Endoscopic Coracoclavicular Ligament Reconstruction Using Allograft

Abstract

An acromioclavicular (AC) joint separation is a common injury of the upper extremity that can lead to both functional and cosmetic problems, particularly in young, active patients and overhead athletes. The joint, at the distal clavicle, is composed of the AC ligament and the coracoclavicular (CC) ligaments. There exist many differing open surgical techniques to address AC joint separations. Most of these techniques cause disruption or damage to the deltoid’s clavicular attachment due to the nature of open repair of the CC ligaments. This all-arthroscopic technique, using a semitendinosus allograft, avoids this problem while also demonstrating excellent results in the treatment of type III and type V AC joint separations. This arthroscopic technique, however, requires a high degree of arthroscopic technical skill. The procedure involves four arthroscopic portals which are used to pass a semitendinosus graft (both allografts and autografts are used) around the coracoid and through two tunnels made in the clavicle. The graft is secured using BioComposite tenodesis screws. This technique allows for excellent reconstruction of the conoid and trapezoid coracoclavicular ligaments. When performed successfully, this technique allows for lower morbidity and likely faster postoperative recovery times, allowing the surgeon to simultaneously address other possible intraarticular shoulder pathologies arthroscopically during the same procedure.