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Arthroscopic Acromioclavicular/Coracoclavicular Joint Reconstruction with Allograft and Suspensory Button Fixation

February 10, 2018

Contributors: Amos Dai, BS; Dylan Lowe, MD; Karan Patel, MD; Robert J Meislin, MD; Robert J Meislin, MD

Keywords: Bony Procedure

Purpose: Acromioclavicular (AC) joint disruptions are a common injury in young, active, athletic individuals that usually occur due to a direct axial load or trauma to an adducted shoulder. They can become a source of chronic pain and AC joint instability, limiting a patient’s normal activities. While many AC joint injuries can be managed non-operatively with good results, surgical management is indicated in severe cases or cases that fail non-operative management. While many techniques have been described to treat this condition, recurrent dislocations remain a major complication. Various techniques have been developed to restore the normal joint anatomy and to reconstruct torn ligaments to stabilize the acromioclavicular joint. The purpose of this video is to present the surgical technique for an arthroscopic acromioclavicular joint reconstruction using a semitendinosus allograft and dog bone suture technique that restores normal joint anatomy for an acromioclavicular joint separation.

Methods: We discuss the case of a 53-year old male who sustained a Rockwood Type III AC joint separation after falling off of his bicycle 3.5 years prior to presentation. He had limited motion and persistent pain in that shoulder that improved with physical therapy and non-operative management. He then re-injured his shoulder when he ran into a door frame while carrying a box and had persistent sharp pain and a sense of instability in the left shoulder. We review his physical exam, which was significant for tenderness to palpation over the left AC joint, and pain with horizontal adduction. He had a prominence in the left shoulder with laxity. His radiographic imaging are reviewed which demonstrate a Type IV AC joint separation. We then present the technique for performing an arthroscopic acromioclavicular joint reconstruction with allograft and suspensory button fixation.

Results: After demonstrating the surgical technique, we review the final construct arthroscopically and compare the patient’s preoperative and postoperative radiographs. In his most recent physical exam, he had full painless range of motion of the shoulder.

Conclusion: AC joint separations are a cause of morbidity, and the techniques that adequately restore joint anatomy, such as reconstruction with semitendinosus allograft and suspensory button fixation, may be effective in preventing recurrent separations, providing pain relief, and restoring function.

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