Modified Internal Fixation Technique for Acromio-Clavicular (AC) joint dislocation: The “Hidden Knot Technique”

Document Type : TECHNICAL NOTE

Authors

1 Knee and Sport Medicine Research Center, Milad hospital, Tehran, Iran

2 University of Social Welfare and Rehabilitation Sciences Knee and Sport Medicine Research Center, Milad hospital, Tehran, Iran

3 Department of Sports Medicine, Shahid Beheshti University of Medical Sciences,Tehran, Iran

Abstract

Acromioclavicular (AC) joint injuries are common and often seen in contact athletes, resulting from a fall on the shoulder
tip with adducted arm. This joint is stabilized by both static and dynamic structures including the coracoclavicular (CC)
ligament. Most reconstruction techniques focus on CC ligament augmentation as the primary stabilizer of the AC joint.
The best surgical technique for some AC joint dislocations is still controversial. In this study, we explained a modification
of the CC ligament reconstruction technique described by Wellmann. The method is based on minimally invasive CC
ligament augmentation with a flip button/polydioxanone (PDS) repair, typically used for extracortical ACL graft fixation.
Patients commonly complain that heavy sutures under the skin in subcutaneous tissue irritate the skin and sometimes
require reoperation for suture removal. We present an augmentation technique that resolves this issue by changing the
suture knot location to the sub-clavicular position.

Keywords

Main Subjects

References

1. Abat F, Sarasquete J, Natera LG, Calvo A, Perez-
Espana M, Zurita N, et al. Biomechanical analysis
of acromioclavicular joint dislocation repair
using coracoclavicular suspension devices in two
different configurations. J Orthop Traumatol. 2015;
16(3):215-9.
2. Balog TP, Min KS, Rumley JC, Wilson DJ, Arrington
ED. Arthroscopic anatomic coracoclavicular ligament
repair using a 6-strand polyester suture tape and
cortical button construct. Arthrosc Tech. 2015;
4(6):e757-61.
3. Rockwood CA, Williams GR, Young D. Disorders
of theacromioclavicular joint. Philadelphia: The
Saunders; 1998.
4. Beris A, Lykissas M, Kostas-Agnantis I, Vekris M,
Mitsionis G, Korompilias A. Management of acute
acromioclavicular joint dislocation with a doublebutton
fixation system. Injury. 2013; 44(3):288-92.
5. Wang Y, Zhang J. Acromioclavicular joint reconstruction
by coracoid process transfer augmented with hook
plate. Injury. 2014; 45(6):949-54.
6. Rosslenbroich SB, Schliemann B, Schneider KN,
Metzlaff SL, Koesters CA, Weimann A, et al. Minimally
invasive coracoclavicular ligament reconstruction
with a flip-button technique (MINAR): clinical and
radiological midterm results. Am J Sports Med. 2015;
43(7):1751-7.
7. Sandmann GH, Martetschlager F, Mey L, Kraus
TM, Buchholz A, Ahrens P, et al. Reconstruction of
displaced acromio-clavicular joint dislocations using
a triple suture-cerclage: description of a safe and
efficient surgical technique. Patient Saf Surg. 2012;
6(1):25.
8. Beitzel K, Obopilwe E, Chowaniec DM, Niver GE, Nowak
MD, Hanypsiak BT, et al. Biomechanical comparison
of arthroscopic repairs for acromioclavicular joint
instability: suture button systems without biological
augmentation. Am J Sports Med. 2011; 39(10):2218-25.
9. Shao RY, Zhang YC, Lou CJ, Shi GC, Yu JF, Luo C,
et al. Coracoclavicular ligament reconstruction
using autologous double-strand palmaris longus
tendon and artificial ligament for the treatment of
acromioclavicular joint dislocation. Zhongguo Gu
Shang. 2011; 24(3):202-4.
10. Wellmann M, Zantop T, Petersen W. Minimally invasive
coracoclavicular ligament augmentation with a flip
button/polydioxanone repair for treatment of total
acromioclavicular joint dislocation. Arthroscopy.
2007; 23(10):1132.e1-5.
11. Karas V, Barker J, Strauss E, Mcgill K, Provencher MT,
Bach BR, et al. Can you achieve anatomic femoral
tunnel placement with transtibial anterior cruciate
ligament reconstruction using smaller tunnel sizes?
Arthroscopy. 2011; 27(10):e195-6.
12. Wellmann M, Zantop T, Weimann A, Raschke MJ,
Petersen W. Biomechanical evaluation of minimally
invasive repairs for complete acromioclavicular joint
dislocation. Am J Sports Med. 2007; 35(6):955-61.
13. Yoo YS, Seo YJ, Noh KC, Patro BP, Kim DY.
Arthroscopically assisted anatomical coracoclavicular
ligament reconstruction using tendon graft. Int
Orthop. 2011; 35(7):1025-30.
14. Kumar N, Sharma V. Hook plate fixation for
acute acromioclavicular dislocations without
coracoclavicular ligament reconstruction: a functional
outcome study in military personnel. Strategies
Trauma Limb Reconstr. 2015; 10(2):79-85.
15. Li Q, Hsueh PL, Chen YF. Coracoclavicular ligament
reconstruction: a systematic review and a
biomechanical study of a triple endobutton technique.
Medicine. 2014; 93(28):e193.
16. Wellmann M, Kempka JP, Schanz S, Zantop T, Waizy
H, Raschke MJ, et al. Coracoclavicular ligament
reconstruction: biomechanical comparison of
tendon graft repairs to a synthetic double bundle
augmentation. Knee Surg Sports Traumatol Arthrosc.
2009; 17(5):521-8.
The Archives of Bone and Joint Surgery
Volume 6, Issue 1
January 2018
Pages 81-84

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History

  • Receive Date: 14 February 2017
  • Revise Date: 29 October 2017
  • Accept Date: 29 November 2017

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