[Minimally Invasive Acromioclavicular Joint Reconstruction (MINAR)].

OBJECTIVE: Reduction and retention of an acromioclavicular (AC) joint dislocation with a button/suture augmentation cerclage (Flip tack, Karl Storz, Tuttlingen, Germany). INDICATIONS: Dislocation of the AC joint (Rockwood III and V). Chronic instabilities in combination with autogenous replacement of the coracoclavicular ligaments. Lateral clavicular fracture with rupture of the coracoclavicular ligaments. CONTRAINDICATIONS: Patients in poor general condition. Local soft-tissue infection. Low-degree dislocation of AC joint (Rockwood I und II). Fracture of the clavicular shaft. Chronic instabilities without ligament replacement. SURGICAL TECHNIQUE: The coracoid process is exposed by a 3 cm long skin incision. A hole is drilled through the coracoid process with the help of a specific aiming device. The suture cerclage is connected to two buttons. One of the buttons is then pushed through the coracoid process. The button is flipped and the suture thereby fixed to the coracoid process. The other anchor is pulled through a hole in the clavicle and the cerclage is secured with a surgical knot after reduction of the AC joint. POSTOPERATIVE MANAGEMENT: Application of an abduction splint for 4 weeks (15 degrees).
RESULTS: 23 patients with an acute luxation of the AC joint were operated with a minimally invasive coracoclavicular cerclage (five patients with Rockwood type III and 18 patients with Rockwood type V). Mean operative time was 28.6 min. Perior postoperative complications such as nerve and vascular injuries, thoracic injuries, infection, thrombosis, and embolism did not occur. The mean Constant Score was 94.1 points (73-100 points) after a mean of 23.3 months (18-28 months). In two cases, a slight loss of reposition of less than half of the clavicle width in comparison with the contralateral side was observed.