Primary Acromioclavicular-Coracoclavicular Reconstruction Using 2 Allografts, TightRope, and Stabilization to the Acromion

Abstract

Acromioclavicular (AC) joint injuries are a common cause of shoulder pain, particularly among young athletes participating in contact sports. Injuries to the AC joint most commonly occur from direct impact at the acromion and are classified as types I to VI. Although most AC joint injuries can be treated nonoperatively, types IV to VI are best treated with surgery, with type III being controversial and most surgeons recommending an initial trial of nonoperative treatment. Although numerous surgical techniques have been described, no gold standard technique has been established. Biomechanical testing suggests that anatomic reconstruction of both the AC and coracoclavicular ligaments results in a superior surgical construct. The objective of this Technical Note is to describe our preferred technique for the primary treatment of AC joint instability in the acute and chronic setting. Using 2 free tendon grafts in combination with a cortical button suspensory device combines the advantages of a nonrigid biologic and anatomic AC and coracoclavicular ligament reconstruction while benefiting from the strength of a cortical suspensory device in resisting displacement of the AC joint.

Clinical Outcome of a Modified Coracoid Tunnel-Free Coracoclavicular Sling Technique With Remnant Preservation for the Treatment of High-Grade Acromioclavicular Joint Separation: A Report of 48 Cases With 2 to 5 Years of Follow-up

“…22 High-grade AC separations are usually treated surgically because of instability and pain of the AC joint. 5,8…”

“…22 High-grade AC separations are usually treated surgically because of instability and pain of the AC joint. 5,8 Several surgical techniques have been proposed to treat AC joint dislocation. 5,7,8,12,18,19,22 In a recent systematic review, the complication rate after use of a suspensory device was 6.2% lower than that after hook plate/K-wire treatment (26.3%), Weaver-Dunn or modified Weaver-Dunn technique (12.8%), or free graft reconstruction (10.3%).…”

<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

“…In the following years, a multitude of techniques were developed to address this issue, mainly focusing on restoring the integrity of the AC capsule and ligaments. 90,91,97,100 The addition of an AC cerclage to the CC stabilization lead to superior radiological results with a lower incidence of dynamic posterior instability and improved clinical outcomes in a study performed by Hann et al 101 . Furthermore, reconstruction of both the AC and CC ligaments proved to be beneficial in a study conducted by Tauber et al in which a single-bundle technique was compared to a triple-bundle technique using hamstring autografts in 26 patients.…”

Treatment of a Failed Type V Acromioclavicular Separation Due to Coracoid Fracture: Revision of Acromioclavicular-Coracoclavicular Reconstruction and Coracoid Fixation

“…Because of the prevalence of AC joint injuries, there are numerous studies that have described both the nonoperative and operative treatments. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 A systematic review by Beitzel and colleagues 17 looked at 120 studies that collectively describe 162 different techniques for AC management. The study concluded that there is no consensus on a gold-standard procedure.…”