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Closed-Loop, Double Cortical Button Technique for Reconstruction of Acute and Chronic Acromioclavicular Joint Dislocations

March 01, 2019

Contributors: Dylan Lowe, MD; Steven Struhl, MD; Theodore S. Wolfson, BS; Theodore S. Wolfson, BS

Acute acromioclavicular (AC) joint injuries are common, accounting for almost 50% of all athletic shoulder injuries. Despite this high prevalence, management is controversial, and current recommendations vary widely. Low-grade AC joint injuries are initially managed nonsurgically, and surgery usually is indicated for the management of high-grade AC joint dislocations; however, management of acute Rockwood type III AC joint dislocations remains controversial. Numerous strategies that vary in timing, technique, and fixation have been used for repair or reconstruction of the AC joint. However, these techniques have resulted in inconsistent outcomes, largely because of nonanatomic design, uniplanar stability, overconstraint, inadequate implant strength or durability, lack of biologic healing, and the need for revision surgery. To address and avoid these shortcomings, we recommend a continuous-loop, double cortical button technique for consistent, durable reconstruction of acute and chronic AC joint dislocations. This video demonstrates AC joint reconstruction via a continuous-loop, double cortical button technique. This video provides a brief overview of the anatomy, diagnosis, and management of AC joint disruptions followed by a discussion of the surgical considerations and rationale for the continuous-loop, double cortical button technique. The video discusses the case presentation of two young, active men, one with a Rockwood type V AC joint dislocation and the other with a Rockwood type III AC joint dislocation. Comprehensive surgical footage demonstrates open reduction and fixation via the continuous-loop, double cortical button technique. Illustrations and models are used to orient and guide the viewer. Excellent reduction and fixation was obtained intraoperatively, and excellent postoperative clinical outcomes with maintenance of reduction was achieved in both patients. The continuous-loop, double cortical button system is a safe and reliable treatment option for the management of acute and chronic AC joint dislocations; however, consistent, durable results are contingent on careful technique.