Anatomical Evaluation of the Proximity of Neurovascular Structures During Arthroscopically Assisted Acromioclavicular Joint Reconstruction: A Cadaveric Pilot Study.

Purpose: The purpose of this study was to examine the safety of an arthroscopic technique for acromioclavicular joint (ACJ) reconstruction by investigating its proximity to important neurovascular structures.
Methods: Six shoulders from 4 cadaveric specimens were used for ACJ reconstruction in this study. The procedure consists of performing an arthroscopic acromioclavicular (AC) reduction with a double button construct, followed by coracoclavicular ligament reconstruction without drilling clavicular tunnels. Shoulders were subsequently dissected in order to identify and measure distances to adjacent neurovascular structures.
Results: The suprascapular artery and nerve were the closest neurovascular structures to implanted materials. The mean distances were 8.2 (standard deviation [SD] = 3.6) mm to the suprascapular nerve and 5.6 (SD = 4.2) mm to the suprascapular artery. The mean distance of the suprascapular nerve from implants was found to be greater than 5 mm (P = .040), while the distance to the suprascapular artery was not (P > .5). Neither difference was statistically significant (P = .80 for artery; P = .08 for nerve).
Conclusions: Mini-open, arthroscopically assisted ACJ reconstruction safely avoids the surrounding nerves, with no observed damage to any neurovascular structures including the suprascapular nerve and artery, and may be a viable alternative to open techniques. However, surgeons must remain cognizant of possible close proximity to the suprascapular artery.
Clinical Relevance: This study represents an evaluation of the safety and feasibility of a minimally invasive ACJ reconstruction as it relates to the proximity of neurovascular structures.
(Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)