Slide 1: Reconstruction of shoulder separation and a.c. dislocation
2: This injury is most common in the 2nd decade. To commonly sided mechanisms of injury included direct force to the superior aspect of the shoulder blade.
3: Type III dislocations 10 to be the most controversial with regard to whether surgery or nonsurgical treatment results in the past outcomes. This is partly because there are so many reported techniques with correspondingly high failure rates. When evaluating a technique it's important to evaluate the initial strength of fixation, the cyclic failure load and rate.
4: This is also a relatively low-volume procedure for most orthopedic surgeons so the level of expertise on the learning curve is also correspondingly low. Our goal is to review a reliable technique for both acute and chronic injuries in this presentation.
5: The basis of this technique is to visualize the inferior aspect of the coracoid so that this can be drilled under direct visualization to minimize risk.
6: Once the appropriate drill hole has been placed the ToggleLoc flip button is passed to the inferior aspect of the coracoid for primary cortical fixation.
7: Once the button has been deployed, the 2nd washer is placed at the superior aspect of the clavicle to allow reduction of the separation.
8: Once the reduction has been achieved the ZipLoop technology provides excellent primary fixation.
9: That completed acute repair and the device are shown here
10: Here is in animation of the technique
11: For the chronic technique we include reconstruction of the ligaments in an anatomic method without drilling large holes in the clavicle or coracoid to minimize risk of fracture propagation. We perform all shoulder arthroscopy in the modified lateral decubitus position
12: Arthroscopic view of the guidewire and cannulated drill at the inferior aspect of the coracoid
13: The device with 2 zip loops allows one loop to be utilized for reduction and the other loop to secure the graft at the coracoid origin of the ligaments
14: Here is a sawbones model demonstrating that technique with initial deployment of the flip button at the inferior aspect of the coracoid
15: Arthroscopic view of the deployed button followed by retrieval of one loop anterior to clavicle while leaving the 2nd loop through the drill hole in the clavicle for reduction
16: The graft has been secured to the origin of the ligaments at the superior aspect of the coracoid by reducing the anterior loop completely. One limb of the graft is now passed posterior to the clavicle.
17: The loop coming through the clavicle is utilized to reduce the separation/dislocation followed by tying the graft over the clavicle securely. This recreates both limbs of the native ligaments. The graft also remodels and is completely replaced by the patient's own tissue over a 6-18 month time course so that the knot on top of the clavicle gradually remodels flat.