ACROMIOCLAVICULAR [CASE 3] TightRope Fixation

Anatomical reduction of the acromioclavicular dislocation requires precision in creating two independent, aligned holes — one in the coracoid process and another in the clavicle — in a region of high vascularization and limited bone exposure, where any deviation of a few centimeters in the approach compromises retraction and visualization of the structures. This training presents reduction and fixation with the TightRope device through a minimally invasive longitudinal approach, guided by biplanar fluoroscopy, with a deliberate hypercorrection technique to compensate for the natural settling of soft tissues — all documented in 4K video, from the surgeon's direct perspective. TRAINING FOCUS Patient positioning and radiographic views (anteroposterior and simulated axillary) Skin marking guided by dual fluoroscopic imaging Infiltration with vasoconstrictor anesthetic for bleeding control Minimally invasive longitudinal approach Detachment of the pectoral muscle and exposure of the superior surface of the clavicle Delimitation of the coracoid process with Langenbeck and Farabeuf retractors Creation of the hole in the coracoid process under direct visualization Drilling of the clavicle with a drill bit compatible with the TightRope Passage of the wires with Mixter forceps and guide instrumentation Introduction and locking of the TightRope button Reduction with deliberate hypercorrection and bone anchoring Layered suturing and closure of the surgical wound DETAILED CONTENT Biplanar radiographic views: combination of anteroposterior and simulated axillary views for precise localization of the coracoid process and the lateral third of the clavicle prior to incision. Marking with a dermographic pen: transposition of fluoroscopic reference points onto the skin, reducing the risk of a poorly positioned approach and retraction difficulties. Infiltration with vasoconstrictor: bleeding control in a highly vascularized region, keeping the field clean throughout the dissection. Triple retraction of the coracoid process: combined use of Langenbeck and Farabeuf retractors for top-to-bottom bone exposure without residual soft tissue. Independent, aligned holes: drilling of the coracoid process and the clavicle at calculated points to ensure a trajectory compatible with the TightRope device. Wire passage guided by Mixter forceps: technique for transposing the needled wire through the created hole, preparing for implant introduction. Locking and testing of the TightRope button: traction maneuver to confirm adequate bone anchoring, verified by control fluoroscopy. Deliberate hypercorrection of the reduction: planned compensation for the expected loss of correction due to soft tissue interposition at the inferior button. Concealed knot suturing: technique of folding the excess wire for coverage beneath the muscular plane, optimizing aesthetic and functional outcomes. INCLUDED MATERIAL Detailed PDF: document with the complete case analysis, including the step-by-step operative sequence, the biomechanical principles of TightRope fixation at the acromioclavicular joint, and the positioning, fluoroscopy, and post-fixation control protocols used in the procedure. Master acromioclavicular dislocation reduction and fixation with TightRope through a real case, documented in detail — enroll now and bring this technique to your surgical practice.