Sepp Braun, M. D. , Knut Beitzel, M. D. , Stefan Buchmann, M. D

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Arthroscopically Assisted Treatment of Acute Dislocations of the Acromioclavicular Joint Sepp Braun, M.D., Knut Beitzel, M.D., Stefan Buchmann, M.D., Andreas B. Imhoff, M.D. Arthroscopy Techniques Volume 4, Issue 6, Pages e681-e685 (December 2015) DOI: 10.1016/j.eats.2015.07.029 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Right shoulder of patient positioned in beach-chair position. Portals and skin incisions are marked preoperatively: standard posterior portal (a), antero working portal (b), lateral portal for better visualization of coracoid base (c), skin incision at the area of the anatomic coracoclavicular ligament insertion for drilling of the coracoclavicular tunnel (d), and skin incision over the acromioclavicular joint (e). Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Anterior view of right shoulder with flexible cannula (PassPort) positioned in anterosuperior working portal. Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Arthroscopic view through the standard posterior portal showing probe testing of the biceps insertion to evaluate for SLAP lesions. Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Arthroscopic view through the standard posterior portal showing the application of the second anterolateral portal. Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Outside view of a right shoulder from anterior showing the arthroscope positioned in the lateral portal for better visualization of the coracoid base and an electrothermal device placed in the anterolateral working portal. Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Outside view of right shoulder. A 2.4-mm cannulated drill is used to drill a horizontal hole into the lateral clavicle, approximately 10 to 15 mm medial and parallel to the acromioclavicular joint line in a posterior-to-anterior direction (the acromioclavicular joint is still unreduced and the lateral clavicle is mobile). Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Outside view of right shoulder. A 1.5-mm polydioxanone cord (a) is passed through the medial drill hole. A second drill hole (b) is placed into the acromion, approximately 10 mm lateral to the joint line, starting from the anteroinferior edge to the acromion surface at the posterior border of the acromioclavicular joint. The polydioxanone cord is then passed in a figure-of-8 configuration, as shown in the inset. Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 Outside view of right shoulder. The acromioclavicular joint drill guide (AC Guide) is inserted through the anterolateral portal. To prevent cortical blowout, retractors are placed at the anterior and posterior edges of the clavicle. Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 Arthroscopic view of a right shoulder through the anterolateral portal showing the positioned aiming device for arthroscopically controlled drilling of the coracoclavicular tunnel. Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 10 Arthroscopic view of a right shoulder through the anterolateral portal showing the button and tapes correctly positioned at the center of the coracoid base. Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 11 Outside view of right shoulder. The 4 strands of the suture tapes are threaded in a titanium button (DogBone) on top of the clavicle and finally fixed after radiographic control of correct repositioning. Arthroscopy Techniques 2015 4, e681-e685DOI: (10.1016/j.eats.2015.07.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions