Center for Biotechnology InformationU. An arthroscopic reconstruction could possibly maintain the native superior AC ligaments even after performing a lateral acromioclavicupar resection. Bipolar dislocation of the clavicle: Type III acromioclavicular joint separation associated with late brachial plexus neuropraxia.
Eaton R, Serletti J. Migration of a threaded Steinmann pin from an acromioclavicular joint into the spinal canal: Abstract Acromioclavicular AC dislocation is a common injury especially among sportsmen.
Aditya Pawaskar declares that he has no conflict of interest. An intact CC ligament after reconstruction with biological graft offers long-term stability. Support Center Support Center. An indirect suture shuttle usually Ethilon 1 is passed under the coracoid with acromiocavicular help of a Satinsky forceps from medial to lateral.
Hook plate eroding through acromion has been noted as early as 32 days after surgery. Farber emphasized the anatomic reconstruction with its benefits [ 22 ].
The excess graft is passed across the AC joint in the anterior acromion and wound back to the lateral end clavicle into a suture anchor in lateral end of clavicle to replace the AC ligament acromiocclavicular well. The premise of doing fixations in AC joint dislocations is to expect the native CC ligament to heal up once the AC joint is reduced.
Acromioclavicular joint dislocations
Coracoclavicular ligaments are the laterally located trapezoid ligament and the more medial conoid ligament. Introduction Acromioclavicular AC joint injuries are not uncommon and occur across different age groups.
Conservative treatment of acromioclavicular dislocation. Htesis modern approach has been to reconstruct anatomic CC ligament with fixation or a loop at base of coracoid and a biological graft passing through clavicle either through a single drill hole or 2, to mimic the course of the conoid and trapezoid ligament.
Functional in overhead athletes. They reported that the graft sutured on to itself with supplemental sutures was the most secure method of fixation.