We present a new arthroscopic technique for chronic AC joint dislocations with coracoacromial ligament transposition and augmentation by the Tight Rope device (Arthrex, Naples, USA). First the glenohumeral joint is visualised to repair concomitant lesions, such as SLAP lesions, if needed. Once the rotator interval is opened and the coracoid is identified, the arthroscope is moved to an additional anterolateral portal. A 1.5 cm incision is made 2 cm medial to the AC joint. After drilling a 4 mm hole with a cannulated drill through the clavicle and coracoid a Tight Rope is inserted, the clavicule is reduced and stabilized with the implant. The arthroscope is moved to the subacromial space and a partial bursectomy is performed to visualise the CA ligament and lateral clavicle. The CA ligament is armed with a strong braided suture using a Lasso stitch and dissected from the undersurface of the acromion. It is then reattached to the distal part of the clavicle by transosseous suture fixation after abrasion of its undersurface. Although this combined arthroscopic procedure of AC joint augmentation with a Tight Rope combined with a ligament transposition is technically demanding, it is a safe method to reconstruct the coracoclavicular ligaments and achieve a sufficient reduction of the clavicle without the need of further implant removal or autologous tendon transplantation.

译文

:我们提出了一种新的关节镜技术,用于通过锁紧韧带装置(Arthrex,那不勒斯,美国)进行伴有肩锁韧带移位和增生的慢性AC关节脱位。首先,如果需要,将肱肱关节可视化以修复伴随的病变,例如SLAP病变。一旦打开了转子间隔并确定了喙突,便将关节镜移至另一个前外侧门。在AC关节内侧2厘米处开一个1.5厘米的切口。用空心钻在锁骨和喙突上钻一个4毫米的孔后,插入一根紧绳,锁骨缩小并通过植入物稳定。将关节​​镜移至肩峰下间隙,并进行部分滑囊切除术以可视化CA韧带和外侧锁骨。 CA韧带采用拉索针法结扎有强力的编织线,并从肩峰下表面解剖。然后在其下表面磨损后,通过穿骨缝线固定将其重新连接到锁骨的远端。尽管在技术上要求将AC关节增强术与紧绳结合韧带移位的联合关节镜检查方法相结合,但这是一种安全的方法,可重建锁骨锁骨韧带并实现锁骨的充分复位,而无需进一步去除种植体或自体肌腱移植。

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