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Official Journal of the Italian Society of Orthopaedics and Traumatology

Fig. 4 | Journal of Orthopaedics and Traumatology

Fig. 4

From: Management of chronic unstable acromioclavicular joint injuries

Fig. 4

Reproduced with permission and copyright© of Arthroscopy Techniques, Elsevier. a The AC drilling guide is placed at the coracoid base with the sliding tube of the guide in the superior aspect of the clavicle, 4.5 cm medial to its lateral border (conoid native origin). A 2.4-mm K-wire is passed through the AC guide. b A cannulated 4.5- to 6-mm (depending on the graft diameter) drill is passed over the K-wire and comes out from the inferior aspect of the coracoid. c A shuttle 1-mm PDS suture is passed through the cannulated drill located in the trapezoid tunnel. The PDS is recovered with a grasper from the anterior portal. d Superior perspective of the clavicle in which both shuttle sutures are emerging from the tunnels. e The PDS that arises from the trapezoid tunnel in the clavicle is pulled out in a cranial direction to recover the limb of the graft that is going to surround the base of the coracoid at its lateral aspect, coming from its tunnel and then being directed laterally and superiorly, configuring the anatomical 'V' shape of the graft. f Once the graft has passed through both clavicle tunnels, the ZipTight is tied to the distal limb of the shuttle FiberWire that is still free in the conoid tunnel

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