Acromioclavicular joint instability - Reconstruction indications and techniques

Injuries to the acromioclavicular joint are common and may lead to instability or degenerative changes requiring surgical intervention. The spectrum of injury ranges from sprain to disruption of the acromioclavicular and coracoclavicular ligaments, which provide horizontal and vertical stability to the distal clavicle. Most injuries are the result of direct trauma to the acromioclavicular joint. The majority of injuries can be nonoperatively managed. However, with significant disruption to the surrounding supportive structures, painful instability may result. Multiple stabilization procedures for the acromioclavicular joint have been described. Many of these techniques have fallen out of favor due to high complication rates. Common reconstruction techniques include either coracoclavicular ligament reconstruction with or without clavicle resection (ie, modified Weaver-Dunn) or coracoclavicular stabilization (ie, with Bosworth screw) with repair or reconstruction of the coracoclavicular ligaments. The purpose of this paper is to review the basic anatomy, biomechanics, and treatment of acromioclavicular joint instability.