Free Tissue Graft Reconstruction of the Acromioclavicular Joint

Acromioclavicular (AC) joint injuries are commonly encountered in the contact athlete. Although most may be treated nonoperatively, more severe AC dislocations require surgical stabilization. Many procedures describe repair or reconstruction of the AC joint, focusing mainly on treatment of the ruptured coracoclavicular ligaments. Clinical results have been mixed, often reporting significant complications, postoperative clavicle subluxation, and patient dissatisfaction. In addition, cadaveric testing data often demonstrate inferior biomechanical properties, compared with the native AC joint. Multiple studies have concluded that the AC ligaments are important constraints to clavicle translation, and their reconstruction should be considered in the treatment of AC joint injuries. Despite these findings, there are few techniques reported that address the AC ligaments. This report describes a new procedure for the treatment of AC injuries, involving a free tissue intramedullary graft reconstruction of the AC ligaments, in addition to reconstruction of the coracoclavicular ligaments. By recreating the principal ligamentous structures, stability of the AC joint may be restored.