Arthroscopic Transarticular Distal Clavicle Resection

Bursal and superior direct arthroscopic distal clavicle resection techniques exist. An indirect transarticular distal clavicle resection (TADCR) technique, in which the bone resection is performed directly through the acromioclavicular joint (ACJ), is presented. With the arthroscope in the lateral portal and viewing at the ACJ, the TADCR begins by inserting a needle into the ACJ to determine the angle of entrance (a 5-mm skin incision directly over the mid portion of the ACJ is made). Then, with a No. 11 blade, a 4to 5-mm incision, which is just large enough to ensure the pass of the motorized instruments, is made in the mid portion of the superior acromioclavicular ligament (SACL) parallel to its fibers. A radiofrequency probe is inserted, and the ACJ`s soft tissues are excised, taking care not to damage the SACL. Then, the saver is introduced to clean up the soft tissue`s debris. Finally, a 4.0-mm oval burr is inserted and, with a fan-shaped motion, bone is resected from clavicle and acromion without damaging the superior ligament. The TADCR is an easy technique that produces consistent bone resection, sparing the SACL.