title: [Arthroscopically assisted reconstruction of acute and chronic AC joint separations].
abstract: OBJECTIVE
  The surgical procedure aims at anatomic reduction and stabilization of the acromioclavicular joint in vertical and horizontal planes for acute separations using a trans-clavicular and trans-coracoidal suture tape fixation with additional acromioclavicular joint augmentation with a PDS cord cerclage. For chronic instability adding a tendon graft is essential for sustainable stability.
  
  
  METHODS
  Acute und chronic acromioclavicular joint separations type Rockwood III-VI. Recurrent AC-joint instability with intact coracoid process (with tendon graft).
  
  
  METHODS
  Acromioclavicular joint separations type Rockwood I-II. Asymptomatic chronic AC-separations type Rockwood III-IV. Fracture close to base of coracoid process General contraindications for (elective) surgery.
  
  
  METHODS
  Vertical reconstruction of the coraco-clavicular ligaments using a drill-guide for trans-clavicular and trans-coracoidal tunnel placement for high-strength suture tapes over titanium buttons. Additional stabilization of the AC-joint with a transosseus figure of 8 PDS suture cord cerclage.
  
  
  METHODS
  Postoperatively the arm is put in a regular sling for 6 weeks. Free active range of motion of wrist and elbow. Shoulder range of motion is limited to 30° of flexion and abduction and 80° internal and 0° external rotation for 2 weeks. Extended to active-assisted 45° flexion and abduction in weeks 3 and 4 and advanced to 60° flexion/abduction and free internal/external rotation in weeks 5 and 6. Range of motion is unlimited from week 7. Full daily life activities after 3 months, high-impact sports after 5-6 months postoperatively.
  
  
  RESULTS
  The presented surgical technique reliably stabilizes the acromioclavicular joint. It's biomechanical properties with only the single-tunnel coracoclavicular suture tapes is on the level of the native vertical stability, which can be additionally improved for better horizontal stability with the cerclage over the AC-joint.
authors.affiliation: Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland, sebra16@mac.com.
authors.forename: S
authors.initials: S
authors.lastname: Braun
authors.forename: F
authors.initials: F
authors.lastname: Martetschläger
authors.forename: A B
authors.initials: AB
authors.lastname: Imhoff
mesh_terms: D000173:Acromioclavicular Joint; D001178:Arthroplasty / Q000295:instrumentation / Q000379:methods* / Q000534:rehabilitation; D006801:Humans; D007103:Immobilization / Q000379:methods; D004204:Joint Dislocations / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome