Arthroscopic Distal Clavical Resection Using “Vis-à-Vis” Portal Kevin Kruse, M.D., Matthew Yalizis, M.B.B.S., F.R.A.C.S., Lionel Neyton, M.D. Arthroscopy Techniques Volume 5, Issue 3, Pages e667-e670 (June 2016) DOI: 10.1016/j.eats.2016.02.023 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 1 Standard portals used for the arthroscopic acromioclavicular joint resection via the vis-à-vis portal (posterior, lateral, anterolateral, and anterior). Arthroscopy Techniques 2016 5, e667-e670DOI: (10.1016/j.eats.2016.02.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 2 View of the acromioclavicular joint from the posterior portal in a right shoulder in the beach chair position (acromion marked with arrow and clavicle with asterisk). It is evident that the superior and posterior portions of the distal clavicle are blocked by the medial aspect of the acromion. When performing a distal clavicle resection from this view, it is often necessary to resect the medial aspect of the acromion in order to visualize the entire end of the distal clavicle. Arthroscopy Techniques 2016 5, e667-e670DOI: (10.1016/j.eats.2016.02.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 3 View of the acromioclavicular joint from the lateral portal in a right shoulder in the beach chair position (acromion marked with arrow and clavicle with asterisk). It is evident that the superior and posterior portions of the distal clavicle are blocked by the medial aspect of the acromion. When performing a distal clavicle resection from this view, it is often necessary to resect the medial aspect of the acromion in order to visualize the entire end of the distal clavicle. Arthroscopy Techniques 2016 5, e667-e670DOI: (10.1016/j.eats.2016.02.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 4 View of the acromioclavicular joint from the vis-à-vis portal in a right shoulder in the beach chair position (acromion marked with arrow and clavicle with asterisk). When using this portal the entire superior as well as posterior aspect of the distal clavicle can be visualized, without having to resect any of the medial acromion. This is due to the “on face” angle of the portal. Arthroscopy Techniques 2016 5, e667-e670DOI: (10.1016/j.eats.2016.02.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 5 The first step of the resection is to remove the anterior ligament of the acromioclavicular joint as well as all the soft tissue around the joint with an electrocautery (acromion marked with arrow and clavicle with asterisk). Arthroscopy Techniques 2016 5, e667-e670DOI: (10.1016/j.eats.2016.02.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 6 The next step is to burr the medial side of the acromion moving inferior to superior (acromion marked with arrow and clavicle with asterisk). Arthroscopy Techniques 2016 5, e667-e670DOI: (10.1016/j.eats.2016.02.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 7 The last step of the procedure is burring down the lateral end of the distal clavicle moving inferior to superior (acromion marked with arrow and clavicle with asterisk). Arthroscopy Techniques 2016 5, e667-e670DOI: (10.1016/j.eats.2016.02.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 8 Final acromioclavicular joint (ACJ) resection as viewed from the “vis-à-vis” portal. There is an adequate resection of the ACJ with no residual bone left in the posterior or superior portion of the clavicle. The superior ligaments of the ACJ remain intact (acromion marked with arrow and clavicle with asterisk). Arthroscopy Techniques 2016 5, e667-e670DOI: (10.1016/j.eats.2016.02.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions