2021 Annual Meeting Shoulder Access Pass-Case Panel: My Worst Complications-Bottoni

Video Transcription

joint surgery. First one, don't operate on all AC joints. If you operate, you're going to get failure.  Results of non-operative treatment in both type 3 and type 5 have been demonstrated to get adequate results, so don't think about operating on all AC joints.  Late reconstruction have been shown to have equivalent results, so you certainly can wait and see if the patient does okay, and then operate if necessary.  If you do operate, as our illustrious leader says, do an anatomic reconstruction and use a graft. So whether it's autograft or allograft, use a graft as part of the reconstruction.  So anatomic reconstruction of both cone and trapezoid have best success. Preserve the distal clavicle. It does give you bony stability, and like I said, use a graft.  This is not so anatomic. So number three, ensure your coracoid tunnel is central, otherwise you're going to run into problems.  Aim as close to the base as possible, posteriorly on the coracoid. Use as small as possible drill.  An eccentric coracoid hole will cause either loss of fixation or possibly coracoid fracture, which results in a very, very bad day. Four, use fluoroscopy to confirm reduction.  This is one of those don't ask me why I know this. Anatomic variation of the distal clavicle will make confirmation by palpation very difficult.  So if you do not expose the AC joint, you will be tricked. Have contralateral side to compare the operative side to, and use a mini CR or intraoperative X-ray to confirm reduction.  There is significant variation of your distal clavicle and your AC joint which can throw you off as you see these two pictures here.  The distal clavicle on the left is much higher, much more superior. Use your fluoroscopy. Last, go very, very slow with your post-op rehab. These are operations waiting to fail.  If your patient does not commit to a prolonged immobilization, they are going to fail. The stress across the AC joint is highest with increased forward flexion.  So keep the patient locked down and no forward flexion past 90 degrees for at least 4-6 weeks or they will fail.  Have this discussion with your patient before you proceed with surgical intervention. Thank you. Stay up there Craig. Just stay up there.

Video Summary

The video content discusses key points in joint surgery for AC joints. The speaker advises against operating on all AC joints and highlights the effectiveness of non-operative treatment for type 3 and type 5 injuries. Late reconstruction is also mentioned as a viable option. Anatomic reconstruction using a graft, either autograft or allograft, is recommended for best success. The importance of preserving the distal clavicle for bony stability and ensuring a central coracoid tunnel is emphasized. The need for fluoroscopy to confirm reduction and the potential variation of the distal clavicle are mentioned. Lastly, the speaker emphasizes the importance of slow post-operative rehabilitation and prolonged immobilization to prevent failure. No credits are mentioned in the transcript.

Asset Caption

Dr. Craig Bottoni

Keywords

joint surgery

non-operative treatment

anatomic reconstruction

distal clavicle

post-operative rehabilitation