3D C-arm navigated acromioclavicular joint stabilization

Abstract

Introduction Surgical treatment options for acromioclavicular joint separations are varied. Frequently, suspension devices (SD) are inserted for stabilization under arthroscopic view. This study investigates the feasibility and accuracy of three-dimensional (3D) digital-volume-tomography (DVT) C-arm navigated implantation with regard to the general trend toward increasingly minimally invasive procedures. Materials and methods The implantation of a TightRope® suture button system (SD) via a navigated vertical drill channel through the clavicle and coracoid was investigated in 10 synthetic shoulder models with a mobile isocentric C-arm image intensifier setup in the usual parasagittal position. Thereby, in addition the placement of an additive horizontal suture cerclage via a navigated drill channel through the acromion was assessed. Results All vertical drill channels in the Coracoclavicular (CC) direction could be placed in a line centrally through the clavicle and the coracoid base. The horizontal drill channels in the Acromioclavicular (AC) direction ran strictly in the acromion, without affecting the AC joint or lateral clavicle. All SD could be well inserted and anchored. After tensioning and knotting of the system, the application of the horizontal AC cerclage was easily possible. The image quality was good and all relevant structures could be assessed well. Conclusion Intraoperative 3D DVT imaging of the shoulder joint using a mobile isocentric C-arm in the usual parasagittal position to the patient is possible. Likewise, DVT navigated SD implantation at the AC joint in CC and AC direction on a synthetic shoulder model. By combining both methods, the application in vivo could be possible. Further clinical studies on feasibility and comparison with established methods should be performed.

The Method of 3D C-arm Navigated AC Joint Stabilization-Surgical Technique

“…By using intraoperative 3D imaging with image-guided computer navigation to assess the AC joint position and drill tunnel placement, the NSB method should be even less invasive and more accurate [39][40][41]45].…”

“…The clinical feasibility of intraoperative 3D imaging on the shoulder can make imagebased computer navigation possible with the option of navigated drill tunnel creation and suture button system implantation (navigated suture button (NSB) method). A few in vitro studies on cadaver shoulders and synthetic shoulder models have already been published [39][40][41], but the method has not yet been demonstrated clinically. However, in the future, it may be possible to achieve a further reduction in invasiveness while, at the same time, increasing the precision of implant placement for the best possible anatomical reconstruction.…”