Arthroscopic Acromioclavicular Joint Reconstruction With TightRope and FiberTape Loop

Abstract

High-grade acromioclavicular (AC) injuries are frequent in the active population, and their treatment in the acute setting has reduced sequelae such as chronic pain, functional impairment, and inability to return to sports. Multiple techniques have been described to achieve reduction and fixation of the AC joint, but still there is no consensus. The objective of this Technical Note is to describe the reduction and internal fixation under arthroscopic assistance of the AC joint with the use of a double button implant plus high-strength tape in the acute setting.

Fig 1

Direct view of left shoulder with patient in beach chair position. Posterior (P), anterolateral (AL), and anterior (A) portals are marked. Mini open incision on clavicle marked with red line.

Fig 2

Left shoulder in beach chair position. (A) The coracoclavicular guide is inserted through the anterolateral (AL) portal reaching the center of the clavicle on top (red arrow) and the center of the coracoid's base on the bottom. (B) View from the anterior portal. The guide drill pin should reach the center of the coracoid's base (*) and should be stopped by the coracoclavicular guide under direct vision over the subscapularis (SC).

Fig 3

Left shoulder in beach chair position. (A) Arthroscopic anterior portal view. The oblong button (OB) of the TightRope is positioned under direct vision at the base of the coracoid (*). (B) After reduction of the acromioclavicular (AC) joint, AC reduction and TightRope position is confirmed under fluoroscopy. TightRope buttons should be parallel and the clavicular tunnel should reach the center of the coracoid's base (*). (SC, subscapularis.)

Fig 4

Left shoulder in beach chair position. (A) The knot pusher with the FiberTape loop is advanced from the posterior (P) edge of the clavicle to reach the medial border of the coracoid. (B) Arthroscopic anterior (A) portal view. The knot pusher and the FiberTape loop (red arrow) reaching the medial border of the coracoid (*). (C) From the anterolateral (AL) portal, the FiberTape loop is pulled with a grasper (red arrow). (D) From the anterior edge of the clavicle, a grasper is advanced toward the lateral edge of the coracoid (red arrow). (E) The FiberTape loop is grabbed with a grasper and pulled upward (red arrow) anterior to the clavicle.

Fig 5

Left shoulder in beach chair position. (A) Arthroscopic anterior portal view. The FiberTape (FT) should be anterior of the oblong coracoid button (OB) of the TightRope. (B) A Nice knot is done to secure the FiberTape (red arrow).

Fig 6

Illustration of the relationship between the TightRope and FiberTape loop. Top view of the acromioclavicular joint and coracoid. (A) Space where the knot pusher is advanced and the space where it is pulled up by a grasper to make the loop under the coracoid. (B) FiberTape crossing over the clavicle in an anterior to posterior direction. The TightRope is positioned in the center of the coracoid.