Arthroscopically guided navigation for repair of acromioclavicular joint dislocations: a safe technique with reduced intraoperative radiation exposure

Abstract

BackgroundAccuracy evaluation of navigated image free placement of double cortical fixation buttons for coracoclavicular tunnel position in comparison to conventional drill guide based placement.MethodsTwenty-six patients with acute acromioclavicular joint instability were included in this non-randomized cohort study. All patients were treated with a Double- TightRope technique. In 13 cases the conventional drill guide based placement was used (group 1). In 13 patients surgery was performed as a navigated procedure with a fluoro-free optoelectronic system (group 2). The number of coracoclavicular drillings per patient (First pass accuracy; FPA (%)) was documented, the subcoracoidal position of the fixation buttons has been evaluated and graded as “intended position achieved (IPA)” or “intended position not achieved (IPnA)”.ResultsIn group 1 drilling had to be repeated in four patients (30.8 %) to achieve proper placement of the subcoracoidal fixation buttons. 100 % first pass accuracy was observed in group 2 (p = 0.03). In group 1, the intended position of the subcoracoid buttons was not achieved (IPnA) in six patients (46.2 %). In group 2 all intended positions were achieved (p = 0.005).ConclusionArthroscopic controlled fluoro-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation has higher first pass accuracy in comparison to conventional drill guide based placement. Therefore the navigation enables a precise position of the drill holes, may reduce the risk of an iatrogenic coracoid fracture and migration of fixation devices.Trial registrationLocal institutional review board No. 061-14-10032014

Anatomical versus non-anatomical configuration of double coraco-clavicular tunnel technique in acromioclavicular joint reconstruction

“…This is technically challenging and wrong placement or repeated drilling can result in a failure of the coracoid [ 13 , 34 ], presumably discouraging surgeons from using these techniques. As an advanced solution, image-free navigated coracoclavicular drilling may enable a precise anatomical positioning of the drill holes [ 35 ], reducing the risk of iatrogenic coracoid fractures [ 36 ].…”

Clinical outcomes of arthroscopic and navigation-assisted two tunnel technique for coracoclavicular ligament augmentation of acute acromioclavicular joint dislocations

“…The corresponding drilling direction of the sleeve was then compared with the red line to reach the corresponding target point. An autopilot was used to orient the navigated instruments, similar to its recent application in trauma software [ 18 , 20 ].…”

“…When multiple attempts are needed to find the optimal drill hole position, fractures of the coracoid can occur, [14][15][16][17] resulting in construct failure and poor outcomes [14][15][16]. Navigation-assisted techniques can be used to avoid multiple drilling attempts [18][19][20][21]. The aim of this study was to present a navigation-assisted augmentation technique for the ACJ and CC ligaments and to report the clinical and radiological outcomes of this technique.…”

An Accuracy Comparison of Minimally Invasive Transclavicular‐Transcortical Drilling with Free‐Hand, C‐Shape and Assembly‐Type Guide Device: An In Vitro Study

“…The Advantages of the Assembly Guide Device in Transclavicular-Transcoracoid Drilling Compared to c-arm fluoroscopy 17,18 and arthroscopically assisted drilling 8,15 , guide techniques have the advantages of being relatively inexpensive, simple, effective, and free of radiation exposure 6,16,20 . But it is very difficult to locate the basement tunnel under the coracoid process without arthroscopic assistance.…”