Shoulder Separation: Reconstructing the AC Joint With a Suture Implant Animation

Shoulder Separation: Reconstructing the AC Joint With a Suture Implant Animation

This animation will demonstrate a minimally invasive reconstruction of the Acromioclavicular or AC joint using a suture implant following a shoulder separation injury. Here we will see a suture implant with two metal buttons used. The top metal button allows for the suture to be secured without the use of knots. In the past, these knots may have sat on top of the collarbone, and a patient may have been able to feel them after surgery through their skin.

In this animation we see a right shoulder. First, the AC joint is reduced back down to its normal position. Next, we see a purple tube called a cannula, where the surgeon has placed a small camera, an arthroscope, into the shoulder so they may view inside. In another blue cannula, the surgeon will introduce a drill guide and place it under the bony projection called the coracoid process. The other end of this drill guide will be placed through a small mini-open incision on the top of the collarbone and brought down directly onto the bone.

This will help the surgeon drill from the collarbone, the clavicle, to the coracoid, and ultimately helps create where the suture implant will sit. The drill now acts as a hollow tube. Through the drill, the surgeon introduces a flexible wire with a loop at the top end. In this loop you will see that white suture being brought through the collarbone and the coracoid process eventually out the blue cannula in the front of the shoulder. The white suture is part of our suture implant attached to our top metal button.

The bottom of the white suture implant has two loops that are interconnected with one another. Once this interconnected portion is outside the shoulder, the surgeon will attach a metal button to these sutures. This button will sit on the underside of the coracoid process, whereas the other metal button 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. Once complete, the surgeon will take X-rays to double-check that the AC joint is still reduced. They will then cut the tails of the suture and close the incisions.