Minimalinvasive Akromioklavikulargelenk-Rekonstruktion (MINAR)

Several studies have shown that augmentation of the coraco-clavicular ligaments with a suture cerclage is a reliable technique for the treatment of AC joint dislocations. The disadvantage of this technique is its invasiveness for exposing the coracoid process. The aim of this study is to introduce a new minimally invasive technique (MINAR) for reposition and stabilization of the acromio-clavicular (AC) joint by using a button/suture cerclage (FlippTack, Karl Storz, Tuttlingen). Indications for this technique are acute AC joint dislocations Rockwood III–V. The coracoid process is exposed by a 3 cm skin incision and with the aid of a special aiming device a hole is drilled for passing the button through the coracoid. The two buttons are then fixed with a 1 mm Ethibond® suture. Thereafter, one of the buttons is pushed by a special application device through the coracoid and flips underneath the coracoid thereby fixing the suture. The remaining button is pulled through a hole in the clavicle. After repositioning the dislocated joint, the construct is fixed by a surgical knot above the clavicle button. In this study, we were able to evaluate 23 patients with a follow-up of 23 months (range 18–28 months). The mean duration of the surgical intervention was 28.6 min. Peri- or postoperative complications (e.g., vascular or nerve damage, thorax injuries, infections, thrombosis, embolism) were not encountered. Secondary reluxations did not occur. In two cases, we observed a reposition loss of half a shaft width, which did not interfere with the clinical result. The Constant Murley score was 94 points (range 89–97 points). By using our minimally invasive technique for AC joint reconstruction (MINAR), the clinical results are comparable to those achieved by commonly used suture cerclage techniques. Hardware removal like in techniques using a hook plate, Bosworth screw or a k-wire cerclage is not necessary.