Domain of Expertise: Orthopedic Surgery, Sports Medicine, and Surgical Instrumentation.
Persona: Senior Orthopedic Surgeon / Medical Consultant.
Abstract
This instructional video, presented by Paul J. Cagle, MD, details a "tunnelless" approach to acromioclavicular (AC) joint repair utilizing the Arthrex AC FiberTape® cerclage system. The procedure is designed for a single mini-open approach, significantly minimizing soft tissue dissection and avoiding the requirement for bone tunnels. The technique emphasizes a specific order of suture passage—medial to lateral around the coracoid and anterosuperior to posteroinferior around the clavicle—to ensure the final knot resides inferior to the clavicle, thereby mitigating soft tissue irritation. The workflow relies on specialized instrumentation, including dilating passers and a single-use mechanical tensioner, to achieve precise, rigid reduction of the AC joint.
Summary of Procedural Workflow
0:00 Initial Exposure: A 3 to 3.5 cm mini-open longitudinal incision is made over the clavicle, extending from the superior coracoid to the midclavicle. Fascial planes are identified and the deltoid corners are tagged for later reapproximation.
1:20 Kit Overview: The AC Cerclage kit includes a range of specialized tools: a dilating passer for safe passage, a dedicated clavicle passer, and a single-use mechanical tensioner.
2:36 Coracoid Passage: Using the small passer, the surgeon traverses from medial to lateral. If additional clearance is required, a dilating passer is deployed to create space around the coracoid without excessive dissection.
3:55 Clavicle Passage: The suture is passed from anterosuperior to posteroinferior. This placement is critical, as it ensures the resultant knot sits inferior to the clavicle to prevent post-operative subcutaneous hardware irritation.
4:51 Knot Shuttling: The knot mechanism is carefully shuttled and reduced against the inferior aspect of the clavicle, ensuring equal tension across the suture limbs.
5:41 Mechanical Tensioning: The tensioning device is applied. The surgeon monitors demarcations on the device, typically advancing to the "fourth line" to achieve anatomical reduction.
7:03 Compensation for Compression: Surgeons must account for "soft tissue creep" or periosteal compression by adding a final quarter or half-turn of tension to ensure the construct remains rigid.
7:25 Knot Security: After removing the tensioner, the construct is secured with a series of half-hitch knots using the device as an elegant knot-pusher to maintain the reduction during the locking process.