Triple endobuttton technique in acromioclavicular joint reduction and reconstruction

Introduction: Acromioclavicular joint (ACJ) dislocation is a common injury often affecting young athletes. Cyclist, ice hockey players, weight lifters, rugby players and martial exponents are the most common athletes sustaining these injuries. Majority of these athletes sustain high-grade injuries requiring surgical management to allow them to return to their sports. Methods: The author describes a new technique to reduce and maintain reduction of the coraco-clavicular interval, using 3 low profile metallic buttons technique. The fixation device comprises 3 endobuttons (Acufex, Smith & Nephew, Andover, MA) and 2 #5 Fibrewire (TM) suture. Two endobuttons will sit on the clavicle and the third will he flipped at the undersurface of the coracoid. The proposed advantages include a non-rigid fixation of the AC joint which maintains reduction yet allowing for normal movement at the joint. The "snow shoe" bold on cortical bone means that the implant should withstand cyclic loading without cutting out from the bone. The theoretical strength of the fixation is also superior than the original strength of the coracoclavicular ligaments. The relatively low profile means that there is no need for removal of implant. Results: The author has utilised this fixation technique on 5 patients. All the patients had strong intraoperative fixation. Immediate, 2 weeks and 6 months postoperative radiographs demonstrated excellent reduction of the coracoclavicular interval and the AC joint. Conclusion: The short-term follow-up with this technique proves to be a safe and effective way for providing fixation for the ACJ.