Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The “AC- RecoBridge” Technique  Kaywan Izadpanah, M.D., Martin Jaeger, M.D., Peter Ogon, M.D., Norbert P. Südkamp, M.D., Dirk Maier, M.D.  Arthroscopy Techniques  Volume 4, Issue 2, Pages e153-e161 (April 2015) DOI: 10.1016/j.eats.2015.01.012 Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 1 Preparation and reduction of acromioclavicular joint. (A) For reconstruction of the acromioclavicular ligament complex, the complex is carefully separated from the deltotrapezoidal fascia. (B) Next, a 2.0-mm FiberTape is shuttled through a 2.0-mm clavicular drill hole using a SutureLasso. (C) Afterward, anatomic reconstruction of the acromioclavicular joint and temporary transfixation using a 1.8-mm K-wire are performed. Arthroscopy Techniques 2015 4, e153-e161DOI: (10.1016/j.eats.2015.01.012) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 2 Single-channel coracoclavicular suture tape stabilization. Trans–clavicular-coracoid drilling (2.4 mm) is carried out. Clavicular drilling is performed between the footprints of the conoid and trapezoid to avoid additional iatrogenic damage to the ligaments. (A) A ruler can be used to determine the intersection between the clavicular footprints of the coracoclavicular ligament complex. Drilling is performed using the AC Guide (Arthrex). (B) The coracoid part of the aiming device is positioned centrally at the base of the coracoid under arthroscopic control. (C) Coracoclavicular suture tape stabilization is established using 2 FiberTapes loaded with DogBone buttons. (D) The FiberTapes are tightened and tied. The resulting knot chains located over the superior DogBone button can be laid down posteriorly underneath the deltotrapezoidal fascia. Arthroscopy Techniques 2015 4, e153-e161DOI: (10.1016/j.eats.2015.01.012) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 3 Morphology of acromioclavicular ligament tear patterns. (A, B) Acromial-sided tear of acromioclavicular ligaments. The articular disk is intact and remains attached to the lateral clavicle. (C, D) Clavicular-sided tear. A complete detachment of the deltotrapezoidal fascia (DT) occurred. The articular disk is intact and remains attached to the acromion. Arthroscopy Techniques 2015 4, e153-e161DOI: (10.1016/j.eats.2015.01.012) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 4 Shuttling of FiberTape in AC-RecoBridge technique. First, the acromioclavicular ligament complex is reconstructed according to the type of injury (AC-Reco). Afterward, the acromioclavicular cerclage is created in an arthroscopically assisted fashion to provide protective internal bracing for the reconstructed acromioclavicular ligament complex (AC-Bridge). (A) A posterior 2.0-mm acromial-sided vertical drill hole is created. (B, C) A SutureLasso is passed through the drill hole and shuttled out the anterolateral portal. (D-F) The anterior limb of the clavicular-sided FiberTape is passed through the SutureLasso, is pulled through the posterior acromial drill hole subacromially, and then exits the anterolateral cannula (blue arrow). The second, anterior drill hole is created in the craniocaudal direction at the acromion. (G, H) A SutureLasso is passed through this anterior drill hole and shuttled out the anterolateral portal (green arrows). (I-L) The suture tape limb already located within the cannula is inserted into the SutureLasso and shuttled from subacromially to the surface of the acromion, exiting the anterior drill hole (white arrow). Underneath the acromion, a U-shaped configuration of the FiberTape develops. Patients are placed in the beach-chair position. The arthroscope is placed in the posterior portal. Arthroscopy Techniques 2015 4, e153-e161DOI: (10.1016/j.eats.2015.01.012) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 5 Knotting and closure of deltotrapezoidal fascia in AC-RecoBridge technique. The suture tape limb exiting the anterior acromial drill hole is shuttled from posterior to anterior at the clavicle. (A) An eyelet needle is used to pass the limb through the part of the suture tape exiting the posterior clavicle. (B) By pulling this limb anteriorly, the passage is executed. The X-configured cerclage lies on top of the reconstructed acromioclavicular ligament complex, creating a suture-bridge effect comparable with double-row rotator cuff reconstruction. (C) The tightened cerclage is locked, with the knot chain being located at the posterior border of the clavicle. (D) The AC-RecoBridge will be covered after closure of the deltotrapezoidal fascia. Arthroscopy Techniques 2015 4, e153-e161DOI: (10.1016/j.eats.2015.01.012) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions