I was proud to watch Kristine Italia our fellow present on arthroscopic acromioclavicular joint (ACJ) reconstruction at the Asia Pacific Orthopaedic Association (APOA) in Kuala Lumpur today. Kristine was awarded the Young Orthopaedic Surgeon (YOS) Grant to attend the APOA conference to present her scientific paper. It is really terrific to see Kristine becoming a confident speaker on the podium as well as an excellent surgeon. Kristine handled the questions from the other orthopaedic surgeons about her presentation with ease today, the questions can get a bit tricky sometimes.......
This all-arthroscopic technique for acromioclavicular joint reconstruction uses the arthrex dog bone prosthesis with two ABS tightropes to reconstruct the coracoclavicular ligaments and the arthrex internal brace to prosthesis to reconstruct the acromioclavicular joint. Tendon allograft is passed around the coracoid and clavicle to reinforce the repair for long term strength of the construct.
Historically reconstructions of AC joint dislocations have concentrated on the coracoclavicular ligaments which primarily controls supero-inferior stability but does little to control antero-posterior stability. We now appreciate that AC joint dislocations are more complex than a simple superior displacement of the clavicle that is seen on plain XRays. The instability of an AC joint dislocation involves both supero-inferior instability and antero-posterior instability. Success rates with reconstructive procedures are higher if anteroposterior instability is addressed as well.
This technique addresses the antero-posterior instability by reconstructing the AC joint ligaments with the internal brace prosthesis across the front of the AC joint bringing the AC joint into alignment by not only pulling the clavicle down but also forwards so that the AC joint lines up when viewed from above as well as from the front.
To avoid late failure of the construct which happens in at least 30% of reconstructions tendon allograft is placed around the coracoid process and clavicle. This tendon allograft eventually becomes incorporated by the body and takes up the strength of the construct 6 months down the track when the mechanical implants start to be become compromised due to the long term fatigue effects that all mechanical devices are subject to.