Arthroscopic Technique for Stabilization of Chronic Acromioclavicular Joint Instability With Coracoclavicular and Acromioclavicular Ligament Reconstruction.

Slides:



Advertisements
Similar presentations
All-Arthroscopic Double-Bundle Coracoclavicular Ligament Reconstruction Using Autogenous Semitendinosus Graft: A New Technique  Juha O. Ranne, M.D., Janne.
Advertisements

Arthroscopic Superior Capsule Reconstruction Technique in the Setting of a Massive, Irreparable Rotator Cuff Tear  George Sanchez, B.S., William H. Rossy,
Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability  Frank Martetschläger,
Surgical Technique for Arthroscopy-Assisted Anatomical Reconstruction of Acromioclavicular and Coracoclavicular Ligaments Using Autologous Hamstring Graft.
Arthroscopic Recognition and Repair of the Torn Subscapularis Tendon
Using the Long Head of Biceps Tendon Autograft as an Anatomical Reconstruction of the Rotator Cable: An Arthroscopic Technique for Patients With Massive.
Matthew R. Lewington, M. D. , F. R. C. S. C. , Nathan Urquhart, M. D
Arthroscopic Rotator Cuff Repair With Mini-open Subpectoral Biceps Tenodesis  Nicholas I. Kennedy, M.D., George Sanchez, B.S., Sandeep Mannava, M.D., Ph.D.,
Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The.
Subpectoral Biceps Tenodesis Using an Expanding PEEK Device
All-Arthroscopic Double-Bundle Coracoclavicular Ligament Reconstruction Using Autogenous Semitendinosus Graft: A New Technique  Juha O. Ranne, M.D., Janne.
Duncan Tennent, F. R. C. S. (Orth), Henry B. Colaço, M. Sc. , F. R. C
All-Arthroscopic Suprapectoral Long Head of Biceps Tendon Tenodesis With Interference Screw–Like Tendon Fixation After Modified Lasso-Loop Stitch Tendon.
The Subscapularis Interlocking Stitch for the Arthroscopic Treatment of Subscapularis Tendon Tears at the Shoulder  Jörn Kircher, M.D., Ph.D., Knut Schwalba,
Dean Wang, M. D. , Christopher L. Camp, M. D. , Brian C. Werner, M. D
Arthroscopic-Assisted Lower Trapezius Tendon Transfer for Massive Irreparable Posterior-Superior Rotator Cuff Tears: Surgical Technique  Bassem T. Elhassan,
Distal Clavicle Fracture Repair Using Cortical Button Fixation With Coracoclavicular Ligament Reconstruction  Gautam P. Yagnik, M.D., David A. Porter,
Consolidated Proximal Biceps Tenodesis and Subscapularis Repair
Dhong Won Lee, M. D. , Russel Haque, M. D. , Kyu Sung Chung, M. D
Maximilian Petri, M. D. , Joshua A. Greenspoon, B. Sc. , Peter J
Matt Daggett, D. O. , M. B. A. , Andrea Redler, M. D. , Kevin Witte, D
Kevin J. McHale, M. D. , George Sanchez, B. S. , Kyle P. Lavery, M. D
Jin Tang, B.M., Jinzhong Zhao, M.D.  Arthroscopy Techniques 
Arthroscopic Screw Removal After Arthroscopic Latarjet Procedure
Anterior Capsular Reconstruction for Irreparable Subscapularis Tears
Arthroscopic-Assisted Lower Trapezius Tendon Transfer for Massive Irreparable Posterior-Superior Rotator Cuff Tears: Surgical Technique  Bassem T. Elhassan,
Gregory L. Cvetanovich, M. D. , Timothy Leroux, M. D. , Jason T
Arthroscopic Acromioclavicular Fixation With Suture Tape Augmentation After Coracoclavicular Fixation With Dog Bone Button: Surgical Technique  Joong-Bae.
Arthroscopic Latarjet Procedure Combined With Bankart Repair: A Technique Using 2 Cortical Buttons and Specific Glenoid and Coracoid Guides  Philippe.
Arthroscopic Superior Capsular Reconstruction for Treatment of Massive Irreparable Rotator Cuff Tears  Alan M. Hirahara, M.D., F.R.C.S.C., Christopher.
Open Anatomic Coracoclavicular Ligament Reconstruction by Modified Conjoint Tendon Transfer for Treatment of Acute High-Grade Acromioclavicular Dislocation 
Arthroscopic Coracoclavicular Ligament Reconstruction Using Graft Augmentation and Titanium Implants  Juha O. Ranne, M.D., Terho U. Kainonen, M.D., Jussi.
Sepp Braun, M. D. , Knut Beitzel, M. D. , Stefan Buchmann, M. D
Michael B. Banffy, M. D. , Carola F. van Eck, M. D. , Ph. D
Yoshihiro Hagiwara, M. D. , Akira Ando, M. D. , Kenji Kanazawa, M. D
Paolo Consigliere, M. D. , Shadi Salamat, Nardeen Kader, M. B. B. S
Adam Kwapisz, M.D., Ph.D., John M. Tokish, M.D.  Arthroscopy Techniques 
Medial Patellofemoral Ligament Reconstruction: A New Technique for Graft Fixation at the Patella Without Implants  Sven Shafizadeh, M.D., Maurice Balke,
Kenneth Cutbush, M. B. B. S. , F. R. A. C. S. , F. R. A. C. Orth. A
Technique for Type IV SLAP Lesion Repair
Arthroscopic-Assisted Pectoralis Minor Transfer for Irreparable Anterosuperior Massive Rotator Cuff Tear  Kotaro Yamakado, M.D., Ph.D.  Arthroscopy Techniques 
Arthroscopic Iliac Crest Bone Block for Reconstruction of the Glenoid: A Fixation Technique Using an Adjustable-Length Loop Cortical Suspensory Fixation.
Arthroscopic Pectoralis Minor Release
Arthroscopic Subscapularis Repair Through a Single Anterior Portal
Colten Luedke, D.O., Stefan J. Tolan, M.D., John M. Tokish, M.D. 
Joshua A. Greenspoon, B. Sc. , Maximilian Petri, M. D. , Peter J
Technique for Type IV SLAP Lesion Repair
All-Arthroscopic Coracoclavicular Ligament Reconstruction Surgical Technique Using a Semitendinosus Allograft and Tenodesis Screws  Xinning Li, M.D.,
Dynamic Anterior Stabilization Using the Long Head of the Biceps for Anteroinferior Glenohumeral Instability  Philippe Collin, M.D., Alexandre Lädermann,
Arthroscopic Remplissage for Moderate-Size Hill-Sachs Lesion
Michael Marsalli, M.D., Nicolás Moran, M.D., Jose I. Laso, M.D. 
Jillian Karpyshyn, B. Sc. , M. D. , Erin E. Gordey, M. D. , F. R. C. S
Single Portal Subscapular Repair by a Cross Shuttle Loop Technique
Diagnostic Shoulder Arthroscopy: Surgical Technique
Gregory L. Cvetanovich, M. D. , Timothy Leroux, M. D. , Jason T
Avinesh Agarwalla, B. S. , Richard N. Puzzitiello, B. S
Anatomic Reconstruction of Chronic Coracoclavicular Ligament Tears: Arthroscopic- Assisted Approach With Nonrigid Mechanical Fixation and Graft Augmentation 
Superior Capsular Reconstruction With Superimposition of Rotator Cuff Repair for Massive Rotator Cuff Tear  George Sanchez, B.S., Jorge Chahla, M.D. Ph.D.,
Single Portal Subscapular Repair by a Cross Shuttle Loop Technique
Jeung Yeol Jeong, M. D. , Yon-Sik Yoo, M. D. , Ph. D
Arthroscopic-Assisted Management of Unstable Distal-Third Clavicle Fractures: Conoid Ligament Reconstruction and Fracture Cerclage With Sutures  Luis.
Arthroscopic Superior Capsule Reconstruction Technique in the Setting of a Massive, Irreparable Rotator Cuff Tear  George Sanchez, B.S., William H. Rossy,
Arthroscopic Coracoclavicular and Acromioclavicular Stabilization of Acute Acromioclavicular Joint Dislocation By Suspensory Fixation System  Frank Martetschläger,
Nata Parnes, M. D. , Maryellen Blevins, P. A-C. , M. P. A. S
Arthroscopic Coracoacromial Ligament Transfer Augmented With Suspensory V-Shaped Fixation System for Chronic Acromioclavicular Joint Dislocation  Jean.
The Subscapularis Interlocking Stitch for the Arthroscopic Treatment of Subscapularis Tendon Tears at the Shoulder  Jörn Kircher, M.D., Ph.D., Knut Schwalba,
Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The.
Arthroscopic Reverse Remplissage for Posterior Instability
Arthroscopic Iliac Crest Bone Block for Reconstruction of the Glenoid: A Fixation Technique Using an Adjustable-Length Loop Cortical Suspensory Fixation.
Courtney R. Carlson Strother, M. D. , Richard J. McLaughlin, M. D
Presentation transcript:

Arthroscopic Technique for Stabilization of Chronic Acromioclavicular Joint Instability With Coracoclavicular and Acromioclavicular Ligament Reconstruction Using a Gracilis Tendon Graft  Nina Pühringer, M.D., Jens Agneskirchner, M.D., Ph.D.  Arthroscopy Techniques  Volume 6, Issue 1, Pages e175-e181 (February 2017) DOI: 10.1016/j.eats.2016.09.036 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Four portals are required: standard posterior (A), anteromedial (B), anterolateral (C), and supracoracoidal (D), in addition to an incision 2 cm medial to the acromioclavicular joint. Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) Right shoulder, beach chair position—outside view. The arthroscope is in the dorsal standard portal (marked as A in Fig 1), the radiofrequency device is inserted through the anteromedial portal (marked as B in Fig 1). (B) The rotator interval is opened with a shaver to expose the anterior extra-articular space and to find the posterior surface of the coracoid. (C) With the help of a radiofrequency device, the coracoid is exposed posteriorly, laterally, and medially. The next step is to open the clavipectoral fascia. The conjoint tendons are exposed and the coracoid insertion of the CA ligament is detached. (c, coracoid; CJT, conjoint tendons; g, glenoid; h, humeral head; LHB, long head biceps tendon; SSC, M. subscapularis tendon.) Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) Outside view. The camera is in the anterolateral viewing portal (marked as C in Fig 1). The radiofrequency device is inserted in the anteromedial portal (marked as B in Fig 1). (B) The undersurface of the coracoid and the CJ tendons are visualized. (CJ, conjoint tendons; SSC, upper border of the subscapularis tendon; X, undersurface of the coracoid.) Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 (A) To enhance the view, the deltoid muscle is retracted with a switching stick from the anterolateral portal (marked as C in Fig 1). The arthroscope is in the anteromedial portal (marked as B in Fig 1), and the radiofrequency device is in the supracoracoidal portal (marked as D in Fig 1). (B) The medial part of the coracoid is now visualized from extra-articular. The superior third of the insertion of the m. pectoralis minor is detached. ∗Created space for further passage of the graft around the coracoid. (c, coracoid; pm, pectoralis minor tendon.) Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Arthroscopic and outside view. A transclavicular and transcoracoidal hole is drilled and a cortical button is placed in the posterior aspect of the coracoid knee. The second cortical button is placed 2 cm medial to the acromioclavicular joint in the middle of the anterior posterior dimension of the clavicle. The primary reduction is made by knot tying on top of the second cortical button. (c, coracoid; SSC, upper border of the m. subscapularis.) Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 A specific arthroscopic Dechamps is used for graft passage. It is inserted in the supracoracoidal portal (marked as D in Fig 1) around the medial aspect of the coracoid. Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 A flexible graft dilator is used to make a good gracilis graft passage. It is pulled from the medial supracoracoidal portal (marked as D in Fig 1) to the anterolateral portal (marked as C in Fig 1). ∗Flexible graft dilator. (c, coracoid.) Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 The looped end of the graft dilator is used to pull the prepared gracilis tendon around the coracoid from medial to lateral. The gracilis tendon is anterior to the cortical button. (c, coracoid; gr, gracilis tendon graft.) Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 Lateral to the previously placed cortical button, a K-wire is drilled through the clavicle in a sagittal direction from anterior to posterior. The K-wire is overdrilled with a 4.5-mm drill. ∗Cortical button. (cl, clavicle.) Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 10 (A) By using a nitinol wire, 2 FiberWires (Arthrex), which are used as shuttle sutures later, are pulled through the sagittal clavicular drill hole. One loop is placed anteriorly (x) and the other one posteriorly (y). (B) A KingFisher suture retriever (Arthrex) is inserted from anterior to the clavicle in an antero-inferior direction, and the lateral end of the gracilis tendon graft is retrieved. ∗Lateral end of the gracilis tendon graft. (C) Through the trapezius fascia, posterior to the clavicle the medial end of the gracilis tendon is retrieved. ∗Medial end of the gracilis tendon graft. (D) Both graft ends are retrieved. The medial end of the tendon graft (x) is posterior, and the lateral graft end (y) anterior, to the clavicle. ∗Gracilis tendon graft. (c, coracoid; cl, clavicle; kf, KingFisher posterior to the clavicle.) Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 11 The graft is looped in a figure-of-8 around the coracoid, the medial part of the tendon is anterior to the lateral one. (c, coracoid; x, lateral end of graft; y, medial end of graft.) Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 12 With the earlier-placed shuttle sutures, the free ends of the gracilis tendon are now pulled against each other in the sagittal drill hole of the clavicle. (cl, clavicle.) Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 13 Under tension on both ends, a SwiveLock 4.75-mm biocomposite anchor (Arthrex) is inserted from anterior to posterior in the drill hole. Arthroscopy Techniques 2017 6, e175-e181DOI: (10.1016/j.eats.2016.09.036) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions