A paper in Arthroscopy Techniques
Dr Cutbush has had a paper published in the Journal of Arthroscopy, Arthroscopy Techniques describing an all-arthroscopic procedure for the reconstruction of acromioclavicular joint dislocations.
What the AC joint is and how it dislocates
The acromioclavicular joint is the small joint at the top of the shoulder where the outer end of the collarbone meets the shoulder blade. It is held in place by the capsule and ligaments around the joint itself and, more importantly for vertical stability, by the coracoclavicular ligaments running from the collarbone down to the coracoid process. A fall directly onto the point of the shoulder is the usual mechanism of injury, and depending on which of those structures tear, the collarbone can sit progressively more prominently.
Many of these injuries do not require surgery. Lower-grade separations are generally managed in a sling with a period of rehabilitation, and the prominence that remains is often cosmetic rather than functional.
What this technique does differently
Where reconstruction is indicated, most described techniques concentrate on reconstructing the coracoclavicular ligaments. The technique in this paper reconstructs those ligaments and, in addition, the acromioclavicular joint capsule and ligaments.
The rationale is that including the joint's own capsule and ligaments adds strength to the reconstruction, particularly against horizontal movement of the collarbone, which the coracoclavicular ligaments alone do not control well. The expectation is that this will translate into lower failure rates, and Dr Cutbush is researching whether success rates exceed those of previously described procedures. That work was ongoing at the time of writing and no outcome data is presented here.
Why an arthroscopic approach
Arthroscopic techniques are generally associated with less post-operative pain and reduced morbidity than equivalent open surgery, which is the reason for pursuing an all-arthroscopic version of this reconstruction. Individual results vary.
Related information
See our pages on AC joint arthrosis, shoulder injuries and shoulder surgery. To arrange an assessment, see the consultation page.