Arthroscopic Transarticular Distal Clavicle Resection

ABSTRACT Bursal and superior direct arthroscopic distal clavicleresection techniques exist. An indirect transarticulardistal clavicle resection (TADCR) technique, in whichthe bone resection is performed directly through theacromioclavicular joint (ACJ), is presented. With thearthroscope in the lateral portal and viewing at the ACJ,the TADCR begins by inserting a needle into the ACJ todetermine the angle of entrance (a 5-mm skin incisiondirectly over the mid portion of the ACJ is made). Then,with a No. 11 blade, a 4- to 5-mm incision, which is justlarge enough to ensure the pass of the motorized instru-ments, is made in the mid portion of the superioracromioclavicular ligament (SACL) parallel to its fibers.A radiofrequency probe is inserted, and the ACJ`s softtissues are excised, taking care not to damage the SACL.Then, the saver is introduced to clean up the soft tissue`sdebris. Finally, a 4.0-mm oval burr is inserted and, with afan-shaped motion, bone is resected from clavicle andacromion without damaging the superior ligament. TheTADCR is an easy technique that produces consistentbone resection, sparing the SACL.Keywords: arthroscopic, distal clavicle, resection,Munford procedure