Treatment of Failed Coracoclavicular Ligament Reconstructions: Primary Acromioclavicular Ligament and Capsular Reconstruction and Revision Coracoclavicular Ligament Reconstruction

Acromioclavicular (AC) joint dislocations are a common injury affecting 2 of every 10,000 people in the general population and comprise 9% to 12% of all injuries to the shoulder. Most injuries occur through contact activity, which drives the acromion inferiorly with the clavicle remaining in its anatomic position, initiating a cascade of injury propagating from the AC ligament followed by failure of the coracoclavicular ligaments. Many techniques have been described for AC joint injuries, without a consensus gold standard. The revision setting offers even less consensus on treatment options and countless difficulties for surgeons. There have been more than 60 described procedures regarding AC and coracoclavicular ligament reconstructions, with significant controversy regarding the optimal intervention for each injury. When these techniques fail, it is important to pinpoint the mechanism of failure to construct a successful plan for revision. The purpose of this Technical Note is to describe our preferred method of primary AC and revision coracoclavicular reconstruction using a combination of autograft and allograft semitendinosus as well as TightRope fixation.