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.