Innovations in AC-Joint reconstruction using low-profile implants

Background: Acromioclavicular (AC) joint dislocations are common orthopedic injuries. While various arthroscopic techniques using pulley-like implants have been developed, high rates of persistent horizontal instability and dynamic posterior translation (DPT) remain a clinical challenge. Furthermore, conventional double-button devices often lead to symptomatic hardware prominence and knot stack irritation, frequently necessitating secondary implant removal.

Objective: This article describes a minimally invasive, arthroscopically assisted surgical technique for acute high-grade AC joint separations using a low-profile double-button device combined with an acromioclavicular cerclage to address both vertical and horizontal instability.

Key Points: The procedure utilizes a beach-chair position and three arthroscopic portals to visualize the subcoracoid space. Under fluoroscopic guidance, a transclavicular-transcoracoidal tunnel is established for the insertion of a low-profile TightRope system. Vertical stabilization is achieved through a self-tensioning mechanism, applying 80-100 N of force per suture. To address horizontal stability, a percutaneous AC cerclage is performed by drilling 2.7 mm tunnels through the clavicle and acromion, followed by the placement of a non-absorbable tape in a triangular configuration. This combined approach aims to restore anatomical alignment while the low-profile design minimizes soft tissue irritation and the risk of wound healing complications. Postoperative management involves six weeks of protected range of motion before progressing to strengthening.

Conclusion: The integration of a low-profile double-button system with an additional AC cerclage provides multiplanar stability for acute AC joint dislocations. This technique simplifies anatomical reduction and potentially reduces the need for hardware removal by mitigating knot-related complications.