Injuries to the acromioclavicular (AC) joint are becoming common with contact sports and bike accidents. It is well known that in AC dislocations, the first structure to fail is the AC capsule followed by the trapezoid and conoid ligaments. The function of these ligaments must be restored to restore the anatomy and physiology of the AC joint to get the best results. Until now, no technique has emerged as the gold standard for restoration of the AC joint anatomy and function. In our technique, the stress is on recreating the anatomy to make it more individualized based on individual variations. This Technical Note describes a procedure to reconstruct the coracoclavicular ligaments and AC joint by an arthroscopy-assisted technique. Arthroscopy helps to diagnose additional intra-articular pathologies that can be treated simultaneously, and better preparation of the undersurface of the coracoid helps in bone-to-graft healing. Our approach is more individualized as clavicle tunneling is done according to the size of the coracoid base instead of a fixed distance. Vertical stability is provided by coracoclavicular ligament reconstruction, horizontal stability is provided by AC ligament reconstruction, and the articular disc is recreated by soft-tissue graft interposition, thus restoring the complete anatomy.

Anatomic orientation of the graft in anatomic anterior cruciate ligament reconstruction is the key to improved knee stability, restoration of normal knee kinematics, and the prevention of long-term joint degeneration. The graft position and orientation in the joint depend on the position of the tibial and femoral tunnels. Graft displacement in the tibial tunnel due to the position of the interference screw when the screw has proximal fixation also has an effect on the orientation of the graft. We have developed a technique for adjusting guidewire placement for the interference screw posterolaterally in the tibial tunnel in anatomic single-bundle anterior cruciate ligament reconstruction. This technique helps to push the graft medially and anteriorly in the tibial tunnel, avoids impingement of the graft with the lateral femoral condyle, and helps to maintain the orientation of the graft in a more anatomic way.

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A musculotendinous junction tear is a rare type of rotator cuff tear. There is very little literature available on musculotendinous junction tears. We propose a technique for repair of this type of tear using lateral-row anchors. In this technique, the torn tendon is freshened and sutures are passed through the medial part of the torn tendon. When it is fixed with lateral-row anchors, the tear is reduced and tendon-to-tendon healing is seen. The enthesis and the tendon length are preserved.

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