Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 12, pp 3779–3796 | Cite as

Anatomic and non-anatomic reconstruction improves post-operative outcomes in chronic acromio-clavicular instability: a systematic review

  • Francisco Xará-Leite
  • Renato Andrade
  • Pedro Silva Moreira
  • Luís Coutinho
  • Olufemi R. Ayeni
  • Nuno Sevivas
  • João Espregueira-MendesEmail author



To systematize the surgical outcomes of anatomic and non-anatomic reconstruction in patients with chronic acromio-clavicular joint (ACJ) instability and determine which technique is superior.


This review was conducted according to the PRISMA guidelines. PubMed and Cochrane Library databases were searched up to April 30th, 2018 for original articles that assessed the outcomes of one or more surgical techniques of anatomic and non-anatomic reconstruction in patients with chronic ACJ instability. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Pre-to-post meta-analysis was performed for both anatomic and non-anatomic reconstructions.


Twenty-eight studies were included comprising 799 patients (mean age of 36.6 years old and 84% males) with a mean follow-up of 34.6 months (range 13 to 74). Surgical techniques included anatomic (tendinous or synthetic grafts/constructs) and non-anatomic reconstruction (Weaver–Dunn or Modified Weaver–Dunn, conjoined tendon transfer, or temporary hook plate). There were significant pre-to-post improvements on the constant score with an average improvement ranging from 11.1 to 50.7 (p < 0.01). Average failure rate was 7.6% (7.5% for anatomic and 8.5% for non-anatomic reconstruction). Non-comparative studies had a mean MINORS score of 9 points (out of 16) and comparative studies 17 (out of 24) with excellent interrater agreement (k = 0.910).


Both anatomic and non-anatomic ACJ reconstructions provide significant post-operative improvements, but definitive conclusions on optimal technique remain elusive. Notwithstanding, comparative studies support the use of anatomic ACJ reconstruction which should be preferably used. However, until superiority is demonstrated by robust studies, surgeons should supplement their decision-making with experience and patient preference.

Level of evidence



Acromio-clavicular Chronic instability Anatomic reconstruction Non-anatomic reconstruction 



The authors declare that there was no funding of this study.

Compliance with ethical standards

Conflict of interest

None to declare.

Ethical approval

No ethical approval was required for this study.

Supplementary material

167_2019_5408_MOESM1_ESM.docx (111 kb)
Supplementary material 1 (DOCX 110 KB)


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Centro Hospitalar do PortoPortoPortugal
  2. 2.Clínica do DragãoEspregueira-Mendes Sports Centre-FIFA Medical Centre of ExcellencePortoPortugal
  3. 3.Dom Henrique Research CentrePortoPortugal
  4. 4.Faculty of SportsUniversity of PortoPortoPortugal
  5. 5.Life and Health Sciences Research Institute (ICVS), School of MedicineUniversity of MinhoBragaPortugal
  6. 6.ICVS/3B’s—PT Government Associate LaboratoryBraga/GuimarãesPortugal
  7. 7.Division of Orthopaedic SurgeryMcMaster UniversityHamiltonCanada
  8. 8.Orthopaedics DepartmentHospital de BragaBragaPortugal
  9. 9.School of MedicineUniversity of MinhoBragaPortugal

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