Anatomic approach to reconstruction of the unstable acromioclavicular joint

Acromioclavicular separation is a common athletic shoulder injury. While many can be treated nonoperatively, high-grade injuries can result in pain and loss of shoulder function. While numerous operative techniques have been proposed, a recent renewed focus on the anatomy of the coracoclavicular ligaments has led to anatomic reconstructive techniques that show promise in biomechanical comparisons. These techniques involve reconstruction of the conoid and trapezoid ligaments through anatomically-based tunnels in the clavicle. Preservation of the distal clavicle improves the biomechanical stability of this construct. Reconstruction of the acromioclavicular joint may be added in revisions in patients with distal clavicular deficiency. While clinical outcomes are still early, longer-term studies and prospective trials are needed to elucidate the optimal technique for management of this operative condition.