ARTHROSCOPIC STABILISATION OF ACUTE DISTAL CLAVICLE FRACTURES AND DISLOCATIONS USING THE TIGHTROPE SYNDESMOSIS REPAIR SYSTEM.

Disruption of the coraco-clavicular ligaments may be associated with either dislocation of the AC joint or fracture of the distal clavicle. If sufficient displacement occurs, functional disability results. Traditional techniques have required a bra-strap incision and often require late removal of the metalwork. The Tightrope syndesmosis repair system was adapted to be used arthroscopically to reduce and hold the clavicle enabling healing of the ligaments and any associated fracture using a minimally invasive technique but ensuring accurate reduction and secure stabilisation. Between December 2004 and November 2006, 21 patients with acute injuries to the corac-clavicular ligaments in our institution were treated using this system. As the system was in evolution the majority were treated arthroscopically and a few using an “open” technique. All had either the acromio-clavicular joint reduced or a distal clavicle fracture reduced and stabilised using the Tightrope Syndesmosis Repair system. The system had been modified from that commercially available for use in the ankle with the consent of the manufacturer (Arthrex, Naples, Fla). All patients were evaluated at a minimum of 6 months (range 6–32 months) post operatively using the DASH, ASES and Constant scores The mean ASES score was 95, the mean Constant score was 94, and the mean DASH score was 2.5. There were no complications and two patient required removal of the clavicle endobutton. The authors conclude that this new technique is a safe, simple, cosmetically acceptable and reproducible method of reducing and stabilising the distal clavicle allowing for healing of either the coraco-clavicular ligaments or the distal clavicle