Arthroscopically-Assisted Anatomic Coracoclavicular Ligament Reconstruction With Tendon Grafts: Biomechanical Rationale, Surgical Technique, and a Review of Clinical Outcomes

Management strategies for acromioclavicular joint injuries depend heavily on the severity of the injury. Operative treatment is typically indicated for Rockwood grades IV-VI injuries and selected grade III injuries, especially after failure of nonoperative management. When surgical treatment is indicated, we prefer to perform an anatomic coracoclavicular ligament reconstruction (ACCR) technique with a tendon graft looped around the coracoid and tied over the top of the clavicle with the addition of two supplemental cortical fixation buttons. The purpose of this article is to present the biomechanical rationale, our detailed surgical technique, and reported clinical outcomes following ACCR with tendon grafts.