Table 1.

Pearls, Pitfalls, Key Points, and Indications

Pearls
Use of a 70° arthroscope can be very helpful in visualization near the base of the coracoid.
The anterolateral portal provides an optimal trajectory for clearing away the soft tissue from the base of the coracoid.
Be familiar with the order of placement of and passing of the shuttling devices and sutures to allow an uncomplicated graft passage around the coracoid.
Meticulous preparation of the leading end of the graft will ease its passage around the coracoid.
It is helpful to have an experienced assistant perform the drilling of the conoid and trapezoid guidewires and tunnels while the surgeon visualizes his or her approach to the guide target.
During the tensioning of the graft around the coracoid, use simultaneous downward displacement of the clavicle with superior displacement of the scapulohumeral complex to minimize any excess slack in the graft before fixation.
During the fixation of the graft in the clavicular tunnels, pull the graft superiorly and in line with both its tunnel and 5.5-mm PEEK (polyether ether ketone) screw to minimize the risk of graft tearing between the bone and the screw.
Verify an acceptable position of the reduced acromioclavicular joint with a Zanca radiograph before fixation with the second PEEK screw.
Place the patient in a gunslinger brace before awaking from anesthesia to minimize undue stress to the reconstruction.
Pitfalls
Debridement near the base of the coracoid poses particular risk to the musculocutaneous nerve if dissection drifts medially or inferiorly.
Anterior and anterolateral 8.25-mm cannulated portals placed too close together in the anterior shoulder can cause crowding of the cannulas making coracoid dissection difficult.
A suboptimally prepared graft without a smooth contoured leading edge will more easily be caught up in the soft tissues during passage around the coracoid.
The surgeon should be familiar with the detailed anatomy of the anterior shoulder as well as the open approach technique for coracoclavicular ligament reconstruction before use of this technique.
Key Points
This technique carries the advantages of an arthroscopic approach to anatomic coracoclavicular ligament reconstruction while preserving the structural integrity of the coracoid process.
If necessary this approach can be extended to a traditional open approach at any stage during the procedure.
Indications
This technique is indicated for chronic (>4 weeks) type III to V acromioclavicular joint separations.

PEEK, polyether ether ketone.