Intraoperative Use of Ultrasound and Cannulated Dilators to Safely Identify and Access the Acromioclavicular Joint for Distal Clavicle Excision: A Technique Guide.

Distal clavicle excision for acromioclavicular (AC) joint pathologies classically has been performed via an open approach, but less-invasive arthroscopic approaches are becoming popular. The technique of localizing the AC joint via inspection and palpation of boney landmarks can be challenging. Our technique optimizes this process in 2 ways: (1) by using ultrasound imaging to place the starting guidewire perfectly into the AC joint; and (2) by using a cannulated dilator system that allows for placement of the anterior portal directly centered over the original guidewire. Unlike other techniques, this technique and use of the dilator system allows for use of a standard arthroscope and currently is not described, to our knowledge, in the existing literature. This technique will allow surgeons to perform distal clavicle excisions in a more efficient, reproducible and safer manner.