Arthroscopic Acromioclavicular Joint Fixation in Acute High-Grade Injuries Using a Single Button Over the Clavicle...

As the existing literature attests, the treatment modalities of acute acromioclavicular (AC) joint injuries are diverse, and outcomes are often unpredictable due to a significant rate of complications. The lack of consensus even exists in the very indications for operative treatment, notably for Rockwood type 3 injuries. Historically, popular methods of fixation like hook plate and k-wires have recently given way to a suspensory type of fixation to stabilize the clavicle using the coracoid, which offers a more appealing option as they have been found to have lesser complications in comparison to the former methods. The use of hook plates mandates a second surgery for implant removal and presents risks of acromial osteolysis, rotator cuff injury, and altered scapular biomechanics, whereas k-wires are notorious for their potential to migrate in the chest wall, cause hardware irritation, and have a higher rate of loss of reduction. In this article, we describe an arthroscopic-assisted method of reducing the AC joint using a Hohman's retractor as a lever, maintaining vertical stability by internal bracing of the coracoclavicular ligaments using a FiberTape (Arthrex) and dog button (Arthrex) and conferring horizontal stability by AC ligament reconstruction.