Anchorless Acromioclavicular and Coracoclavicular Ligament Repair Using a Graft-Passing Instrument to Pass Suture Under the Coracoid.

Acromioclavicular joint separation is a common shoulder injury. Grade I and II separation may be treated nonoperatively, whereas higher grades tend to require surgical intervention. Various repair techniques have been described in the literature, with no consensus on the gold standard. This Technical Note describes our use of a graft-passing instrument to pass suture under the coracoid during an anatomic reconstruction of both the acromioclavicular and coracoclavicular ligaments. Although this approach is technically challenging, it avoids coracoid drilling and requires smaller-diameter clavicle and acromion drilling. Furthermore, using suture instead of graft material increases the cost-effectiveness of the procedure.

Arthroscopic Single Portal, Single Anchor Knotless Subscapularis Repair with Concomitant Tenodesis of the Long Head of the Biceps Tendon.

Anterior shoulder pathology involving the subscapularis is often associated with the biceps tendon because both anatomic structures intersect the lesser tuberosity. Standard procedures for such pathology often involve simultaneous subscapularis repairs and biceps tenodesis. Single anterior portal subscapularis repairs have been emerging in the past 5 years because of cost-effectiveness and efficiency. Biceps tenodesis is a common procedure performed both open and arthroscopically. This technique takes advantage of the close relation between the long head of the biceps tendon and subscapularis tendon to restore the functional length-tension relation and preserve function through fixation using a single portal and a single knotless suture anchor.

Mini-Open Subpectoral Biceps Tenodesis Using a Suture Anchor with Bone-Bridge Backup.

Pathology of the long head of the biceps tendon is a known cause of anterior shoulder pain. Current surgical management options include tenotomy and tenodesis. Tenodesis can be performed arthroscopically or as an open procedure. Arthroscopic tenodesis typically uses a suprapectoral attachment, which may fail to address tendon pathology in the bicipital groove. Open tenodesis carries iatrogenic risk to neurovascular structures and a fracture risk while drilling, as well as the morbidity of an open procedure. This technique paper describes a mini-open subpectoral approach using a suture anchor and bone bridge backup for dual fixation. Use of a suture anchor instead of an interference screw reduces drill hole diameter reducing the risk of iatrogenic humeral fracture. Dual fixation provides a robust repair which may be of use for athletic patients desiring an accelerated recovery.