Shoulder Separation: Reconstructing the AC Joint With a Suture Implant

Shoulder Separation: Reconstructing the AC Joint With a Suture Implant

This surgical demonstration will show the repair of the AC joint following an acute shoulder separation using a knotless suture implant. To review, a shoulder separation is where the ligaments connecting the collarbone, also called the clavicle, to different parts of the shoulder blade are torn. When the ligaments are torn, the collarbone can pop-up out of place. This procedure helps bring the collarbone back down to its normal position with a suture implant that has two metal buttons attached.

Let's get started. Here we have a right shoulder. The front of the patient is to the right of the screen, and the back of the patient is to the left of the screen. The surgeon has the camera, called an arthroscope, positioned in the back of the shoulder. Now, we can see what the camera sees inside the shoulder. Here the surgeon is feeling one of the bony structures of the shoulder blade, called the coracoid process. This is helping them prepare for the next steps in the procedure.

To help bring the collarbone back down, the suture implant will need to pass through both the collarbone and the coracoid process. A drill guide being introduced here, will help the surgeon create this tunnel. The tip of the drill guide will be positioned underneath the coracoid process, and the drill sleeve will be brought down onto the top of the collarbone. The drill is then used to create the path. The center sleeve of the drill is removed, and a passing wire is introduced and retrieved outside of the shoulder.

With the wire pass, the remaining outside portion of the drill is removed. The implant is then brought through the tunnel created using the passing wire. Now that the implant is outside the front of the shoulder, a metal button can be attached. This button will sit underneath the coracoid process. There is already another metal button attached to the top portion of the suture implant that will sit on top of the collarbone. The surgeon will then guide the bottom button into place using a small grasping tool.

Next, the surgeon will begin to tighten the top button down onto the collarbone to complete the reconstruction. To tighten the top button, the surgeon will alternate pulling on each free strand of suture. This will walk the top button down to the collarbone. As the surgeon is pulling, there is a finger trap mechanism just underneath this button that allows the suture construct to tighten and stay tightened without having to tie any knots. Once the collarbone has been reduced back to its normal position, the tensioning sutures of the implant can be cut, and the surgery is complete.