title: Electromagnetic navigation provides high accuracy for transcoracoid-transclavicular drilling.
abstract: OBJECTIVE
  A novel radiation-free electromagnetic navigation system (ENS)-based method was developed, and its feasibility and accuracy for transclavicular-transcoracoid drilling procedures were evaluated in an experimental setting.
  
  
  METHODS
  Sixteen arthroscopically assisted electromagnetic navigated transcoracoid-transclavicular drilling procedures with subsequent TightRope device implantation were performed on eight human cadavers. Post-operative fluoroscopy and CT-scan analysis were acquired to determine tunnel placement accuracy. Optimal tunnel placement was defined as both the coracoid entry and exit point of the tunnel localized in the centre position of the coracoid base without cortical breach or fracture.
  
  
  RESULTS
  Successful tunnel placement was accomplished in all 16 cases. The mean overall operation time was 30.3 ± 5.0 min. Regarding the coracoid exit point, 15 of 16 tunnels (93.8%) were localized in the desired base-centre position. During the navigated drilling procedure, no misguidance of the drill requiring directional readjustments or restarts occurred. No cortical breach, no fractures and no complications occurred.
  
  
  CONCLUSIONS
  The electromagnetically navigated transcoracoid-transclavicular drilling procedure used in this study demonstrated high targeting accuracy, required no intraoperative radiographs, was associated with no complications and provided user-friendliness.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany, mi.hoffmann@uke.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoffmann
authors.forename: Maximilian
authors.initials: M
authors.lastname: Hartel
authors.forename: Malte
authors.initials: M
authors.lastname: Schroeder
authors.forename: Oliver
authors.initials: O
authors.lastname: Reinsch
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Spiro
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Ruecker
authors.forename: Lars
authors.initials: L
authors.lastname: Grossterlinden
authors.forename: Daniel
authors.initials: D
authors.lastname: Briem
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Rueger
authors.forename: Jan Phillip
authors.initials: JP
authors.lastname: Petersen
mesh_terms: D000173:Acromioclavicular Joint / Q000293:injuries / Q000601:surgery*; D000328:Adult; D001182:Arthroscopy; D002102:Cadaver; D002968:Clavicle / Q000000981:diagnostic imaging / Q000601:surgery*; D055590:Electromagnetic Phenomena; D005240:Feasibility Studies; D005471:Fluoroscopy; D006801:Humans; D019919:Prosthesis Implantation; D012540:Scapula / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed