Summary

This paper presents a new anatomical technique for the reconstruction of both coraco-clavicular ligaments with re-insertion of the avulsed posterosuperior AC capsule using an EHL allograft and Y-knot suture anchors

Abstract

After several technical adaptations and cadaveric workshops, we operated the first patient using this technique back in April 2018. In this all anatomic open technique, we reconstruct the coraco-clavicular ligaments individually and we re-suture the torn posterosuperior AC capsule. First, we drill two seperate tunnels into the clavicle, close to the native insertions of the conoid and trapezoid ligament . We dissect the coracoid from the tip to the base and we look for the remnants of the conoid ligament on the coracoid insertion . An all-suture 1,3 Y-knot ribbon anchor is drilled into this insertion with a guide which is specifically made for this purpose . The ribbon is brought through the conoid tunnel and will be tied later on the coracoid base . An extensor hallucis longus allograft is pulled through a 4,5 mm drilled trapezoid tunnel . One end of the graft is tunnelled underneath the coracoid and conjoined tendon . Both ends of the graft are positioned , in opposite directions , onto the lateral part of the conjoined tendon , where they will be sutured using ethibond #2 sutures . Finally we drill two all suture 1,3 Y-knot anchors into the posterosuperior part of the distal clavicle to repair the torn AC capsule . Now we reduce the AC joint and first we tie the Y-knot ribbon onto the coracoid . Next, the two ends of the EHL graft are sutured onto the conjoined tendon and finally the two y-knot anchor threads are sutured through the AC capsule . Since April 2018, we've operated 46 patients . All patients sustained at least a type 3 Rockwood AC dislocation ( nearly all of them were 3B instabilities ) . All injuries were caused by a fall on the affected shoulder ( cycling 20 , skiing 5 , soccer 5 ). We present 39 male patients and 7 females with an average age of 42,5 . Every patient is evaluated with X-ray findings , DASH scores , SSV , VAS and Constant score . All but one patients were happy with their result . The one patient showed anoying paresthesia around the incision and presented some cuff symptoms . Three others had minor numbness around the scare . Four patients lost superior reduction but were posteriorly stable enough . One patient showed wound problems which resolved after time . We experienced no hardware problems and none of the patients were re-operated . To this date, we can state that our new triple A technique for AC stabilization presents good to very good results with few complications