Radiographic features and complications following coracoclavicular ligament reconstruction



To report radiographic features and complications of coracoclavicular ligament reconstruction and the association of radiographic features with symptomatology.

Materials and methods

Retrospective picture archiving and communication system query (1/2012–8/2018) identified subjects with prior coracoclavicular ligament reconstruction. Post-operative radiographs were reviewed with attention to the following: (1) acromioclavicular alignment, (2) coracoclavicular width, (3) distal clavicular osteolysis, (4) osseous tunnel widening, and (5) hardware complication or fracture. Medical records were reviewed to determine purpose of imaging follow-up (symptomatic versus routine). Statistical analysis determined associations between binary features and outcomes, and inter-reader agreement.


Review of 55 charts identified 32 subjects (23 male, 9 females; age range 24–64; imaged 1–34 months following surgery) meeting inclusion criteria. Loss of acromioclavicular reduction was the most common imaging finding (n = 25, 78%), with 76% progressing to coracoclavicular interval widening. Distal clavicular osteolysis was seen in 21 cases (66%) and was significantly associated with loss of acromioclavicular joint reduction (p = 0.032). Tunnel widening occurred in 23 patients (82%) with more than one follow-up radiograph. Six (19%) had hardware complication or fracture. No radiographic feature or complication had significant correlation with symptomatology (p values 0.071–0.721). Inter-reader agreement was moderate to substantial for coracoclavicular interval widening and hardware complication, fair to substantial for tunnel widening, and fair to moderate for loss of acromioclavicular reduction and distal clavicular osteolysis.


Loss of acromioclavicular joint reduction, coracoclavicular interval widening, distal clavicular osteolysis, and tunnel widening are common radiographic features after coracoclavicular ligament reconstruction; however, they do not necessarily correlate with symptomatology.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7


  1. 1.

    Li X, Ma R, Bedi A, Dines DM, Altchek DW, Dines JS. Management of acromioclavicular joint injuries. J Bone Jt Surg - Ser A. 2014;96:73–84.

    Article  CAS  Google Scholar 

  2. 2.

    Rockwood CA, Green DP, Bucholz RW. Rockwood and Green’s fractures in adults. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. p. 1581–8.

    Google Scholar 

  3. 3.

    Lee SJ, Nicholas SJ, Akizuki KH, McHugh MP, Kremenic IJ, Ben-Avi S. Reconstruction of the coracoclavicular ligaments with tendon grafts a comparative biomechanical study. Am J Sports Med. 2003;31:648–55.

    Article  Google Scholar 

  4. 4.

    Wellmann M, Zantop T, Petersen W. Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthrosc - J Arthrosc Relat Surg. 2007. 23:1132.e1–5.

  5. 5.

    Carofino BC, Mazzocca AD. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elb Surg. 2010;19:37–46.

    Article  Google Scholar 

  6. 6.

    Nicholas SJ, Lee SJ, Mullaney MJ, Tyler TF, McHugh MP. Clinical outcomes of coracoclavicular ligament reconstructions using tendon grafts. Am J Sports Med. 2007;35:1912–7.

    Article  Google Scholar 

  7. 7.

    Jeon IH, Dewnany G, Hartley R, Neumann L, Wallace WA. Chronic acromioclavicular separation: the medium term results of coracoclavicular ligament reconstruction using braided polyester prosthetic ligament. Injury. 2007;38:1247–53.

    Article  Google Scholar 

  8. 8.

    DeBerardino TM, Pensak MJ, Ferreira J, Mazzocca AD. Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system. J Shoulder Elb Surg. 19:47–52.

  9. 9.

    Banffy MB, van Eck CF, ElAttrache NS. Clinical outcomes of a single-tunnel technique for coracoclavicular and acromioclavicular ligament reconstruction. J Shoulder Elb Surg. 27:S70-S75.

  10. 10.

    Baran S, Belisle JG, Granger EK, Tashjian RZ. Functional and radiographic outcomes after allograft anatomic coracoclavicular ligament reconstruction. J Orthop Trauma. 2018;32:204–10.

    Article  Google Scholar 

  11. 11.

    Singh B, Mohanlal P, Bawale R. Early failure of coracoclavicular ligament reconstruction using TightRope system. Acta Orthop Belg. 2016;82:119–23.

    PubMed  Google Scholar 

  12. 12.

    Ramsingh V, Yewlett A, Pullen H. Three intrasubstance failures of a LARSTM ligament used for ligament reconstruction. Ann R Coll Surg Engl. 2019;101:e79–83.

    Article  CAS  Google Scholar 

  13. 13.

    Gowd AK, Liu JN, Cabarcas BC, et al. Current concepts in the operative management of acromioclavicular dislocations: a systematic review and meta-analysis of operative techniques. Am J Sports Med. 2018.

  14. 14.

    Moatshe G, Kruckeberg BM, Chahla J, et al. Acromioclavicular and coracoclavicular ligament reconstruction for acromioclavicular joint instability: a systematic review of clinical and radiographic outcomes. Arthrosc - J Arthrosc Relat Surg. 2018;34:1979–95.

    Article  Google Scholar 

  15. 15.

    Natera Cisneros L, Sarasquete RJ. Unstable acromioclavicular joint injuries: is there really a difference between surgical management in the acute or chronic setting? J Orthop. 2017;14:10–8.

    Article  Google Scholar 

  16. 16.

    Choi NH, Lim SM, Lee SY, Lim TK. Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations. J Shoulder Elb Surg. 2017;26:692–8.

    Article  Google Scholar 

  17. 17.

    Spencer HT, Hsu L, Sodl J, Arianjam A, Yian EH. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques. Bone Jt J. 2016;98-B:512–8.

    Article  CAS  Google Scholar 

  18. 18.

    Vascellari A, Schiavetti S, Battistella G, Rebuzzi E, Coletti N. Clinical and radiological results after coracoclavicular ligament reconstruction for type III acromioclavicular joint dislocation using three different techniques. A retrospective study. Joints. 2015;3:54–61.

    Article  Google Scholar 

  19. 19.

    Clavert P, Meyer A, Boyer P, Gastaud O, Barth J, Duparc F. Complication rates and types of failure after arthroscopic acute acromioclavicular dislocation fixation. Prospective multicenter study of 116 cases. Orthop Traumatol Surg Res. 2015;101:S313–6.

    Article  CAS  Google Scholar 

  20. 20.

    Millett PJ, Horan MP, Warth RJ. Two-year outcomes after primary anatomic coracoclavicular ligament reconstruction. Arthrosc - J Arthrosc Relat Surg. 2015;31:1962–73.

    Article  Google Scholar 

  21. 21.

    Rosslenbroich SB, Schliemann B, Schneider KN, et al. Minimally invasive coracoclavicular ligament reconstruction with a flip-button technique (MINAR): clinical and radiological midterm results. Am J Sports Med. 2015;43:1751–7.

    Article  Google Scholar 

  22. 22.

    Martetschläger F, Horan MP, Warth RJ, Millett PJ. Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2013;41:2896–903.

    Article  Google Scholar 

  23. 23.

    Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM. Early failures with single clavicular transosseous coracoclavicular ligament reconstruction. J Shoulder Elb Surg. 2012;21:1746–52.

    Article  Google Scholar 

  24. 24.

    Milewski MD, Tompkins M, Giugale JM, Carson EW, Miller MD, Diduch DR. Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2012;40:1628–34.

    Article  Google Scholar 

  25. 25.

    Mares O, Luneau S, Staquet V, Beltrand E, Bousquet PJ, Maynou C. Acute grade III and IV acromioclavicular dislocations: outcomes and pitfalls of reconstruction procedures using a synthetic ligament. Orthop Traumatol Surg Res. 2010;96:721–6.

    Article  CAS  Google Scholar 

  26. 26.

    Yoo JC, Choi NH, Kim S-Y, Lim TK. Distal clavicle tunnel widening after coracoclavicular ligament reconstruction with semitendinous tendon: a case report. J Shoulder Elb Surg. 2006;15:256–9.

    Article  Google Scholar 

  27. 27.

    Levine AH, Pais MJ, Schwartz EE. Posttraumatic osteolysis of the distal clavicle with emphasis on early radiologic changes. Am J Roentgenol. 1976;127:781–4.

    Article  CAS  Google Scholar 

  28. 28.

    Cahill BR. Osteolysis of the distal part of the clavicle in male athletes. J Bone Jt Surg - Ser A. 1982;64:1053–8.

    Article  CAS  Google Scholar 

  29. 29.

    Schwarzkopf R, Ishak C, Elman M, Gelber J, Strauss DN, Jazrawi LM. Distal clavicular osteolysis: a review of the literature. Bull NYU Hosp Jt Dis. 2008;66:94–101.

    PubMed  Google Scholar 

  30. 30.

    Nuzzo MS, Adamson GJ, Lee TQ, McGarry MH, Husak L. Biomechanical comparison of fracture risk created by 2 different clavicle tunnel preparations for coracoclavicular ligament reconstruction. Orthop J Sport Med. 2014;2:2325967114555478.

    Article  Google Scholar 

  31. 31.

    Thomas K, Litsky A, Jones G, Bishop JY. Biomechanical comparison of coracoclavicular reconstructive techniques. Am J Sports Med. 2011;39:804–10.

    Article  Google Scholar 

  32. 32.

    Schliemann B, Roßlenbroich SB, Schneider KN, et al. Why does minimally invasive coracoclavicular ligament reconstruction using a flip button repair technique fail? An analysis of risk factors and complications. Knee Surgery, Sport Traumatol Arthrosc. 2015;23:1419–25.

    Article  Google Scholar 

Download references


We would like to thank Dr. James Babb for providing statistical analysis for our study.

Author information



Corresponding author

Correspondence to Brian P. Kennedy.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This study has been approved by the Institutional Review Board at NYU Langone Health

Electronic supplementary material


(DOCX 181 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kennedy, B.P., Rosenberg, Z.S., Alaia, M.J. et al. Radiographic features and complications following coracoclavicular ligament reconstruction. Skeletal Radiol 49, 955–965 (2020).

Download citation


  • Shoulder
  • Coracoclavicular reconstruction
  • Post-operative