Chronic instability of the acromioclavicular joint Reconstruction of the coracoclavicular and acromioclavicular ligaments-current concepts

Neglected, undetected or underestimated acute acromioclavicular (AC) joint injuries as well as failed previous treatment may lead to chronic AC joint instability. Treatment of these instabilities often presents a challenge. Low-grade, isolated vertical AC joint instabilities with symptomatic AC joint arthritis presenting as the major factor may be treated with careful lateral clavicle resection. High-grade, monodirectional instabilities can be treated with coracacromial ligament transfer (Weaver-Dunn). However, biomechanical and clinical data suggest that isolated coracoclavicular (CC) augmentation with a tendon transfer yields superior results. High-grade instabilities with combined vertical and horizontal translation are treated with biologic augmentation using a tendon transfer (e.g. gracilis or semitendinosus tendon) and a pulley-like implant. Clinical and radiologic results of arthroscopically assisted techniques in these challenging patients have been promising with an acceptable revision rate.