Acromioclavicular Joint Dislocation: Anatomic Coracoclavicular Ligament Reconstruction (ACCR)

Abstract

The acromioclavicular (AC) and coracoclavicular (CC) ligaments are the principal stabilizers of the AC joint. AC joint injuries are common in contact sports and are graded according to the severity of injury to AC and CC ligaments and radiographic displacement of the AC articulation. Complete AC joint dislocation involves disruption of the AC and CC ligaments and the deltotrapezial fascia. Lower-grade injuries (types I and II) are initially managed nonoperatively and most patients do well. Operative treatment is indicated for higher-grade dislocations (types IV, V and VI). The management of type III AC joint dislocation is controversial and a matter of ongoing debate. A large number of surgical procedures and their modifications have been described in literature, but there is no consensus on the ideal procedure of choice for the treatment of AC joint dislocation. The anatomic coracoclavicular reconstruction (ACCR) restores stability to the AC joint by reconstructing the CC and AC ligaments. In this surgical technique, allograft or autograft tissue is used as biologic graft, and a suture or tape is used as a nonbiological method of fixation. Postoperative immobilization and rehabilitation is an essential component of the AC joint reconstructive process. In this article, we describe in detail the indications, surgical technique, postoperative rehabilitation, and outcomes of open anatomical CC ligament reconstruction for AC joint dislocation.