ACROMIOCLAVICULAR [CASE 3] TightRope Fixation

Anatomical reduction of the acromioclavicular dislocation requires precision in creating two independent, aligned holes — one in the coracoid process and another in the clavicle — in a region of high vascularization and limited bone exposure, where any deviation of a few centimeters in the approach compromises retraction and visualization of the structures. This training presents reduction and fixation with the TightRope device through a minimally invasive longitudinal approach, guided by biplanar fluoroscopy, with a deliberate hypercorrection technique to compensate for the natural settling of soft tissues — all documented in 4K video, from the surgeon's direct perspective.

TRAINING FOCUS

• Patient positioning and radiographic views (anteroposterior and simulated axillary)
• Skin marking guided by dual fluoroscopic imaging
• Infiltration with vasoconstrictor anesthetic for bleeding control
• Minimally invasive longitudinal approach
• Detachment of the pectoral muscle and exposure of the superior surface of the clavicle
• Delimitation of the coracoid process with Langenbeck and Farabeuf retractors
• Creation of the hole in the coracoid process under direct visualization
• Drilling of the clavicle with a drill bit compatible with the TightRope
• Passage of the wires with Mixter forceps and guide instrumentation
• Introduction and locking of the TightRope button
• Reduction with deliberate hypercorrection and bone anchoring
• Layered suturing and closure of the surgical wound

DETAILED CONTENT

• Biplanar radiographic views: combination of anteroposterior and simulated axillary views for precise localization of the coracoid process and the lateral third of the clavicle prior to incision.
• Marking with a dermographic pen: transposition of fluoroscopic reference points onto the skin, reducing the risk of a poorly positioned approach and retraction difficulties.
• Infiltration with vasoconstrictor: bleeding control in a highly vascularized region, keeping the field clean throughout the dissection.
• Triple retraction of the coracoid process: combined use of Langenbeck and Farabeuf retractors for top-to-bottom bone exposure without residual soft tissue.
• Independent, aligned holes: drilling of the coracoid process and the clavicle at calculated points to ensure a trajectory compatible with the TightRope device.
• Wire passage guided by Mixter forceps: technique for transposing the needled wire through the created hole, preparing for implant introduction.
• Locking and testing of the TightRope button: traction maneuver to confirm adequate bone anchoring, verified by control fluoroscopy.
• Deliberate hypercorrection of the reduction: planned compensation for the expected loss of correction due to soft tissue interposition at the inferior button.
• Concealed knot suturing: technique of folding the excess wire for coverage beneath the muscular plane, optimizing aesthetic and functional outcomes.

INCLUDED MATERIAL

Detailed PDF: document with the complete case analysis, including the step-by-step operative sequence, the biomechanical principles of TightRope fixation at the acromioclavicular joint, and the positioning, fluoroscopy, and post-fixation control protocols used in the procedure.

Master acromioclavicular dislocation reduction and fixation with TightRope through a real case, documented in detail — enroll now and bring this technique to your surgical practice.