Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 9, pp 2237–2242 | Cite as

Electromagnetic navigation provides high accuracy for transcoracoid-transclavicular drilling

  • Michael HoffmannEmail author
  • Maximilian Hartel
  • Malte Schroeder
  • Oliver Reinsch
  • Alexander S. Spiro
  • Andreas H. Ruecker
  • Lars Grossterlinden
  • Daniel Briem
  • Johannes M. Rueger
  • Jan Phillip Petersen



A novel radiation-free electromagnetic navigation system (ENS)–based method was developed, and its feasibility and accuracy for transclavicular-transcoracoid drilling procedures were evaluated in an experimental setting.


Sixteen arthroscopically assisted electromagnetic navigated transcoracoid-transclavicular drilling procedures with subsequent TightRope® device implantation were performed on eight human cadavers. Post-operative fluoroscopy and CT-scan analysis were acquired to determine tunnel placement accuracy. Optimal tunnel placement was defined as both the coracoid entry and exit point of the tunnel localized in the centre position of the coracoid base without cortical breach or fracture.


Successful tunnel placement was accomplished in all 16 cases. The mean overall operation time was 30.3 ± 5.0 min. Regarding the coracoid exit point, 15 of 16 tunnels (93.8 %) were localized in the desired base-centre position. During the navigated drilling procedure, no misguidance of the drill requiring directional readjustments or restarts occurred. No cortical breach, no fractures and no complications occurred.


The electromagnetically navigated transcoracoid-transclavicular drilling procedure used in this study demonstrated high targeting accuracy, required no intraoperative radiographs, was associated with no complications and provided user-friendliness.


Navigation AC joint injuries AC joint dislocation AC joint reconstruction Shoulder Acromioclavicular Coracoclavicular 

Supplementary material

Supplementary material 1 (MPEG 10990 kb)


  1. 1.
    Choi SW, Lee TJ, Moon KH, Cho KJ, Lee SY (2008) Minimally invasive coracoclavicular stabilization with suture anchors for acute acromioclavicular dislocation. Am J Sports Med 36:961–965PubMedCrossRefGoogle Scholar
  2. 2.
    Coale RM, Hollister SJ, Dines JS, Allen AA, Bedi A (2013) Anatomic considerations of transclavicular-transcoracoid drilling for coracoclavicular ligament reconstruction. J Shoulder Elbow Surg 22:137–144PubMedCrossRefGoogle Scholar
  3. 3.
    DeBerardino TM, Pensak MJ, Ferreira J, Mazzocca AD (2010) Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system. J Shoulder Elbow Surg 19:47–52PubMedCrossRefGoogle Scholar
  4. 4.
    Deshmukh AV, Wilson DR, Zilberfarb JL, Perlmutter GS (2004) Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med 32:1492–1498PubMedCrossRefGoogle Scholar
  5. 5.
    Eberle C, Fodor P, Metzger U (1992) Hook plate (so-called Balser plate) or tension banding with the Bosworth screw in complete acromioclavicular dislocation and clavicular fracture. Z Unfallchir Versicherungsmed 85:134–139PubMedGoogle Scholar
  6. 6.
    Ejam S, Lind T, Falkenberg B (2008) Surgical treatment of acute and chronic acromioclavicular dislocation Tossy type III and V using the Hook plate. Acta Orthop Belg 74:441–445PubMedGoogle Scholar
  7. 7.
    Ferreira JV, Chowaniec D, Obopilwe E, Nowak MD, Arciero RA, Mazzocca AD (2012) Biomechanical evaluation of effect of coracoid tunnel placement on load to failure of fixation during repair of acromioclavicular joint dislocations. Arthroscopy 28:1230–1236PubMedCrossRefGoogle Scholar
  8. 8.
    Flik K, Lyman S, Marx RG (2005) American collegiate men’s ice hockey: an analysis of injuries. Am J Sports Med 33:183–187PubMedCrossRefGoogle Scholar
  9. 9.
    Gerhardt DC, VanDerWerf JD, Rylander LS, McCarty EC (2011) Postoperative coracoid fracture after transcoracoid acromioclavicular joint reconstruction. J Shoulder Elbow Surg 20:e6–e10PubMedCrossRefGoogle Scholar
  10. 10.
    Hoffmann M, Petersen JP, Schröder M, Hartel M, Kammal M, Rueger JM, Ruecker AH (2012) Accuracy analysis of a novel electromagnetic navigation procedure versus a standard fluoroscopic method for retrograde drilling of osteochondritis dissecans lesions of the knee. Am J Sports Med 40:920–926PubMedCrossRefGoogle Scholar
  11. 11.
    Hoffmann M, Petersen JP, Schröder M, Spiro AS, Kammal M, Rueger JM, Ruecker AH (2012) Retrograde drilling of talar osteochondritis dissecans lesions: a feasibility and accuracy analysis of a novel electromagnetic navigation method versus a standard fluoroscopic method. Arthroscopy 28:1547–1554PubMedCrossRefGoogle Scholar
  12. 12.
    Hoffmann M, Schröder M, Petersen JP, Spiro AS, Kammal M, Lehmann W, Rueger JM, Ruecker AH (2012) Arthroscopically assisted retrograde drilling for osteochondritis dissecans (OCD) lesions of the knee. Knee Surg Sports Traumatol Arthrosc 20:2257–2262PubMedCrossRefGoogle Scholar
  13. 13.
    Lädermann A, Gueorguiev B, Stimec B, Fasel J, Rothstock S, Hoffmeyer P (2013) Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques. J Shoulder Elbow Surg 22:171–178PubMedCrossRefGoogle Scholar
  14. 14.
    Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA (2006) A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med 34:236–246PubMedCrossRefGoogle Scholar
  15. 15.
    Milewski MD, Tompkins M, Giugale JM, Carson EW, Miller MD, Diduch DR (2012) Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med 40:1628–1634PubMedCrossRefGoogle Scholar
  16. 16.
    Motta P, Maderni A, Bruno L, Mariotti U (2011) Suture rupture in acromioclavicular joint dislocations treated with flip buttons. Arthroscopy 27:294–298PubMedCrossRefGoogle Scholar
  17. 17.
    Rios CG, Arciero RA, Mazzocca AD (2007) Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med 35:811–817PubMedCrossRefGoogle Scholar
  18. 18.
    Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38:1179–1187PubMedCrossRefGoogle Scholar
  19. 19.
    Sanders R, Koval KJ, DiPasquale T, Schmelling G, Stenzler S, Ross E (1993) Exposure of the orthopaedic surgeon to radiation. J Bone Joint Surg Am 75:326–330PubMedGoogle Scholar
  20. 20.
    Scheibel M, Dröschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39:1507–1516PubMedCrossRefGoogle Scholar
  21. 21.
    Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37:136–139PubMedCrossRefGoogle Scholar
  22. 22.
    Tomlinson DP, Altchek DW, Davila J, Cordasco FA (2008) A modified technique of arthroscopically assisted AC joint reconstruction and preliminary results. Clin Orthop Relat Res 466:639–645PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36:2398–2406PubMedCrossRefGoogle Scholar
  24. 24.
    Yoo J-C, Ahn J-H, Yoon J-R, Yang J-H (2010) Clinical results of single-tunnel coracoclavicular ligament reconstruction using autogenous semitendinosus tendon. Am J Sports Med 38:950–957PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Michael Hoffmann
    • 1
    Email author
  • Maximilian Hartel
    • 1
  • Malte Schroeder
    • 1
  • Oliver Reinsch
    • 1
  • Alexander S. Spiro
    • 1
  • Andreas H. Ruecker
    • 1
  • Lars Grossterlinden
    • 1
  • Daniel Briem
    • 1
  • Johannes M. Rueger
    • 1
  • Jan Phillip Petersen
    • 1
  1. 1.Department of Trauma, Hand and Reconstructive SurgeryUniversity Medical Center Hamburg-EppendorfHamburgGermany

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