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Fig 3

 

Four  or  five  portals  are  used  for  the  arthroscopy: the  posterior  (P),  lateral  (L)  and  anterolateral  (AL). An  additional  anterior  portal  (A)  may  be  added. A longitudinal 2.5 mm clavicular (C) incision is made on the clavicle to expose the bone for subsequent drilling.  Later  on,  the  incision  may  be  extended  to address the AC joint (Fig 3).

The operation is initiated by inserting the arthroscope into the joint through the posterior portal The lateral portal (L) is marked with a needle in front of the long head of the biceps tendon allowing proper angle to
the neck of the coracoid.

The joint is checked for possible additional pathology. The arthroscope is then moved to the subacromial space,  viewing  through  the  L  portal.  The  primary camera  position  during  the  actual  reconstruction is  in  the  L  portal.  The  coraco-acromial  ligament  is located.  The  AL  and  A  portals  are  established  with the help of a needle.

Locating the portals correctly is extremely important to ensure easy access to the neck of the coracoid. The  location  of  the  clavicular  incision  is  marked with a needle behind the dorsal clavicle. Easy access from the dorsal clavicle to the coracoid neck area is crucial.

 


Fig 3.