Reducing fluoroscopy in acromioclavicular joint reconstruction: Clinical value of the three-point positioning technique

Abstract

Acromioclavicular joint dislocation (ACJD) is one of the shoulder girdle injuries that particularly affects young and active individuals. Although various surgical techniques have been developed for coracoclavicular ligament reconstruction, TightRope fixation has gained popularity. The procedure relies on frequently repeated intraoperative fluoroscopy to ensure the accuracy of tunnel placement, which increases radiation exposure for both patients and surgical teams. In the recent issue of World Journal of Orthopedics, Chen et al present a novel three-point positioning technique designed to guide tunnel trajectory and implant placement while reducing fluoroscopy time during TightRope fixation. Their retrospective analysis of patients with acute Rockwood type III ACJD demonstrated favorable functional outcomes and, in particular, low intraoperative fluoroscopy exposure. In this editorial, we discuss the clinical significance of radiation reduction in shoulder surgery and highlight the importance of procedural innovations that improve surgical workflow without increasing technical complexity. Simplified intraoperative positioning strategies may represent an important step toward safer and more efficient minimally invasive acromioclavicular joint reconstruction. Furthermore, techniques that minimize radiation exposure while maintaining surgical precision may contribute to improved occupational safety in orthopedic practice. Such practical innovations could play an important role in the future evolution of image-guided shoulder surgery.

Keywords: Acromioclavicular joint dislocation; TightRope fixation; Fluoroscopy reduction; Three-point positioning technique; Coracoclavicular stabilization; Shoulder surgery

Core Tip: The three-point positioning technique represents a pragmatic shift toward reducing fluoroscopy dependence in acromioclavicular joint reconstruction. By enabling accurate tunnel placement through simple anatomical alignment, this approach has the potential to redefine intraoperative workflow and establish a new safety standard in minimally invasive shoulder surgery by prioritizing both surgical precision and radiation minimization.