Arthroscopic-Assisted Coracoclavicular and Acromioclavicular Ligament Reconstruction for Chronic AC Joint Separation

Abstract

Background: Management of acromioclavicular joint (ACJ) separations depends on the type, chronicity of injury, and patient demographics. Indications: Coracoclavicular and acromioclavicular ligament reconstruction may be indicated for patients with chronic type 3 ACJ separation who have failed conservative treatment. We describe an arthroscopic-assisted approach to facilitate graft passage around the coracoid. Technique: Patients are placed in a beach chair position. A longitudinal incision at the midline of the distal clavicle is utilized for access to the ACJ, the distal clavicle, and the coracoid. The anterior, posterior, and undersurface of the distal clavicle are exposed. A standard posterior viewing and anterolateral working portals are created. A shuttling suture is passed arthroscopically and used to pass allograft and nonbiologic augmentation around the coracoid. The nonbiologic sutures are passed through a singular hole in the distal clavicle and secured with a DogBone button. The allograft is wrapped around the clavicle to recreate the coracoclavicular ligaments and secured with sutures. The ACJ capsule is reconstructed by suturing the posterior/medial limb, which is kept long, to the capsule and periosteum. Meticulous, layered closure is performed with particular attention to closing the deltotrapezial fascia. Results: A postoperative x-ray at 2 weeks and 6 months are obtained to confirm proper positioning. The sling is discontinued at 6 weeks, and supervised physical therapy is initiated. At 6 months, patients are typically cleared to full unrestricted activity. Discussion/Conclusion: Arthroscopic-assisted coracoclavicular and acromioclavicular ligament reconstruction in patients with chronic type 3 ACJ separation who fail conservative management can have excellent outcomes. The use of arthroscopic assistance may ease the passage of graft and nonbiologic suture around the coracoid. A 70° scope is helpful for coracoid visualization, and biologic reconstruction of the ligament with tendon graft with suture augmentation in chronic cases is vital in achieving a good outcome. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.