All-Arthroscopic Double-Bundle Coracoclavicular Ligament Reconstruction Using Autogenous Semitendinosus Graft: A New Technique

Abstract

We present our novel arthroscopic anatomic double-bundle coracoclavicular ligament reconstruction technique using a semitendinosus tendon autograft. The dorsal limb of the graft is positioned around the dorsal edge of the clavicle, re-creating the conoid ligament. The anterior limb proceeds superiorly and re-creates the trapezoid ligament. The solution effectively stabilizes the acromioclavicular joint and prevents anterior posterior translation. This new arthroscopic doublebundle coracoclavicular joint reconstruction is an effective and reliable method in stabilizing the clavicle and neutralizing the anterior-posterior translation, and we find it to be technically practical for the surgeon.

Modified Arthroscopic Latarjet Procedure With Coracoid Exteriorization for Treatment of Anterior Glenohumeral Instability

“…The safety of this operation was similar to that of other operations on the coracoid process in the proximity of the brachial plexus. 5 The advantages of this operation were that the potential risk of brachial plexus injury was minimized by pulling the coracoid externally and that the instrumentation is simple, making the operation safe and practical to perform. A limitation is that it may be difficult to exteriorize the coracoid in extremely heavily built patients.…”

Conjoint tendon transfer: Tenodesis for coracoclavicular ligaments reconstruction in acute high grade acromioclavicular dislocation

“…58% early postoperative complications and 50% late instability after kook plate fixation and 17% early postoperative complications and 34% late instability after polydiaxone suture suspension were also reported [28,29] . While CCL repair, reconstruction or substitution showed relatively better results and had evolved over the last several decades [10][11][12][30][31][32] . Many surgeons use tendon grafts as semitendinosus or gracilis passed through coracoid and clavicular bone tunnels for CCL reconstructions with fixation by different methods of fixation [10][11][12][30][31][32] .…”

“…While CCL repair, reconstruction or substitution showed relatively better results and had evolved over the last several decades [10][11][12][30][31][32] . Many surgeons use tendon grafts as semitendinosus or gracilis passed through coracoid and clavicular bone tunnels for CCL reconstructions with fixation by different methods of fixation [10][11][12][30][31][32] . But tendon graft reconstructions are costly [10] , technically demanding may precipitate coracoid or clavicular fracture [10,32] and may be associated with distant site morbidity, graft stretch, tunnel widening [31] and infection.…”

“…Many surgeons use tendon grafts as semitendinosus or gracilis passed through coracoid and clavicular bone tunnels for CCL reconstructions with fixation by different methods of fixation [10][11][12][30][31][32] . But tendon graft reconstructions are costly [10] , technically demanding may precipitate coracoid or clavicular fracture [10,32] and may be associated with distant site morbidity, graft stretch, tunnel widening [31] and infection. Weaver -Dunn procedure (1972) comprises excision of the lateral end of clavicle and transfer of the coracoacromial ligament [27] .…”

“…Surgical techniques for fixation of ACJ dislocation were associated with a high incidence of early and late postoperative complications [28,29] . While CCL repair, reconstruction or substitution showed relatively better results and had evolved over the last several decades [10][11][12][30][31][32] . It was found that the conjoint tendon has better properties and greater consistency of quality compared with those of coracoacromial ligament [14,21,25] .…”