Sports surgery – acromioclavicular dislocation

Definition of acromioclavicular joint dislocations:

In sports surgery, the acromioclavicular joint dislocation is found as a result of a violent fall onto the shoulder, as in combat sports or cycling. The dislocation between the acromion and the clavicle is a frequent injury; this trauma, called acromioclavicular dislocation, is the consequence of a violent fall onto the shoulder point.

Acromioclavicular dislocation, violent fall onto the shoulder point in combat sportsAcromioclavicular dislocation is frequent in cycling falls

 

In this sports injury of the shoulder, when the dislocation of the acromion and the clavicle extends to the coracoclavicular ligament, a piano key forms under the skin at the clavicle. In these severe traumatic forms, specialist arthroscopic shoulder repair surgery must be performed.

Video of arthroscopic surgery for acromioclavicular joint dislocation:

Video of arthroscopic sports surgery for acromioclavicular joint dislocation / Toulouse specialist

Diagnosis of acromioclavicular joint dislocation:

This x-ray shows the shoulder opposite the injured one, with the joint between the acromion and the clavicle perfectly aligned.
On the side of the injured shoulder, however, there is a loss of articular contact and it is possible to see the clavicle protruding under the skin.

Shoulder trauma, acromioclavicular joint dislocation, piano key of clavicleUntraumatized contralateral shoulder, acromioclavicular congruity, Toulousee

 

Arthroscopic surgical treatment of acromio-clavicular joint dislocation:

In this arthroscopic shoulder surgery, only 3 mini-incisions are needed, one superior 3,5 cm away from the free edge of the clavicle and two arthroscopic portals, one anterolateral for optics and one anteromedial for instruments.
Dissection begins in the subacromial space of the shoulder and then, by following the acromiocoracoid ligament, the inferior edge of the coracoid is found. The acromioclavicular ligament will thus be perfectly preserved; besides it can be used to reinforce the surgical repair in forms treated belatedly. The inferior edge of the coracoid is released step by step until its process is visible at one extremity and the conjoined tendon at the other extremity.
A target guide is then introduced for a coaxial tunnel to be drilled between the clavicle and the coracoid. First a pin is introduced, whose perfect centring under the coracoid is verified, then a cannulated drill bit and finally, through the cannulated drill bit, a guide can be passed and retrieved from the anteromedial incision.

Acromioclavicular dislocation operated arthroscopically, inferior side of coracoidAcromioclavicular dislocation at shoulder arthroscopy, implant under the coracoid, Toulouse

 

 

A relay thread can then be passed, which will allow the implant to be positioned between the clavicle and the coracoid. Once the implant is positioned, it is put under tension so as to achieve reduction of the coracoclavicular interval and then the acromioclavicular joint of the shoulder. The relay thread can be removed.
In dislocations that are operated on early, this is the end of arthroscopic surgery.
Below is the x-ray of the reduction, with the two plates of the implant perfectly positioned, one over the clavicle, the other underneath.

Only three cutaneous mini-incisions are necessary in arthroscopic shoulder surgery for acromioclavicular dislocations

Postoperative x-ray of the shoulder in an acromioclavicular dislocation treated by arthroscopic surgery, ToulousePostoperative x-ray of the shoulder in an acromioclavicular dislocation treated by arthroscopic surgery, Toulouse

 

Recovery and recuperation after acromioclavicular joint dislocation surgery

Shoulder scarring is minimal. Daily life activities can resume at 6 weeks, forceful movements with the shoulder such as rugby can resume at 3 months.

Arthroscopic shoulder surgery for acromioclavicular dislocation, scar at 1 monthArthroscopy for acromioclavicular dislocation, rugby resumes at 3 months, Toulouse