Stabilization of the acromioclavicular joint with suture-button systems via coracoclavicular tunnels Avoidance of complications

Arthroscopically assisted stabilization of dislocations of the acromioclavicular joint (ACJ) with suture-button systems enables sufficient anatomical reduction with subsequent ligament healing in the acute phase and primary stability in chronic cases. For correct orthograde positioning of bone tunnels an intraoperative image converter control is recommended in addition to the arthroscopic aiming device. To avoid breakages of the button or fractures of the clavicle or coracoid process, a transclavicular-transcoracoidal bone tunnel with a 2.4 mm cannulated drill with a single implant is recommended. In chronic injuries, in addition to the single implant for primary stability, the autologous tendon graft for coracoclavicular (CC-)ligament augmentation can be circumclavicularly and circumcoracoidally shuttled to avoid further bone tunnels. For reconstruction of the ACJ capsule and for horizontal stabilization, in acute as well as chronic cases an AC cerclage with sutures, tape or graft in addition to coracoclavicular stabilization is biomechanically recommended. A coracoid fracture can be arthroscopically reduced via an anterior portal with a 1.6 mm K-wire and fixed above by a 4.5 mm screw. To reduce the load on the fixed coracoid fracture the addition of a hook plate can be indicated for temporary ACJ stabilization.