Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft

The purpose of this study was to introduce a novel surgical technique for simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft and to compare its biomechanical characteristics to those of a coracoid cerclage reconstruction of the coracoclavicular ligaments.

Six matched pairs of human acromioclavicular joints with an average age of 54.8 ± 7.8 years were used. One shoulder from each pair received the single tendon acromioclavicular–coracoclavicular reconstruction; the contralateral shoulder received the coracoid cerclage reconstruction. Bovine extensor tendon was used for both techniques. The single tendon acromioclavicular–coracoclavicular reconstruction technique provided anatomic restoration of the two coracoclavicular ligaments and the superior and inferior acromioclavicular ligaments simultaneously using one coracoid hole, one acromion hole, and two clavicular holes with interference screws. Anterior–posterior and superior–inferior translations were quantified for all specimens before and after reconstruction, followed by load to failure testing.

Following coracoid cerclage reconstruction, total anterior–posterior translation was significantly greater than intact (10.0 ± 5.7 mm; p = 0.008). Following single tendon acromioclavicular–coracoclavicular reconstruction, there was no significant difference in anterior–posterior translation compared to intact (−1.6 ± 2.2 mm; n.s.). The coracoid cerclage technique demonstrated significantly greater anterior–posterior translation than the single tendon acromioclavicular–coracoclavicular technique (p = 0.007). Both techniques restored superior–inferior translation to the intact condition (n.s.). Ultimate load, deformation at ultimate load, and energy absorbed at ultimate load were significantly greater after acromioclavicular–coracoclavicular reconstruction than after coracoid cerclage reconstruction (p < 0.05).

This novel single tendon anatomic acromioclavicular–coracoclavicular reconstruction provided greater stability and stronger load to failure characteristics than the isolated coracoid cerclage reconstruction. A simultaneous acromioclavicular–coracoclavicular reconstruction technique using a single free tendon graft provided anatomic reconstruction of the conoid, trapezoid, and superior and inferior acromioclavicular ligaments and may reduce postoperative subluxation.