Economic Reliable Arthroscopic Technique for Reduction and Fixation of Acute Acromioclavicular Joint Dislocation

Abstract

Separation of the acromioclavicular joint (ACJ) is a common orthopaedic injury among athletes involved in contact sports and victims of motor vehicle accidents. ACJ disruptions are common in athletes. Treatment is guided by the level of injury; grade 1 and 2 injuries are managed nonoperatively. Grades 4-6 are managed operatively, whereas grade 3 is an area of controversy. Several operative techniques have been described to restore anatomy and function. We present a technique that’s safe, economic, and reliable in the management of acute ACJ dislocation. It allows intra-articular glenohumeral assessment and relies on a coracoclavicular sling. This is an arthroscopic-assisted technique. It entails a small transverse or vertical incision over distal clavicle 2 cm away from ACJ, which enables us to reduce the ACJ and maintain reduction with a k-wire, checked by the C-arm. Diagnostic shoulder arthroscopy is then performed to assess the glenohumeral joint. The rotator interval is liberated and the coracoid base is exposed, and PROLENE sutures are then passed anterior to the clavicle medial and lateral to the coracoid. It is the used to shuttle polyester tape and ultrabraid as a sling under the coracoid. A tunnel is then made in the clavicle, then one end of suture is passed through the tunnel whereas the other end remains anterior. Several knots are made to ensure it is secured, then the deltotrapezial fascia is closed as a separate layer.