Purpose
The aim of this cadaveric study was to evaluate the accuracy, feasibility, and operation
time of a novel electromagnetic navigation system (ENS) and procedure for transclavicular-transcoracoid
tunnel placement compared with a standard minimally invasive (SMI) reconstruction
method for minimally invasive arthroscopically assisted anatomic acromioclavicular
joint reconstruction.
Methods
Ten arthroscopically assisted electromagnetic-navigated transclavicular-transcoracoid
drilling procedures and 10 SMI procedures were performed on 10 human cadavers using
2 TightRope reconstructions (Arthrex, Naples, FL) for each site. Postoperative computed
tomography scans were acquired to determine tunnel placement accuracy. Optimal coracoid
tunnel placement was defined according to the anatomic insertions of the trapezoid
and conoid ligaments with the oblong button placed in a center-base position at the
coracoid undersurface without cortical breach or fracture. Both reconstruction procedures
were performed without fluoroscopy.
Results
Successful tunnel placement was accomplished in 98.8% using the ENS method and in
83.8% using the SMI procedure (P = .087). The mean overall operation time was 28.5 ± 6.6 minutes for the ENS method
and 35.2 ± 3.9 minutes for the SMI method (P = .012). The ENS procedure required no directional readjustments or restarts. Drill
misguidance with subsequent cortical breach occurred twice in the SMI group. In both
groups no fractures were documented.
Conclusions
In this descriptive laboratory study, both the ENS and the SMI techniques achieved
the desired anatomic reconstruction. Compared with the SMI method, the ENS procedure
showed higher accuracy, required a shorter operation time, and was associated with
no complications.
Clinical Relevance
Length of surgery, drilling accuracy, and reduction of radiation exposure in acromioclavicular
joint reconstruction procedures affect the safety of both patients and surgeons.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V.Am J Sports Med. 2009; 37: 136-139
- American collegiate men's ice hockey: An analysis of injuries.Am J Sports Med. 2005; 33: 183-187
- Anatomic considerations of transclavicular-transcoracoid drilling for coracoclavicular ligament reconstruction.J Shoulder Elbow Surg. 2013; 22: 137-144
- Clinical results of single-tunnel coracoclavicular ligament reconstruction using autogenous semitendinosus tendon.Am J Sports Med. 2010; 38: 950-957
- Long-term results of conservative treatment for acromioclavicular dislocation.J Bone Joint Surg Br. 1996; 78: 410-412
- A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction.Am J Sports Med. 2006; 34: 236-246
- Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations.Am J Sports Med. 2010; 38: 1179-1187
- Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations.Am J Sports Med. 2011; 39: 1507-1516
- The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: A biomechanical study.Am J Sports Med. 2008; 36: 2398-2406
- Biomechanical evaluation of effect of coracoid tunnel placement on load to failure of fixation during repair of acromioclavicular joint dislocations.Arthroscopy. 2012; 28: 1230-1236
- Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments.Am J Sports Med. 2007; 35: 811-817
- Acromioclavicular joint reconstruction: A comparative biomechanical study of three techniques.J Shoulder Elbow Surg. 2013; 22: 171-178
- Rockwood type III acromioclavicular dislocation: Surgical versus conservative treatment.J Shoulder Elbow Surg. 2008; 17: 220-225
- Arthroscopic stabilization of acromioclavicular joint dislocation using the AC GraftRope system.J Shoulder Elbow Surg. 2010; 19: 47-52
- Stability of acromioclavicular joint reconstruction: Biomechanical testing of various surgical techniques in a cadaveric model.Am J Sports Med. 2004; 32: 1492-1498
- Minimally invasive coracoclavicular stabilization with suture anchors for acute acromioclavicular dislocation.Am J Sports Med. 2008; 36: 961-965
- A modified technique of arthroscopically assisted AC joint reconstruction and preliminary results.Clin Orthop Relat Res. 2008; 466: 639-645
- Hook plate (so-called Balser plate) or tension banding with the Bosworth screw in complete acromioclavicular dislocation and clavicular fracture.Z Unfallchir Versicherungsmed. 1992; 85 (in German): 134-139
- Surgical treatment of acute and chronic acromioclavicular dislocation Tossy type III and V using the hook plate.Acta Orthop Belg. 2008; 74: 441-445
- Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder.AJR Am J Roentgenol. 2004; 182: 1271-1278
- Complications related to anatomic reconstruction of the coracoclavicular ligaments.Am J Sports Med. 2012; 40: 1628-1634
- Arthroscopically assisted retrograde drilling for osteochondritis dissecans (OCD) lesions of the knee.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 2257-2262
- Accuracy analysis of a novel electromagnetic navigation procedure versus a standard fluoroscopic method for retrograde drilling of osteochondritis dissecans lesions of the knee.Am J Sports Med. 2012; 40: 920-926
- Exposure of the orthopaedic surgeon to radiation.J Bone Joint Surg Am. 1993; 75: 326-330
Article info
Publication history
Published online: May 06, 2014
Accepted:
March 11,
2014
Received:
June 16,
2013
Footnotes
Michael Hoffmann and Malte Schroeder contributed equally and therefore share first authorship.
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
