Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system

Background: Separation of the acromioclavicular joint (ACJ) is a common orthopaedic injury among athletes involved in contact sports and victims of motor vehicle accidents, particularly motorcycle crashes. High-grade ACJ disruptions (type IV-VI) are managed surgically through a variety of procedures. These range from simple plate and screw fixation to more complex procedures involving ligament repair, transfer, and reconstruction. Methods: This paper describes a new technique utilizing a direct subacromial arthroscopic approach to performing a reconstruction of the ruptured coracoclavicular ligaments. The appropriately over-engineered fixation device is made up of a subcoracoid button secured via nonabsorbable sutures to a special clavicular washer and augmented by a centrally placed soft tissue graft. Results: To date, the senior author has performed 10 cases on both acute and chronic high-grade ACJ separations. All patients greater than 6 months out from surgery have returned to their normal pre-injury level of activity. No complications (infection, hardware, or graft failure) have been documented, and all have maintained the interoperative reduction of the acromioclavicular joint and coracoclavicular space. Conclusion: The arthroscopic reconstruction of the AC separation is a low-morbidity, safe, and reproducible operation that provides adequate fixation and stability combined with the use of a soft tissue graft to promote sound biologic healing.