Abstract
High-grade acromioclavicular (AC) joint injuries (Rockwood types IV, V, and VI) are usually treated operatively due to considerable morbidity associated with a persistently dislocated AC joint and severe soft tissue disruption. In some type IV-VI injuries, primary conservative treatment may be considered; however, if the patient remains chronically symptomatic, surgical intervention is recommended. Additionally, surgery is recommended in chronic AC joint instability (including type III) with previously failed conservative treatment and/or persistent horizontal instability, limited range of motion (ROM), and scapular dyskinesia—especially if these symptoms occur in high-demand athletes or manual laborers. At the author’s institution, anatomic coracoclavicular ligament reconstruction technique (ACCR), utilizing a semitendinosus allograft to replicate the coracoclavicular (CC) ligaments in their anatomic location is predominantly used. Biomechanically, this along with other anatomic reconstruction techniques, have been shown to be more effective in restoring native AC joint properties when compared to a coracoacromial ligament transfer. More importantly, using these anatomic techniques may lead to more favorable clinical and radiographic outcomes.
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