Tunnel-less Modification of the All-Suture Tape Cerclage Technique for Reconstruction of the Coracoclavicular Ligament Complex.

Abstract

Current techniques used in the surgical management of high-grade acromioclavicular joint separation injuries suffer from high rates of postoperative complications. Failure of fixation is the most common adverse event, occurring in approximately 20% of patients. Although it occurs less frequently, postoperative fracture of the clavicle or coracoid involving iatrogenic drill tunnels is a potentially devastating complication that may be avoidable. Capitalizing on the unique structural properties of a commercially available suture tape cerclage, members of the current author group previously published our preferred technique for all-suture tape cerclage reconstruction of the coracoclavicular interval. This technique, however, involved the creation of a drill tunnel through the clavicle for suture passage. After observing 2 patients experience postoperative fractures involving this tunnel, we believed that this technique could be improved on. The resulting modified tunnel-less procedure presented in this article maintains the advantages of the original all-suture tape cerclage technique-namely negligible risk of hardware irritation, limited material requirements, and reliable maintenance of reduction-while reducing the risk of postoperative fracture. In this modified procedure, the suture tape is shuttled around the clavicle, rather than through it, and at no point is cortical bone violated.