Name: Chronic Acromioclavicular Reconstruction Using the AC FiberTape® Cerclage Implant System
Uploaded: 2026-10-30T00:00:00Z
Duration: 16 min 56 s
Channel: Arthrex
Description: Stephen Brockmeier, MD (Charlottesville, VA), demonstrates a chronic acromioclavicular (AC) reconstruction using the AC FiberTape® Cerclage implant system.

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<p>Stephen Brockmeier, MD (Charlottesville, VA), demonstrates a chronic acromioclavicular (AC) reconstruction using the AC FiberTape® Cerclage implant system.</p>

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VID1-009871-en-US | A | Chronic Acromioclavicular Reconstruction Using the AC FiberTape® Cerclage Implant System

Stephen Brockmeier

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Chronic Acromioclavicular Reconstruction Using the AC FiberTape® Cerclage Implant System

Speaker  This is Steve Brockmeyer from Charlottesville, Virginia. And today we'll be treating an AC separation, doing an AC reconstruction with the AC Cerclage kit. So you can see here this is a right shoulder specimen. And if you look on the floor image, you see that we've created a high grade separation. This is the standard circumstance where I'm doing this procedure clinically. You can see here this is the incision that I will use to do this procedure. So not a terribly long incision. Direct superior. You can see we've marked out the coracoid here in the front. The AC joint itself is obvious here with the deformity. And so I'll center my incision between the CC ligament complex here and the AC joint here. And I'll extend it from just the back edge of the clavicle, the collarbone, and extend it just a little bit further anteriorly down so that we can access the coracoid space for suture cerclage passage as well as Graf passage. So you can see again incision from the posterior aspect of the clavicle which is here, and then extends a little bit more anteriorly here. So we're staring directly at the top portion of the clavicle. All right. So once we have our exposure then we move towards reduction of the injury. What I find with these most acute you can actually define this. But typically what will happen is the ligaments will avulse off the upper edge of the clavicle. As you can see, the end of the clavicle here and the AC capsule will evolve soft. Speaker  So normally this is fairly denuded of tissue. And you'll find the tissue right here. So this is the tissue right here of the AC capsule. So step one is I'll go in and I'll kind of pull that tissue free. Or sometimes if it's really scarred into place, I'll actually incise it longitudinally like this and have an anterior and a posterior flap. So now once we have everything dissected out, we move towards the procedure. So you can see here the coracoid, the coracoid has got some unusual anatomy. So it's important to be thoughtful about how we're approaching this lateral to the coracoid. You can see there's some soft tissue structures, your coracohumeral ligament, etc.. I think it's important to realize that where we're trying to get is very posterior. So kind of where the coracoid neck comes into the scapula, that's where you want this pass to happen. So I'll create a window here and then we'll move medially. Now medially. What attaches to the coracoid is the pec minor. So I'm coming around medially there again. I'm trying to stay posteriorly because you don't want your cerclage to pull the clavicle non anatomically to the anterior aspect. So you want to be as posterior as possible here. But I'll come through and I'll very carefully just spread through that muscle. So I'll create a window there so that when we pass around with our coracoid passer, we're coming through in that safe plane right up against that medial edge of the coracoid. Speaker  And it's important that you take a few minutes to do this during the case. So this coracoid pass goes smoothly. Typically I will pass. You can pass from medial to lateral or lateral to medial depending on the anatomy that you're that you're you're set up with. Ideally you're going to come from medial and work towards lateral. All right. So I'm hugging the bone here coming from medial to lateral to be as safe as possible. And you can see through that window. I'm seeing the tip of my my parser. All right. And then sometimes I'll try to sneak a skid in here or a device so I can really kind of bring this north. So I think you can see that right there. All right. So now we have that in position. I'm going to get my hand out of the way so you can see. And then I'm going to have my assistant load in the nitinol wire and pass it through. So you can see now that's coming up the skid and we have it passed. So we'll stop there. So then we'll grab our nitinol wire here and we're going to take out our instruments. And now we're ready to do our work around the coracoid. And so with the nitinol wire I'll give it a quick feel just to make sure I've been cautious to make sure I'm hugging the bone here right around the coracoid. Speaker  So you have this secured perfectly and this looks quite good. So next step is we'll use the dilating device called the flexible obturator. All right. So you can see it's basically got suture on each end. And it's got a center core here that allows us to dilate a path to blaze the path for our suture material and our graft around the coracoid. So we'll link this as such. Here we go. We'll pull it into place with our nitinol wire. And we'll use this to open up that space you can see right there. And then use that to make sure that you have a nice clear space, safe space for passage of your graft right around that coracoid, very posterior, right where you're going to want your graft and your cerclage to reduce and fix this injury. And then you can use this then for the next step, which is to pass two FiberLink sutures that we use for both suture and graft passage. So we'll bring those through right here. And then we'll use our flexible obturator to pull it through. And now you're ready for for passage of your cerclage and your graft around the coracoid. All right. So we've already shown some components of the Cerclage kit. Also in there are two FiberTape cerclages. All right. So one is blue and one is white Tiger configuration. Speaker  I'll take the blue one and I'll use it in a typical class fashion on the the orange on the orange card for for placement and tensioning for the white one. I'm actually going to deconstruct it. All right. So what I'll do here, this one actually comes with a needle on it. We're not going to use the needle in this technique. So I'm going to have my assistant just cut the needle off with a pair of scissors. And then I'm actually going to take it off entirely here. And we're going to deconstruct this. What I'm going to end up doing with this is I'm going to actually use it in a luggage tag fashion with the luggage tag around the coracoid. And then we're going to bring it up through a very small drill hole. And as we do this technique, you'll kind of see why I do that. But the general reason is because I think it gives us a second vector of stabilization of the CC ligament. So you have your cerclage looping around, and then you'll see that this is going to give us a different way to stabilize it as well. My assistant has already prepared a semitendinosus allograft. So you can see here is the allograft and you can see it's a big graph. So I always in this case is, you know, when they ask what kind of graph do you want? I tell them, give me the biggest and longest semi tee I have in the freezer. Speaker  And so this one I think is a little over 300 in. Length and average thickness. You can see this is a pretty beefy looking graft here. What's nice is, is my assistance actually has coned this down at the tip and bulleted it with a FiberLoop so that it makes it very easy to pass around the coracoid. So we have two fiber links. One is going to be for the graft, one is going to be for the FiberTape cerclage both of them. All right, so we have the blue one. I'm going to go ahead and start to take some of this off of our introducer, but we'll leave a decent amount on it. All right. My assistant's going to hold that there and then let me see the white one as well that we've already deconstructed. So we have the two leading tips of that. All right. So we're going to take these and we'll take this one here. And we're going to use that to shuttle around the coracoid. So step one is the suture material. One thing that I always do is I make sure that now we're kind of free and clear for the graft passage. It's not being pinned down by suture. And then let's hand the graft up here. And we're going to bring the shuttle the graft around next. So the graft is coming lateral to medial but the ends bulleted you can see here. Speaker  So it's going to come through nice and clean. And we've already cleared this space with our flexible obturator. So it should come through nice and smoothly. It's typically this shouldn't be a struggle here. You should have nice clear path here. So this is nice and atraumatic as you're bringing it through the blue is going to be our cerclage. It's going to go around the coracoid, around the clavicle. And then this is going to be set up with a luggage tag around the coracoid. But I'll link this through and I'll shuttle this down. And again, I'm being cautious not to trap either the suture material or the graft material here so it can slide around easily. But I have a luggage tag now around the coracoid. So now I'm ready and we're good. Now, from the standpoint of the coracoid, we got all our coracoid passing and all our implants and fixation done there. So now we move to the clavicle. So here's our deconstructed cerclage. This is going to come through a small drill hole. That drill hole is placed directly superior to the coracoid base. Right? So this is going to help us reduce our clavicle exactly where we want it. So we have this area secured. We're going to go ahead and just be a spot. So I know exactly where I'm going to make my hole in the kit is a 2.4mm drill bit. Speaker  And so that's what we're going to use to make this hole. We're going Superior to inferior here. All the way through the clavicle. All right, now we're through. So now we're going to pass our nitinol wire. All right. So also in the kit is this instrument here. It's a transosseous suture passer. It's got a nitinol wire on the tip. I'm going to use that to then pull this up through my tunnel. All right. So we'll pull this through and then use this to pull it through our bone tunnel here. And we'll get this up through. And now we have part one ready. All right. We're going to pull this over immediately. So next we're going to pass our cerclage around the clavicle. So in the kit there's this cerclage passer. You can bring it from the back to the front here. So you can see kind of around the collarbone, poke it through, bring it through here. And what I'll typically do is I'll actually crisscross these. So again, it's got a snare. We have our blue cerclage here. I'm going to bring this end around. I'm also going to bring one of the ends of my graft around. Sometimes I'll bring it from the same side. Sometimes I'll bring it from the opposite side. You know, again, it depends on preference. In this case, I'm going to bring it from the same side because that's the bulleted end. It should come around most readily. Speaker  Both of these are wrapping around the clavicle not through. So we want to be really cautious with areas of damage to the clavicle. We don't want to create a stress riser. So again a very small 2.4mm hole. But that's it for this procedure. The rest of this is all being done in a traumatic fashion. So we'll close that down and we'll bring these through. And we'll release. First we're going to bring our suture material through. So our AC cerclage right here. So now we have that wrapped around. And then next and last we'll bring through our grafts. So just like that. And now everything moves freely and smoothly. And now we're ready to reduce the joint and complete our fixation. Okay, so next step. So we have a dog bone that comes in the kit as well. All right. I'll put this on the superior surface of the clavicle. So you want to protect the clavicle, especially in that area. We made the small drill hole. So first we'll take the swedge out of our white stitch. We'll separate these out and we'll thread them through our Dog Bone here. So there's one and we'll put this down where we want it to go. Now this Dog Bone is slotted so you can slide it in as well. So we'll put the Dog Bone down here. And then what I'll do is I'll do one half hitch here. All right. So we'll go ahead and tie this and it'll secure it down. Speaker  I'll orient this like this and I'll bring this to the superior surface. Next we'll take our blue cerclage that's still preloaded on the converter. And we'll go ahead and convert it. So we'll load that through the converter here. All right. And we'll pinch that. We'll pull this through and then we'll get it off the orange tab. All right. We'll take all the slack out here. All right, so we take all the slack out. You can see here I'm purposely now centering this here. And so it kind of pulls this onto the Dog Bone and centers it. So now as your circulation down your circulation down on clavicle, but also the Dog Bone. And it keeps that suture centered right there. All right. And if you need to secure it, you can do a second stitch here, but you don't want to tie it too tight because you're going to resecure this once everything's reduced. So now we're in position to reduce our joint. We can let the the graph drop. Okay. So when you're ready to tension now we got to load the Cerclage tensioner. So you can see this comes in the kit looks a lot like kind of an enlarged anchor introducer. One limb, which will be your post limb will feed through the hole in the bottom here. And you bring that up. And wrap it around a cleat. I'll typically secure this with a couple of turns around the cleat, because you're going to be applying a decent amount of stress on this. Speaker  The second one, we'll go through this open end and similarly wrap around the other cleat. All right. So once we have this in place, we're going to wheel our C-arm in. Typically, I set up the CRM to come in from the top of the table. So it's going to come in from the back of the patient. And then we'll under fluoro we'll reduce this and confirm our reduction. All right. So we've started to reduce this under fluoro. And then to fine tune it we'll kind of use our cerclage tensioner you'll see here. So I'm cranking it down. You can see the first line. So we're adding tension. Second line. And what we're doing is we're pulling the slack out of Cerclage. And we're reducing the joint back down into position. All right, all right. So now what's that set. We'll unload it. You can see how it popped back down. And then we will finish tying it. So I've tied I've already done one half hitch as part of the tensioning. We'll do a second one here and we'll lock it into place. All right. And so now we'll tie a half hitch here with our second stitch. And we'll kind of lock these together. Good. All right. So now we've moved our graph. We've doubled it over. So the anterior limb is being pulled posterior with good traction. Speaker  So what we're using is the graph to basically load it. And so next we're going to secure the graph to itself here. And here. Typically I'll just use a number two FiberWire for this two maybe three sutures depending on the size of the patient size of the graft and kind of availability. You can see how this kind of covers up. Our suture construct and our Dog Bone. So it kind of sits on top of it. And we'll suture that down. Tie this. You do want the graph to see some load. So the graft is you know, is not what's primarily reducing this. But you want the graft under tension. It helps with the reduction. It also helps the graft to ligament ties and take up slack over time. All right. We'll take a knife next and we'll cut off our excess. All right. So we'll cut all the excess off here. So here we go. So this is our final CC construct. So you can see here. Now we're nice and stable Superior to inferior. Right. So everything is kind of back into position. Now, the next important part of this is to move to the A, C and do either a tissue repair there or a reconstruction, depending on what you have to work with. So we have this good tissue here. So we're going to repair this back. And that will help to stabilize the horizontal component with the a C complex. Speaker  So you can see the end of the collarbone here. And the anchor we're going to use is called the FiberTak biceps anchor. So we'll position this right about at the tip. So about five millimeters away from the tip of the a C joint. And you'll see it'll actually you'll have you'll feel two cortical surfaces. This actually ends up being deployed essentially by cortically. So here's the anchor right here. It's a FiberTak anchor with two preloaded sutures and needles. So it's great for repairing suture or capsular tissue back to bone. So it's good for just reinsertion. So we'll pound this in. It'll drop all the way through. And then we'll deploy. We'll take our sutures. The needles are protected with this piece of plastic, so we'll leave that on. And here's that back. Perfect. And then it's slotted for removal. So see how that's going through the clavicle. And it's nice and secure. All right. So there's two preloaded sutures. One's a little darker black and one is a light blue shade. I'll typically put one anterior and one posterior. So we'll set those up like that. We'll do our anterior one first. You can pass these however you want. A lot of times I'll do just a mattress into the anterior tissue and the post and then a mattress in the posterior tissue. And that tends to really pull this down nicely. Now if we don't have good tissue back here, then there are some other bailout options that have been used. Speaker  You can use some of the excess grafts you saw with a lot of graft left in that semi tee. So you can use that graph. You can fold those limbs over laterally. You can do a free graft reconstruction with suture anchors. I've done that in the past. You can even use dermal allograft. So there's a bunch of different ways you can do this if you don't have good tissue. But in most circumstances, I would say probably at least 75% of the time you can repair this capsular tissue back just like that, and it kind of stabilizes that AC component. I'll just tie this down and you can see how that really reinforces the repair nicely. So now we're all set. We got our repair done. So you can see here how this this AC joint is nice and stable here. And then you can check it A to P as well. And you can see how that is all kind of really very much one unit now. All right, so you've addressed the CC component with graft and with FiberTape Cerclage securing it. We've dealt with the AC component with the capsular repair using the FiberTak biceps anchor. And now we're ready to wash and close. So we typically the next step would be to re-approximate the delta trapezial fascia in a layered fashion. And then you close your incision and then you're off and running.

Chronic Acromioclavicular Reconstruction Using the AC FiberTape® Cerclage Implant System

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