The role of the coracoclavicular mechanism in the motion pattern between scapula and clavicle

Abstract

Injuries to the acromioclavicular (AC) joint are becoming common with contact sports and bike accidents. It is well known that in AC dislocations, the first structure to fail is the AC capsule followed by the trapezoid and conoid ligaments. The function of these ligaments must be restored to restore the anatomy and physiology of the AC joint to get the best results. Until now, no technique has emerged as the gold standard for restoration of the AC joint anatomy and function. In our technique, the stress is on recreating the anatomy to make it more individualized based on individual variations. This Technical Note describes a procedure to reconstruct the coracoclavicular ligaments and AC joint by an arthroscopy-assisted technique. Arthroscopy helps to diagnose additional intra-articular pathologies that can be treated simultaneously, and better preparation of the undersurface of the coracoid helps in bone-to-graft healing. Our approach is more individualized as clavicle tunneling is done according to the size of the coracoid base instead of a fixed distance. Vertical stability is provided by coracoclavicular ligament reconstruction, horizontal stability is provided by AC ligament reconstruction, and the articular disc is recreated by soft-tissue graft interposition, thus restoring the complete anatomy.